Zinc deficiency causes abnormalities of the immune response. In chronic
hemodialysis therapy abnormalities in
zinc metabolism as well as an impaired immune response to vaccination have been reported. Therefore we performed a vaccination study against
diphtheria and hypothesized that the response to
diphtheria vaccination is related to serum
zinc deficiency in
hemodialysis patients. Serum
zinc concentrations were assayed in 16 chronic
hemodialysis patients (10 male, 6 female; mean age 65 years) without a documented vaccination history against
diphtheria. Nine of these patients were triple immunized against
diphtheria while seven received a single vaccination. The response to
diphtheria vaccination was measured by ELISA detecting specific
antibodies to
diphtheria-toxoid. Seroconversion 6 and 12 months after vaccination was defined as the doubling of antibody titers in patients > or = 0.1 IU/ml prior to vaccination or as titers > 0.1 IU/ml in all other patients. Only 6/16
hemodialysis patients responded to immunization against
diphtheria by specific antibody production (> 0.1 IU/ml). Twelve months after the single injection 3/7 patients seroconverted while six months after the triple vaccination 3/9 patients responded to immunization. This was not age-dependent, whereas in non-responders we detected significantly decreased serum
zinc levels. In contrast, responders showed similar serum
zinc levels as age-matched controls. Furthermore, we measured a decreased
alpha 2-macroglobulin concentration only in the responders amongst the
hemodialysis patients. Protection against
diphtheria and the immune response to
diphtheria vaccination in
hemodialysis patients is poor. The failure to respond to active
diphtheria vaccination is related to a significantly decreased serum
zinc concentration in
hemodialysis patients.