Abstract | BACKGROUND: This retrospective and comparative study evaluated the relationship between different factors which may contribute to suboptimal immunological response to intramuscular recombinant hepatitis B vaccine in end-stage renal disease ( ESRD) subjects. METHODS: From a cohort of 64 dialysis subjects undergoing primary vaccination with Engerix-B, we determined the predictive factors that impinged on patients' response to vaccine, as defined by anti-HBs level > or = 10 mIU/l. Dose efficacy was further evaluated by comparing three historical cohorts vaccinated by the regimens of 20, 40 and 80 microg/dose, respectively. RESULTS: We identified 64 ESRD patients (mean age 43 +/- 12 years, 81% receiving peritoneal dialysis) who received primary vaccination from April 1997 to September 2004. Median follow-up was 6.5 years. They achieved 81% seroconversion rate. Older age, diabetes mellitus, obesity and low Engerix-B dose were risk factors of inadequate anti-HBs response by univariate analysis. By stepwise logistic regression analysis, hepatitis B vaccine dose was the only independent predictive factor of impaired antibody response. An Engerix-B vaccine dose of 20 microg was associated with more than tenfold increase in risk of non-response to hepatitis B vaccine (hazards ratio 32.2 (95% CI 3.85-250.0)). Immunization with 80 microg of Engerix-B increased the likelihood of persistent protective antibody (log-rank test, p = 0.014). Immunization with Engerix-B 80-microg dose is estimated to prevent one extra ESRD subject who would lose seroprotective anti-HBs level at 1 year for every 5.6 patients treated (number needed to treat to benefit, 5.6 (95% CI 5.4-5.8)). CONCLUSIONS:
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Authors | Kai Ming Chow, Man Ching Law, Chi Bon Leung, Cheuk Chun Szeto, Philip Kam-Tao Li |
Journal | Nephron. Clinical practice
(Nephron Clin Pract)
Vol. 103
Issue 3
Pg. c89-93
( 2006)
ISSN: 1660-2110 [Electronic] Switzerland |
PMID | 16534237
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright 2006 S. Karger AG, Basel |
Chemical References |
- Engerix-B
- Hepatitis B Antibodies
- Hepatitis B Vaccines
- Vaccines, Synthetic
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Topics |
- Adult
- Aged
- Cohort Studies
- Drug Administration Schedule
- Female
- Hepatitis B
(prevention & control, therapy)
- Hepatitis B Antibodies
(biosynthesis, blood)
- Hepatitis B Vaccines
(administration & dosage, therapeutic use)
- Humans
- Injections, Intramuscular
- Kidney Failure, Chronic
(blood, immunology)
- Male
- Middle Aged
- Multivariate Analysis
- Peritoneal Dialysis
- Retrospective Studies
- Survival Analysis
- Vaccination
- Vaccines, Synthetic
(administration & dosage, therapeutic use)
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