Hepatitis B vaccination in haemodialysis patients: a randomized clinical trial.
Author(s): Bock M, Barros E, Veronese FJ
Affiliation(s): Graduate Program in Medical Sciences-Nephrology, Nephrology Division, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Publication date & source: 2009-04, Nephrology (Carlton)., 14(3):267-72. Epub 2009 Jan 13.
Publication type: Comparative Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
AIM: A short vaccination protocol against hepatitis B was compared to the standard approach in patients under haemodialysis who were primarily non-responsive to the vaccine. METHODS: This randomized, controlled open trial included 51 chronic haemodialysis subjects previously vaccinated against hepatitis B and with anti-HBs levels of less than 10 IU/mol/L. Twenty-six patients received 20 microg i.m. once a week for 8 weeks (short protocol) and 25 subjects three doses of 40 microg i.m. at months 0, 1 and 6 (standard protocol). Clinical and laboratory data were compared between responders and non-responders. A logistic regression model included selected parameters to assess risk factors for non-seroconversion. RESULTS: Seroconversion rates to vaccine at 2 months were 80% and 78% in the short and standard protocol groups, respectively (P = 0.99). Median of anti-HBs levels were similar up to 6 months of follow up, but patients in the standard protocol showed a trend to higher anti-HBs in month 3 and a more steady decline in antibody titres. Non-responders were older, had longer duration of dialysis and a higher prevalence of a prior renal transplant and hepatitis C. In multivariate analysis, only advanced age and hepatitis C remained independently associated with non-responsiveness to vaccination. CONCLUSION: In haemodialysis patients, a short vaccination protocol against hepatitis B did not provide any benefit compared to the standard approach with respect to peak anti-HBs titres or a higher rate of seroprotection at the end of follow up. Other strategies to increase seroconversion rates should be explored, especially in the elderly and in patients with hepatitis C.
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