Factors associated with long-term antibody production induced by hepatitis B vaccine in patients undergoing hemodialysis: A retrospective cohort study

Study Objective. To assess the influence of various clinical factors on antibody production induced by hepatitis B vaccine in patients receiving hemodialysis up to 24 months after vaccination. Design. Retrospective cohort study. Setting. Outpatient dialysis center. Patients. Adult patients undergoing hemodialysis who received a three-dose series of intramuscular hepatitis B vaccine 40 mug at time 0, 1, and 6 months, according to protocol. Measurements and Main Results. Antibody to hepatitis B surface antigen (anti-HBs) titers were monitored quarterly, and booster doses were given according to protocol. Patients with anti-HBs of at least 10 mIU/ml were considered seropositive. Clinical variables-age, diabetes mellitus. status, serum albumin level, and equilibrated Kt/V (eKt/V; Kt/V is a measure of urea clearance during dialysis, used to quantify the delivered dose of hemodialysis) - were compared between seropositive and seronegative patients 12 months (cohort 1) and 24 months (cohort 2) after vaccination. In cohort 1 (66 patients), 24 (36.4%) were seropositive at 12 months. In cohort 2 (40 patients), 15 (37.5%) were seropositive at 24 months. Comparison of seropositive and seronegative patients revealed no statistically significant differences in mean age, sex, serum albumin level, or eKt/V However, at 24 months, patients with diabetes were 2.5 times more likely to demonstrate seropositivity than those without diabetes (60% vs, 24%, respectively, p=0.02). Conclusion. Long-term seroprevalence induced by hepatitis B vaccine was low in our patients 12 and 24 months after vaccination. These results were comparable to previously reported long-term results. Larger, prospective studies would be needed to confirm the finding that patients with diabetes had superior hepatitis B vaccine-induced antibody production at 24 months.