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Glomerular filtration rate predicts seroconversion after hepatitis B
vaccination
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NEW YORK (Reuters Health) - When hepatitis B vaccine is given to patients
with renal failure, those with earlier-stage disease are more likely to respond
with seroconversion, Canadian investigators report. They say that while the
mechanism involved is unclear, it should be taken into account in the management
of kidney patients.
At St. Paul's Hospital in Vancouver, British Columbia, 165 patients with
chronic kidney disease who had no serologic evidence of hepatitis B infection or
history of hepatitis B vaccination underwent the standard vaccination schedule
recommended for patients with that condition.
Dr. Gerald DaRoza and his colleagues report in the December issue of the
American Journal of Kidney Diseases that the response rates to the vaccine among
the study subjects, based on their stage of kidney disease.
Disease states were categorized as stage 1 (kidney damage with normal or
increased glomerular filtration rate [GFR]), stage 2 (GFR: 60-89 mL/min), stage 3
(GFR: 30-59 mL/min), stage 4, (GFR: 15-29 mL/min), or stage 5 (GFR <15 ml/min
or requirement for dialysis). Patients were also analyzed according to decile
of GFR (in 10-mL/min categories).
Seroconversion was defined as a hepatitis B surface antigen titer greater
than 10 IU at 3 months after completion of the vaccine series. According to the
authors, 82% of the patients seroconverted. "There [was] a clear stepwise
statistically significant decline in seroconversion when examined in 10-mL/min
decrements," the authors say.
On univariate analysis, significant predictors of seroconversion included
younger age, absence of diabetes, and better kidney function. Multivariate
analysis showed that patients "with the lowest level of kidney function were less
likely to seroconvert than those with better kidney function, independent of
other factors."
In the patients with better kidney function, seroconversion rates approached
those in the general population, Dr. DaRoza and colleagues found. They add,
"The ability of patients to respond at earlier phases underscores the need
for...an action plan delivered by the health care team that includes early
vaccination."
Am J Kidney Dis 2003;42:1184-1192.
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