Abstract: TH-PO792

Association of Hepatitis B Vaccination Response and Sleep in Chronic Hemodialysis Patients

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Han, Maggie, Renal Research Institute, NYC, New York, United States
  • Ye, Xiaoling, Renal Research Institute, NYC, New York, United States
  • Rao, Sharon, Renal Research Institute, NYC, New York, United States
  • Thijssen, Stephan, Renal Research Institute, NYC, New York, United States
  • Bonner, Marcee, Renal Associates of Baton Rouge, Baton Rouge, Louisiana, United States
  • Young, Candace, Renal Associates of Baton Rouge, Baton Rouge, Louisiana, United States
  • Marsh, Daniel, Renal Associates of Baton Rouge, Baton Rouge, Louisiana, United States
  • Hymes, Jeffrey L., Fresenius Medical Care North America, Franklin, Tennessee, United States
  • Kotanko, Peter, Renal Research Institute, NYC, New York, United States
Background

While hepatitis B vaccination (HBVacc) is standard of care in chronic hemodialysis (HD) patients, seroconversion (SC) rate is only 58%, and poor SC has been linked to age, dialysis vintage, albumin level, and diabetes [Lacson, HDI 2005]. In healthy subjects, poor sleep in the night after HBVacc results in a significantly lower SC rate [Lang, J Immnol 2011]. Recent work revealed that patients who start HD early in the day have disturbed sleep-wake patterns [Han, Blood Purif 2016]. We hypothesize that sleep duration in the night after HD (post-HD) impacts HBVacc SC.

Methods

We conducted two studies. First, HD patients in Fresenius Medical Care North America (FMCNA) clinics were followed between 01/2010-12/2015. HBVacc was administered concurrent to HD treatment. Patients who completed the prescribed HBVacc series were included. SC was recorded if a hepatitis B antibody titer of ≥10 IU/mL was detected up to a year after HBVacc. Patients were stratified into early and late groups if 90% of treatments started before or after 8:30am, respectively. In the 2nd study, nightly sleep duration of HD patients were collected over a 5-week period using the Fitbit Flex. Mean post-HD sleep was calculated for shift 1(HD start before 8:30am) and shifts 2,3,and 4 combined(HD start after 8:30am).

Results

Descriptive statistics of the vaccination and sleep study cohort are listed in Table 1. HBVacc SC rates in early vs. late group were 74% vs 72% (Δ=2%;95% C.I. 0.7 to 3.3;p=0.003).Mean post-HD sleep of those patients scheduled for HD in shift 1 vs. shifts 2,3,and 4 combined were 417 minutes vs 380 minutes(Δ=38 minutes;95% CI -3.2 to 78.6;p=0.069).

Conclusion

Patients who started HD before 8:30am had a significantly higher SC rate than those who started later. A previously unrecognized, yet plausible, explanation is that patients in shift 1 slept more on the post-HD night. This finding may add to the many effects sleep, or lack thereof, exerts on HD patients’ health. Further work looking at the sleep following HD in a bigger cohort is required to confirm or reject these initial findings. If confirmed, sleep hygiene intervention in non-seroconverting patients could be considered.

Funding

  • Commercial Support