Abstract: SA-PO987
Hepatitis B Virus Vaccine Immune Response in Dialysis Patients and Mortality: A Meta-Analysis
Session Information
- Hemodialysis and Frequent Dialysis - V
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Udomkarnjananun, Suwasin, Chulalongkorn University, Bangkok, Thailand
- Takkavatakarn, Kullaya, Division of Nephrology, King Chulalongkorn Memorial hospital, Bangkok, Thailand
- Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand
- Jaber, Bertrand L., St. Elizabeth's Medical Center, Boston, Massachusetts, United States
- Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand
- Susantitaphong, Paweena, Chulalongkorn University, Bangkok, Thailand
Background
Despite the effectiveness of the hepatitis B virus (HBV) vaccine in the general population, dialysis patients frequently do not develop a protective immune response. We performed a systematic review and meta-analysis to identify patient- and dialysis-related factors that are associated with HBV vaccine immune response in dialysis patients, and the association between the immune response to the HBV vaccine and mortality.
Methods
Electronic databases were searched for studies of dialysis patients that compared the characteristics of HBV vaccine responders and non-responders. Mortality was analyzed according to the vaccine immune response[NC1] . Random-effects meta-analyses were performed to compute a weighted mean difference (WMD), a pooled odds ratio (OR), and a pooled risk ratio (RR) between groups.
Results
We identified 63 studies (57 cohort studies and 6 clinical trials) with a total of 6,867 dialysis patients receiving the HBV vaccine, resulting in 4,764 (69%) responders and 2,103 (31%) non-responders. By meta-analysis, relative to non-responders, HBV vaccine responders were younger (WMD -4.6 years, P<0.001) and less likely to have diabetes mellitus (pooled OR 0.65, P<0.001), and they were less likely to carry the human leukocyte antigen (HLA) DR3 (pooled OR 0.38, P=0.01). HBV vaccine responders also had a higher serum albumin (WMD 0.12 gm/dL, P<0.001), a higher normalized protein catabolic rate (WMD 0.12 gm/kg/day, P<0.001), a higher hemoglobin (WMD 0.14 gm/dL, P=0.048), a higher parathyroid hormone level (WMD 44 pg/mL, P=0.004), and a higher Kt/V (WMD 0.10, P<0.001). Compared to non-responders, HBV vaccine responders had a 36% lower risk for all-cause mortality (pooled RR 0.64, P<0.001), a 26% lower risk for cardiovascular-related mortality (pooled RR 0.74, P=0.01), and a 24% lower risk for infection-related mortality (pooled RR 0.76, P=0.29).
Conclusion
In dialysis patients, the lack of immune response to the HBV vaccine is associated with older age, diabetes mellitus, HLA-DR3 status, lower nutritional status, lower hemoglobin, lower PTH level, and lower dialysis adequacy. Tackling some of these modifiable factors (e.g., nutritional status and dialysis adequacy) might improve the HBV vaccine immune response.