Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Apr;33(2):343-354.
doi: 10.1007/s40620-019-00668-1. Epub 2019 Nov 7.

Hepatitis B virus vaccine immune response and mortality in dialysis patients: a meta-analysis

Suwasin Udomkarnjananun  1 , Kullaya Takkavatakarn  1 , Kearkiat Praditpornsilpa  1 , Claudia Nader  2   3 , Somchai Eiam-Ong  1 , Bertrand L Jaber  2   3 , Paweena Susantitaphong  4   5
Affiliations
Meta-Analysis

Hepatitis B virus vaccine immune response and mortality in dialysis patients: a meta-analysis

Suwasin Udomkarnjananun et al. J Nephrol. 2020 Apr.

Abstract

Background: We performed a systematic review and meta-analysis to examine factors associated with HBV 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 also analyzed according to the vaccine immune response (defined by hepatitis B surface antibody titer > 10 mIU/mL). Random-effects model 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 61 studies with a total of 6628 dialysis patients who completed the course of HBV vaccination, 4582 responders (69%) and 2046 non-responders (31%). By meta-analysis, relative to non-responders, HBV vaccine responders had a higher dialysis adequacy as measured by Kt/V (WMD 0.08, P < 0.001), 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 0.15 gm/L, P = 0.03), and a higher parathyroid hormone level (WMD 44 pg/mL, P = 0.004). HBV vaccine responders were younger (WMD - 4.68 years, P < 0.001), had been on dialysis for longer (WMD 2.60 months, P < 0.001), were less likely to have diabetes mellitus (pooled OR 0.65, P < 0.001), and were less likely to carry the human leukocyte antigen (HLA) DR3 (pooled OR 0.38, P = 0.01). Compared to non-responders, HBV vaccine responders had lower risk for all-cause mortality (pooled RR 0.64, P < 0.001), and lower risk for cardiovascular-related mortality (pooled RR 0.74, P = 0.02).

Conclusion: In dialysis patients, the lack of immune response to the HBV vaccine is associated with older age, diabetes mellitus, HLA-DR3 status, shorter time on dialysis, lower nutritional status, lower hemoglobin, lower PTH level, and lower dialysis adequacy. Tackling some of these modifiable factors might improve the HBV vaccine immune response.

Keywords: Dialysis; HBV vaccine; Meta-analysis; Mortality; Seroresponsiveness; Systematic review.

PubMed Disclaimer

References

    1. N Engl J Med. 1984 Dec 6;311(23):1515-6 - PubMed
    1. Sci Rep. 2018 Jun 29;8(1):9825 - PubMed
    1. Nephrol Dial Transplant. 2002 Nov;17(11):1982-7 - PubMed
    1. Ren Fail. 2001 Sep;23(5):629-36 - PubMed
    1. DNA Cell Biol. 2013 Feb;32(2):36-40 - PubMed

Substances

LinkOut - more resources