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Glomerular filtration rate predicts seroconversion after hepatitis B vaccination
  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 action plan delivered by the health care team that includes early vaccination."
Am J Kidney Dis 2003;42:1184-1192.
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