Response Rates to Hepatitis B Vaccine in Children with Chronic Kidney Disease on Maintenance Hemodialysis
Authors: Sonia Jannatul Ferdous , Afroz Shireen 
Published: February 2022

Context:
Patients with chronic kidney disease (CKD) are mostly immunocompromised and more prone to infections. Risk of acquisition of infections is increased during dialysis. Hepatitis B virus (HBV) infection remains a major issue among hemodialysis patients and long-term complications of HBV infection in children are more. Following a regular vaccination schedule and maintenance of adequate antibody titer are the important ways to prevent HB infection in the hemodialysis population.

Aims:
The aim of this study was to compare the seroconversion rate of hepatitis B vaccine in children with CKD between maintenance dialysis and nondialysis group.

Materials and Methods:
This interventional study was carried out in the Department of Pediatric Nephrology, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, from July 2018 to December 2019. Total 36 previously diagnosed advanced stages of patients with CKD were enrolled in the study. Patients were divided into two groups: Group A: maintenance hemodialysis (MHD) patients and Group B: nondialytic patients. Baseline antiHBs titer was done in both groups. In each group, 18 patients were enrolled. Patients who had mean baseline antiHBs >10 mIU/mL (seroconversion) were considered as primary response and patients who had mean antiHBs titer <10 mIU/mL were considered as nonseroconversion. Patients of both groups who had mean antiHBs titer 0.00 mIU/mL were given secondary vaccination by three doses of recombinant hepatitis B vaccine (20 μg) intramuscularly in a 0, 1, and 2 months of schedule. Patients who had mean antiHBs titer > 0.00 but <10 mIU/mL were vaccinated by a single booster dose (20 μg). Four weeks after completion of the vaccination, seroconversion (antiHBs titer >10–100 mIU/mL) and seroprotection (antiHBs titer >100 mIU/mL) rates were measured by immunometric technique in both groups and compared between the groups.

Statistical analysis used:
Statistical analysis was performed by the Statistical Package for the Social Sciences (SPSS) software program, version 20.0 for Windows (SPSS, Chicago, Illinois). The quantitative observations were indicated by frequencies and percentages. Fisher's exact test was used to determine the association between categorical variables; Kruskal–Wallis test and unpaired t test were used to determine the association between continuous variables.

Results:
In this study, all enrolled patients (100%) had developed seroconversion (>10 mIU/mL). In Group A only 1 patient (9%) had seroprotection level and total 11 patients had mean antiHBs titer 46.66 ± 10.90 mIU/mL, whereas in Group B 6 patients (54%) had seroprotection level with mean antiHBs titer 326.15 ± 123.27 mIU/mL. Therefore, more seroprotection level was observed in Group B and the difference between Groups A and B was statistically significant (P = 0.0176).

Conclusion:
It may be concluded from the study that the immune response of the hepatitis B vaccine was significantly lower in MHD than nondialysis group patients, so it was realized that hemodialysis had effects on reduction of antiHBs titer.