Comparison of seroconversion rates after hepatitis B vaccination in patients with advanced chronic kidney disease and those receiving maintenance hemodialysis.

BACKGROUND

Patients receiving dialysis are at an increased risk of hepatitis B virus (HBV) infection due to a compromised immune system. While HBV vaccination is recommended, the response rate to the standard vaccination regimen (3 doses of 10 µg HBV vaccine) among patients with chronic kidney disease (CKD) or receiving hemodialysis in Japan is unclear. This study evaluated the seroconversion rate, optimal timing, and CKD stage in patients receiving HBV vaccination.

METHODS

In this prospective, observational study conducted from May 2021 to July 2024, patients with advanced CKD not on dialysis and those receiving maintenance hemodialysis at two centers in Japan received 3 doses of 10 µg HBV vaccine at 0, 1, and 6 months. The primary outcome was the seroconversion rate, defined as anti-HBs antibody levels of ≥10 IU/mL, measured 1-3 months after the third dose.

RESULTS

Overall, 113 participants (63 with non-dialysis CKD and 50 with hemodialysis CKD) were included. The seroconversion rates were 64.3% in non-dialysis patients and 54.2% in patients on hemodialysis, with no significant difference (OR = 0.62, 95% CI 0.28-1.38). Multivariate analysis adjusting for covariates showed no significant difference (OR = 0.74, 95% CI 0.29-1.91), and sensitivity analysis confirmed this finding.

CONCLUSIONS

The seroconversion rate of the standard HBV vaccination (3×10 µg) was not significantly different from those in non-dialysis patients with CKD. More effective vaccination strategies such as higher doses, third-generation vaccines, or vaccination at an earlier CKD stage are required to improve HBV protection in this population.