HBV Vaccination in Chronic Renal Failure Patients

HBV infection in chronic renal failure (CRF) becomes chronic in 30 to 60% compared with less than 10% in nonuremic patients.

Immunological dysfunction in patients on hemodialysis may be related to imbalanced cytokine systems, such as tumor necrosis factor (TNF-|α|) and interleukin (IL) 6,1 by retention of renal metabolite in uremia and chronic inflammation and have a poor immunological reaction to T-cell-dependent antigens, like hepatitis B vaccination. Immunocompromised patients who are unresponsive to hepatitis B vaccination seem to be unable to enhance IL-10 synthesis for control of monokine overproduction.

Moreover, human leukocyte antigen (HLA) genes, which play a major role in the antigen presentation to immunocompetent cells, have also been shown to modulate this immune response.

Unfortunately, seroconversion to anti-HBS has been reported to occur in only 40 to 50% of the vaccine, a significantly lower rate than that observed in healthy adults. Various methods including adjutants such as zinc, gamma interferon, thymopentine, GM-CSF and Levamisol for improving immune responses have been advised. Experience with Pres1/s2, third-generation vaccines is limited and they have not been proven more effective than intradermally (ID) administered second-generation S antigen vaccines.

Both intramuscular (IM) and intradermal (ID) vaccinations against hepatitis B have variable efficiency in hemodialysis and non-responders should be retreated by ID route.