More about Response to Hepatitis B Vaccine in Hemodialysis Patients

Dr. M. Gonella, Servizio di Nefrologia e Dialisi, Ente Ospedaliero, I-15033 Casale Monferrato, (Italia) Dear Sir, We read with much interest the paper by Van Geelen et al. [1], who reported a very high conversion rate (92%) in chronically hemodialyzed patients in their unit by using double doses of MSD vaccine. This good result is suggested to be influenced by the strong female predominance (78%) among the studied patients, since previous investigations [2] showed less responsiveness to hepatitis B (HB) vaccine in dialzyed males. As these results were confirmed in our renal unit, we looked for possible factors which might account for the different responsiveness to HB vaccine. A total of 15 patients (11 males and 4 females) on chronic hemodialysis with no HB markers were given a Pasteur vaccine dose of 5 μg three times at 1 month intervals, with a booster 1 year after. Three months after the last injection, 5 patients (33%) did not show seroconversion. The mean values of serum creatinine and body weight were observed to be significantly lower (p < 0.005 and p < O.Ol, respectively) in the seroconverted patients than in nonresponders who were all males and significantly younger (p < 0.02; table I). The significantly lower age in non responders may be casual and attributed to the small series, since a previous paper has shown a more active seroconversion in Table I. Clinical parameters in anti-HBs responding and nonre-sponding hemodialyzed patients