Hepatitis B virus vaccine immune response and mortality in dialysis patients: a meta-analysis
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We performed a systematic review and meta-analysis to examine factors associated with HBV immune response in dialysis patients, and the association between the immune response to the HBV vaccine and mortality.
Electronic databases were searched for studies of dialysis patients that compared the characteristics of HBV vaccine responders and non-responders. Mortality was also analyzed according to the vaccine immune response (defined by hepatitis B surface antibody titer > 10 mIU/mL). Random-effects model meta-analyses were performed to compute a weighted mean difference (WMD), a pooled odds ratio (OR), and a pooled risk ratio (RR) between groups.
We identified 61 studies with a total of 6628 dialysis patients who completed the course of HBV vaccination, 4582 responders (69%) and 2046 non-responders (31%). By meta-analysis, relative to non-responders, HBV vaccine responders had a higher dialysis adequacy as measured by Kt/V (WMD 0.08, P < 0.001), a higher serum albumin (WMD 0.12 gm/dL, P < 0.001), a higher normalized protein catabolic rate (WMD 0.12 gm/kg/day, P = 0.001), a higher hemoglobin (WMD 0.15 gm/L, P = 0.03), and a higher parathyroid hormone level (WMD 44 pg/mL, P = 0.004). HBV vaccine responders were younger (WMD − 4.68 years, P < 0.001), had been on dialysis for longer (WMD 2.60 months, P < 0.001), were less likely to have diabetes mellitus (pooled OR 0.65, P < 0.001), and were less likely to carry the human leukocyte antigen (HLA) DR3 (pooled OR 0.38, P = 0.01). Compared to non-responders, HBV vaccine responders had lower risk for all-cause mortality (pooled RR 0.64, P < 0.001), and lower risk for cardiovascular-related mortality (pooled RR 0.74, P = 0.02).
In dialysis patients, the lack of immune response to the HBV vaccine is associated with older age, diabetes mellitus, HLA-DR3 status, shorter time on dialysis, lower nutritional status, lower hemoglobin, lower PTH level, and lower dialysis adequacy. Tackling some of these modifiable factors might improve the HBV vaccine immune response.
KeywordsSystematic review Meta-analysis HBV vaccine Seroresponsiveness Dialysis Mortality
The authors thank the staff of the medical library of the Faculty of Medicine at Chulalongkorn University, Bangkok, Thailand. The librarians provided support by obtaining the original articles for the purpose of the systematic review.
Suwasin Udomkarnjananun, M.D.; firstname.lastname@example.org: first author, study design, review of citations and articles, manuscript preparation and draft. Kullaya Takkavatakarn, M.D.; email@example.com: review of citations and articles. Kearkiat Praditpornsilpa, M.D.; firstname.lastname@example.org: study design. Claudia Nader, M.D.; Claudia.email@example.com: manuscript review and edits. Somchai Eiam-Ong, M.D.; firstname.lastname@example.org: manuscript review and edits. Bertrand L. Jaber, M.D., M.S.; bertrand.Jaber@steward.org: study design, manuscript review and edits. Paweena Susantitaphong, M.D., Ph.D.; email@example.com: corresponding author, review of citations and articles, study design, manuscript review and edits.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest related to this article. The results presented in this paper have not been published previously in whole or part, except in abstract format.
The Institutional Review Board of the Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, has exempted this study in compliance with the International guidelines for human research protection as Declaration of Helsinki, The Belmont Report, CIOMS Guideline, International Conference on Harmonization in Good Clinical Practice (ICP-GCP) and 45CFR 46.101(b). (IRB No. 432/62).
Human/animal rights statement
This study did not directly involve with human participants or animal subjects.
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