Blood Purification

Hepatitis B Vaccination Response in Hemodialysis Patients: The Impact of Dialysis Shift

Maggie Han, Xiaoling (Janice) Ye, Stephan Thijssen, Dr. Frank Maddux, Peter Kotanko, Rao S, Williams S

Background/aims: Hepatitis B (HB) vaccination in hemodialysis patients is important as they are at a higher risk of contracting HB. However, hemodialysis patients have a lower HB seroconversion rate than their healthy counterparts. As better sleep has been associated with better seroconversion in healthy populations and early hemodialysis start has been linked to significant sleep-wake disturbances in hemodialysis patients, we examined if hemodialysis treatment start time is associated with HB vaccination response.

Methods: Demographics, standard-of-care clinical, laboratory, and treatment parameters, dialysis shift data, HB antigen status, HB vaccination status, and HB titers were collected from hemodialysis patients in Fresenius clinics from January 2010 to December 2015. Patients in our analysis received 90% of dialysis treatments either before or after 8:30 a.m., were negative for HB antigen, and received a complete series of HB vaccination (Engerix B® or Recombivax HB™). Univariate and multivariate regression models examined whether dialysis start time is a predictor of HB vaccination response.

Results: Patients were 65 years old, 57% male, and had a HD vintage of 10 months. Patients whose dialysis treatments started before 8:30 a.m. were more likely to be younger, male, and have a greater dialysis vintage. Patients receiving Engerix B® and starting dialysis before 8:30 a.m. had a significantly higher seroconversion rate compared to patients who started dialysis after 8:30 a.m. Early dialysis start was a significant predictor of seroconversion in univariate and multivariate regression including male gender, but not in multivariate regression including age, neutrophil-to-lymphocyte ratio, and vintage.

Conclusion: While better sleep following vaccination is associated with seroconversion in the general population, this is not the case in hemodialysis patients after multivariate adjustment. In the context of end-stage kidney disease, early dialysis start is not a significant predictor of HB vaccination response. The association between objectively measured postvaccination sleep duration and seroconversion rate should be investigated.

About the Contributors

Dr. Peter Kotanko, MD

RRI Research Director

SVP, Corporate Research & Development

Peter Kotanko, MD is Research Director at the Renal Research Institute (RRI), New York. Prior to joining RRI, from 1997 to 2007 he served as Vice Chair of a department of internal medicine at an academic teaching hospital in Graz, Austria. Prior to moving to Graz in 1989, he worked 1982-89 at the Department of Physiology and the University Clinic of Internal Medicine, Innsbruck, Austria...

Maggie Han, MSc

Executive Administrative Assistant to Peter Kotanko

Maggie has a bachelor’s degree from New York University where she studied Economics and has a master’s degree in Health Sciences from Pontifícia Universidade Católica do Paraná. She is the executive assistant to Dr. Peter Kotanko, Research Director. In addition to her administrative duties, she is also very active in research...

Stephan Thijssen, M.D.

Vice President, Applied and Basic Research

Prior to coming to New York, Dr. Thijssen worked in the Nephrology Department at the University Hospital Homburg, Germany. He joined Renal Research Institute in 2005 and currently serves as VP of Applied and Basic Research. Dr. Thijssen brings more than one and a half decades of research experience to the RRI team, covering laboratory research, clinical research, epidemiology research and mathematical modeling...

Xiaoling (Janice) Ye, MPH, PhD

Principal Analyst

Xiaoling (Janice) Ye, MPH, Ph.D. (c), is a Principal Analyst at Renal Research Institute. Xiaoling (Janice) holds a B.E. Degree in Pharmaceutical Engineering from the University of Traditional Medicine in Guangzhou, China, Master’s Degree in Epidemiology from Tulane University in New Orleans, and obtaining her Ph.D. (est. 2020), in Medical Science from the University of Maastricht in the Netherlands...