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Nakashima A, Yamamoto I, Kobayashi A, Kimura K, Yaginuma T, Nishio S, Kato K, Kawai R, Horino T, Ohkido I, Yokoo T. Active vitamin D analog and SARS-CoV-2 IgG after BNT162b2 vaccination in patients with hemodialysis. Ther Apher Dial 2024; 28:599-607. [PMID: 38504452 DOI: 10.1111/1744-9987.14121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Vaccination is the effective strategy for coronavirus disease 2019 (COVID-19). However, few studies have investigated the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin (Ig)G and vitamin D. METHODS This study aimed to investigate the association between SARS-CoV-2 IgG and active vitamin D analogs in hemodialysis patients. Blood samples were collected four times: before vaccination and 30, 60, and 90 days after vaccination, BNT162b2 (Pfizer©). RESULTS A total of 418 patients were enrolled. The mean age was 71.1 ± 12 years. Almost two thirds of the patients were prescribed active vitamin D analogs. The distribution of SARS-CoV-2 IgG before vaccination was 235 (93-454) AU/mL. After multiple regression analyses, active vitamin D analog use was found to be associated with higher SARS-CoV-2 IgG levels from prevaccination to 90 days postvaccination. CONCLUSION This study demonstrated an association between higher SARS-CoV-2 IgG and active vitamin D analog use in hemodialysis patients. CLINICAL TRIAL REGISTRATION The study information was registered in the UMIN-CTR (UMIN 000046906).
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Affiliation(s)
- Akio Nakashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Izumi Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Arisa Kobayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | | | - Kazuhiko Kato
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Rena Kawai
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuya Horino
- Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Tokyo, Japan
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Pleros C, Adamidis K, Kantartzi K, Griveas I, Baltsavia I, Moustakas A, Kalliaropoulos A, Fraggedaki E, Petra C, Damianakis N, Mentis A, Drosataki E, Petrakis I, Passadakis P, Panagopoulos P, Stylianou K, Panagoutsos S. Dialysis Patients Respond Adequately to Influenza Vaccination Irrespective of Dialysis Modality and Chronic Inflammation. J Clin Med 2023; 12:6205. [PMID: 37834849 PMCID: PMC10573409 DOI: 10.3390/jcm12196205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Chronic inflammation and suboptimal immune responses to vaccinations are considered to be aspects of immune dysregulation in patients that are undergoing dialysis. The present study aimed to evaluate immune responses in hemodialysis (HD) and online hemodiafiltration (OL-HDF) patients to a seasonal inactivated quadrivalent influenza vaccine (IQIV). (2) Methods: We enrolled 172 chronic dialysis patients (87 on HD and 85 on OL-HDF) and 18 control subjects without chronic kidney disease in a prospective, cross-sectional cohort study. Participants were vaccinated with a seasonal IQIV, and antibody titers using the hemagglutination inhibition (HI) assay were determined before vaccination (month 0) and 1, 3, and 6 months thereafter. Demographics and inflammatory markers (CRP, IL-6, IL-1β) were recorded at month 0. The primary endpoints were the rates of seroresponse (SR), defined as a four-fold increase in the HI titer, and seroprotection (SP), defined as HI titer ≥ 1/40 throughout the study period. Statistical analyses were conducted in R (version 3.6.3) statistical software. The differences between groups were analyzed using chi-square and t-test analyses for dichotomous and continuous variables, respectively. To identify independent determinants of SR and SP, generalized linear models were built with response or protection per virus strain as the dependent variable and group, age, sex, time (month 0, 1, 3, 6), diabetes, IL-6, dialysis vintage, HD access, and HDF volume as independent explanatory variables. (3) Results: SR and SP rates were similar between control subjects, and dialysis patients were not affected by dialysis modality. SP rates were high (> 70%) at the beginning of the study and practically reached 100% after vaccination in all study groups. These results applied to all four virus strains that were included in the IQIV. IL-6 levels significantly differed between study groups, with HD patients displaying the highest values, but this did not affect SP rates. (4) Conclusions: Dialysis patients respond to influenza immunization adequately and similarly to the general population. Thus, annual vaccination policies should be encouraged in dialysis units. OL-HDF reduces chronic inflammation; however, this has no impact on SR rates.
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Affiliation(s)
- Christos Pleros
- Nephrology Department, University Hospital of Heraklion, 71500 Heraklion, Greece; (C.P.); (E.D.); (I.P.)
| | | | - Konstantia Kantartzi
- Nephrology Department, University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.K.); (P.P.); (S.P.)
| | - Ioannis Griveas
- Nephrology Department, 417 Army Share Fund Hospital of Athens, 11521 Athens, Greece;
| | - Ismini Baltsavia
- Laboratory of Computational Biology, Division of Basic Sciences, Medical School, University of Crete, 71500 Heraklion, Greece;
| | | | - Antonios Kalliaropoulos
- National Influenza Reference Laboratory for Southern Greece, Hellenic Pasteur Institute, 11521 Athens, Greece; (A.K.); (A.M.)
| | | | - Christina Petra
- Venizeleio-Pananeio General Hospital of Heraklion, 71409 Heraklion, Greece;
| | | | - Andreas Mentis
- National Influenza Reference Laboratory for Southern Greece, Hellenic Pasteur Institute, 11521 Athens, Greece; (A.K.); (A.M.)
| | - Eleni Drosataki
- Nephrology Department, University Hospital of Heraklion, 71500 Heraklion, Greece; (C.P.); (E.D.); (I.P.)
| | - Ioannis Petrakis
- Nephrology Department, University Hospital of Heraklion, 71500 Heraklion, Greece; (C.P.); (E.D.); (I.P.)
| | - Ploumis Passadakis
- Nephrology Department, University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.K.); (P.P.); (S.P.)
| | - Periklis Panagopoulos
- Department of Infectious Diseases, Second University Department of Internal Medicine, University Hospital of Alexandroupoli, Democritus University of Thrace, 68100 Alexandroupoli, Greece;
| | - Kostas Stylianou
- Nephrology Department, University Hospital of Heraklion, 71500 Heraklion, Greece; (C.P.); (E.D.); (I.P.)
| | - Stylianos Panagoutsos
- Nephrology Department, University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.K.); (P.P.); (S.P.)
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3
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den Hartog Y, Malahe SRK, Rietdijk WJR, Dieterich M, Gommers L, Geers D, Bogers S, van Baarle D, Diavatopoulos DA, Messchendorp AL, van der Molen RG, Remmerswaal EBM, Bemelman FJ, Gansevoort RT, Hilbrands LB, Sanders JS, GeurtsvanKessel CH, Kho MML, Reinders MEJ, de Vries RD, Baan CC. Th 1-dominant cytokine responses in kidney patients after COVID-19 vaccination are associated with poor humoral responses. NPJ Vaccines 2023; 8:70. [PMID: 37198189 DOI: 10.1038/s41541-023-00664-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
Cytokines are regulators of the immune response against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, the contribution of cytokine-secreting CD4+ and CD8+ memory T cells to the SARS-CoV-2-specific humoral immune response in immunocompromised kidney patients is unknown. Here, we profiled 12 cytokines after stimulation of whole blood obtained 28 days post second 100 μg mRNA-1273 vaccination with peptides covering the SARS-CoV-2 spike (S)-protein from patients with chronic kidney disease (CKD) stage 4/5, on dialysis, kidney transplant recipients (KTR), and healthy controls. Unsupervised hierarchical clustering analysis revealed two distinct vaccine-induced cytokine profiles. The first profile was characterized by high levels of T-helper (Th)1 (IL-2, TNF-α, and IFN-γ) and Th2 (IL-4, IL-5, IL-13) cytokines, and low levels of Th17 (IL-17A, IL-22) and Th9 (IL-9) cytokines. This cluster was dominated by patients with CKD, on dialysis, and healthy controls. In contrast, the second cytokine profile contained predominantly KTRs producing mainly Th1 cytokines upon re-stimulation, with lower levels or absence of Th2, Th17, and Th9 cytokines. Multivariate analyses indicated that a balanced memory T cell response with the production of Th1 and Th2 cytokines was associated with high levels of S1-specific binding and neutralizing antibodies mainly at 6 months after second vaccination. In conclusion, seroconversion is associated with the balanced production of cytokines by memory T cells. This emphasizes the importance of measuring multiple T cell cytokines to understand their influence on seroconversion and potentially gain more information about the protection induced by vaccine-induced memory T cells.
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Affiliation(s)
- Yvette den Hartog
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
| | - S Reshwan K Malahe
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
| | - Wim J R Rietdijk
- Department of Hospital Pharmacy, University Medical Center, Rotterdam, The Netherlands
| | - Marjolein Dieterich
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
| | - Lennert Gommers
- Department of Viroscience, University Medical Center, Rotterdam, The Netherlands
| | - Daryl Geers
- Department of Viroscience, University Medical Center, Rotterdam, The Netherlands
| | - Susanne Bogers
- Department of Viroscience, University Medical Center, Rotterdam, The Netherlands
| | - Debbie van Baarle
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Dimitri A Diavatopoulos
- Radboud Institute for Molecular Life Sciences, Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - A Lianne Messchendorp
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Renate G van der Molen
- Radboud Institute for Molecular Life Sciences, Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Ester B M Remmerswaal
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederike J Bemelman
- Renal Transplant Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ron T Gansevoort
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Jan-Stephan Sanders
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Marcia M L Kho
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
| | - Marlies E J Reinders
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
| | - Rory D de Vries
- Department of Viroscience, University Medical Center, Rotterdam, The Netherlands
| | - Carla C Baan
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands.
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4
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Babel N, Hugo C, Westhoff TH. Vaccination in patients with kidney failure: lessons from COVID-19. Nat Rev Nephrol 2022; 18:708-723. [PMID: 35999285 PMCID: PMC9397175 DOI: 10.1038/s41581-022-00617-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 02/06/2023]
Abstract
Infection is the second leading cause of death in patients with chronic kidney disease (CKD). Adequate humoral (antibody) and cellular (T cell-driven) immunity are required to minimize pathogen entry and promote pathogen clearance to enable infection control. Vaccination can generate cellular and humoral immunity against specific pathogens and is used to prevent many life-threatening infectious diseases. However, vaccination efficacy is diminished in patients with CKD. Premature ageing of the immune system and chronic systemic low-grade inflammation are the main causes of immune alteration in these patients. In the case of SARS-CoV-2 infection, COVID-19 can have considerable detrimental effects in patients with CKD, especially in those with kidney failure. COVID-19 prevention through successful vaccination is therefore paramount in this vulnerable population. Although patients receiving dialysis have seroconversion rates comparable to those of patients with normal kidney function, most kidney transplant recipients could not generate humoral immunity after two doses of the COVID-19 vaccine. Importantly, some patients who were not able to produce antibodies still had a detectable vaccine-specific T cell response, which might be sufficient to prevent severe COVID-19. Correlates of protection against SARS-CoV-2 have not been established for patients with kidney failure, but they are urgently needed to enable personalized vaccination regimens.
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Affiliation(s)
- Nina Babel
- Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
- Center for Translational Medicine and Immune Diagnostics Laboratory, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Center for Advanced Therapies (BeCAT) and Berlin Institute of Health, Berlin, Germany.
| | - Christian Hugo
- Medizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timm H Westhoff
- Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
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5
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Jahn M, Korth J, Dorsch O, Anastasiou OE, Krawczyk A, Brochhagen L, van de Sand L, Sorge-Hädicke B, Tyczynski B, Witzke O, Dittmer U, Dolff S, Wilde B, Kribben A. Decline of Humoral Responses 6 Months after Vaccination with BNT162b2 (Pfizer–BioNTech) in Patients on Hemodialysis. Vaccines (Basel) 2022; 10:vaccines10020327. [PMID: 35214785 PMCID: PMC8878048 DOI: 10.3390/vaccines10020327] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
This study analyzed binding and neutralizing antibody titers up to 6 months after standard vaccination with BNT162b2 (two doses of 30 µg each) in SARS-CoV-2 naïve patients (n = 59) on hemodialysis. Humoral vaccine responses were measured before and 6, 12, and 24 weeks after the first vaccination. A chemiluminescent immunoassay (CLIA) was used to quantify SARS-CoV-2 IgG against the spike glycoprotein. SARS-CoV-2 neutralizing activity was tested against the wild-type virus. A multivariable binary regression model was used to identify risk factors for the absence of humoral immune responses at 6 months. At week 6, vaccine-specific seroconversion was detected in 96.6% of all patients with median anti-SARS-CoV-2 IgGs of 918 BAU/mL. At weeks 12 and 24, seroconversion rates decreased to 91.5% and 79.7%, and corresponding median binding antibody titers declined to 298 BAU/mL and 89 BAU/mL, respectively. Neutralizing antibodies showed a decay from 79.6% at week 6 to 32.8% at week 24. The risk factor with the strongest association for vanishing immune responses was low serum albumin (p = 0.018). Regarding vaccine-specific humoral responses 6 months after the standard BNT162b2 vaccination schedule, SARS-CoV-2 naïve patients receiving hemodialysis must be considered at risk of becoming infected with SARS-CoV-2 and being infectious.
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Affiliation(s)
- Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
- Correspondence:
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Oliver Dorsch
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Friesener Straße 37a, 96317 Kronach, Germany;
| | - Olympia Evdoxia Anastasiou
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Adalbert Krawczyk
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Leonie Brochhagen
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Lukas van de Sand
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Burkhard Sorge-Hädicke
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Alfried-Krupp-Str. 43, 45131 Essen, Germany;
| | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
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6
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Liao CC, Tai YH, Yeh CC, Hsu YH, Chen TL, Cherng YG. Effect of influenza vaccination on the outcomes of hospitalization for kidney disease in a geriatric population: A propensity-score matched study. PLoS One 2022; 17:e0262420. [PMID: 35077480 PMCID: PMC8789174 DOI: 10.1371/journal.pone.0262420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 12/24/2021] [Indexed: 11/19/2022] Open
Abstract
Background and aims The effects of influenza vaccination (IV) on the outcomes of patients with kidney disease (KD) are not completely understood. We aimed to evaluate and compare the outcomes during admission of KD between elderly patients who did or did not receive an IV within the previous 12 months. Methods We used health insurance research data in Taiwan and conducted a population-based cohort study that included 22,590 older people aged ≥ 65 years who were hospitalized for KD in 2008–2013. We performed propensity score matching (case-control ratio 1:1) to select 4386 eligible IV recipients and 4386 nonrecipient controls for comparison. The adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of IV associated with complications and mortality during KD admission were calculated using multivariable logistic regression analyses. Results During hospitalization for KD, IV was significantly associated with lower risks of 30-day in-hospital mortality (OR 0.56, 95% CI 0.39–0.82), septicemia (OR 0.77, 95% CI 0.68–0.87), and intensive care (OR 0.85, 95% CI 0.75–0.96). Additionally, IV recipients had a shorter length of hospital stay and lower medical expenditure than nonrecipients. Subgroup analyses further showed that the association of IV with reduced adverse events was confined to patients aged ≥ 75 years. Conclusions Previous IV was associated with reduced risks of complications and mortality and in elderly patients hospitalized for KD. We raised the possibility and suggested the need to promote IV for this susceptible population of patients with KD.
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Affiliation(s)
- Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Ying-Hsuan Tai
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, Illinois, United States of America
| | - Yung-Ho Hsu
- Department of Nephrology, Shuan Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ta-Liang Chen
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- * E-mail:
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Hettenbaugh J, Mullane R, Gillispie G, Shostrom V, Flores L, Fillaus JA, Florescu MC, Murcek D, Tendulkar KK. Hepatitis B Vaccination in Advanced Chronic Kidney Disease: A Quality Improvement Project at a Veteran Affairs Chronic Kidney Disease Clinic. Infect Dis Rep 2021; 13:1036-1042. [PMID: 34940404 PMCID: PMC8701395 DOI: 10.3390/idr13040094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022] Open
Abstract
Hepatitis B vaccination is recommended in all patients with end-stage kidney disease (ESKD). However, only 50–60% of these patients achieve protective antibody levels if immunized after starting dialysis. Strategies to overcome this low seroconversion rate include a 6-month vaccination schedule starting earlier [chronic kidney disease (CKD) stage 4 and 5] to ensure immunity when patients progress to ESKD. We conducted a quality improvement program to immunize pre-dialysis patients. Patients who were found to have a negative baseline serology with a negative hepatitis B surface antibody level (HBsAb) were offered vaccination on a 6-month schedule (0, 1 and 6 months) with one of two available vaccines within the VA system (Recombivax™ or Engerix™). HBsAb titers were checked 3–4 months later, and titers ≥ 12 mIU/mL were indicative of immunity at VA. Patients who did not seroconvert were offered a repeat schedule of three more doses. We screened 198 patients (187 males and 11 females) with CKD 4 and 5 [glomerular filtration rate (GFR) < 29 mL/min/1.73 m2]. The median age of this cohort was 72 years (range 38–92 years). During the study period of 5 years (2015–2020), 10 patients were excluded since their GFR had improved to more than 30 mL/min/1.73 m2, 24 others had baseline immunity and 2 refused vaccination. The hepatitis B vaccination series was not started on 106 patients. Of the remaining 56, 12 patients progressed to ESKD and started dialysis before completion of the vaccination schedule, 6 expired and 1 did not come to clinic in 2020 due to the pandemic. Of the 37 patients who completed the vaccination schedule, 16 achieved seroconversion with adequate HBsAb titers, 10 did not develop immunity despite a second hepatitis B vaccination series, while 11 did not get a second series. Given the low seroconversion rate, albeit in a small cohort, vaccination should be considered in patients with earlier stages of CKD. Other options include studies on FDA approved vaccines of shorter duration. We plan to increase awareness among nephrologists, patients and nursing staff about the importance of achieving immunity against hepatitis B.
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Affiliation(s)
- Jacob Hettenbaugh
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Ryan Mullane
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Gayle Gillispie
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Valerie Shostrom
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Linda Flores
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Jennifer A. Fillaus
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Marius C. Florescu
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Denise Murcek
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Ketki K. Tendulkar
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
- Correspondence: ; Tel.: +1-402-559-9227
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Haddiya I. Current Knowledge of Vaccinations in Chronic Kidney Disease Patients. Int J Nephrol Renovasc Dis 2020; 13:179-185. [PMID: 32801834 PMCID: PMC7394503 DOI: 10.2147/ijnrd.s231142] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 07/03/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease (CKD) patients are at high risk for infectious complications. This is partly due to their dysfunctional immune system, especially in advanced CKD stages. Vaccination represents an important prevention strategy in these patients, as several studies have reported lower infection rates and significantly reduced morbidity and mortality in hospitals adopting vaccination protocols. However, vaccination rates are particularly low in these patients, and the diminished immune responsiveness remains the main issue of vaccination in CKD patients. Besides, there are various immunization protocols across the world in the absence of optimal vaccination policies. This paper aims to discuss the current knowledge of vaccination in this immunocompromised group of patients based on recent evidence and recommendations.
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Affiliation(s)
- Intissar Haddiya
- Department of Nephrology, Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, University Mohamed Premier, Oujda, Morocco
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