Evaluation of Response to Hepatitis B Vaccination in Patients on Maintenance Haemodialysis: Insights From a Satellite Hemodialysis Unit in Kenya

Abstract INTRODUCTION Patients with end-stage renal disease (ESRD) on maintenance haemodialysis (HD) are at an increased risk of acquiring hepatitis B virus (HBV) infection. Active HBV immunization in these patients is recommended. A response rate in HD patients is variable but generally lower than healthy individuals. OBJECTIVES The aim of this study was to evaluate the response of hepatitis B vaccination and to correlate response to various clinical and biomedical factor in patients on maintenance haemodialysis (HD) followed up at parklands kidney centre, Kenya. METHODOLOGY This was a retrospective study conducted between 1st January 2023 to 1st January 2024 at Parklands Kidney Center, renal unit, Nairobi. The study population was adults aged 18 years and above who were undergoing maintenance haemodialysis. They should have received at least 40 μg of HBV vaccine administered intramuscularly in the deltoid region at 0, 1, 2 and 6 months. The patients' responses to vaccine was determined by the measured hepatitis B surface antibody (HBsAb) done 6 to 12 weeks after the last injection. Data of patients undergoing maintenance HD was extracted using a data collection tool. RESULTS Ninety-two patients (78 %) mounted a response with HBsAb >10 mIU/ml and thus were considered as adequate responders. Sixty-four (54.24 %) patients mounted an excellent response with HBsAb >100 mIU/ml. Twenty-six patients (22.03 %) were non-responders. A young age (P = 0.017), diabetes mellitus (0.008), duration of dialysis (0.032), and Urea Reduction Ratio (<0.001) predicted a positive response to HB vaccination. Gender, haemoglobin level, serum albumin, serum ferritin, parathyroid hormone level, C reactive protein and vitamin D had no effect on the response to vaccine. In addition, out of the 118 (100 %) patients on maintenance HD all were HBsAg negative, of those tested for HbcAb 25 (32 %) were positive an indication of occult hepatitis B infection. CONCLUSION A 78 % response rate to HB vaccine was observed in the cohort of this study. Young age, diabetes mellitus, duration of dialysis and urea reduction ratio predicts a favourable response to HBV vaccine in patients on maintenance HD.