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World J Hepatol. Apr 18, 2015; 7(5): 761-768
Published online Apr 18, 2015. doi: 10.4254/wjh.v7.i5.761
Is hemodialysis a reason for unresponsiveness to hepatitis B vaccine? Hepatitis B virus and dialysis therapy
Dede Sit, Bennur Esen, Ahmet Engin Atay, Hasan Kayabaşı
Dede Sit, Bennur Esen, Ahmet Engin Atay, Hasan Kayabaşı, Department of Internal Medicine and Nephrology, Bagcilar Education and Research Hospital, Istanbul 34200, Turkey
Author contributions: Sit D, Esen B, Atay AE and Kayabaşı H planned and wrote the manuscript; Sit D and Atay AE edited and responded to reviewers’ critics.
Conflict-of-interest: Authors declare that there is no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dede Sit, Associate Professor, Department of Internal Medicine and Nephrology, Bagcilar Education and Research Hospital, Mimar Sinan Avenue, 6. Street, Bagcilar, Istanbul 34200, Turkey.
Telephone: +90-532-6462297
Received: August 28, 2014
Peer-review started: August 30, 2014
First decision: November 19, 2014
Revised: November 26, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: April 18, 2015

Impaired renal function is associated with a high risk of chronicity of hepatitis B virus (HBV) infection. Patients on hemodialysis (HD) or peritoneal dialysis are at an increased risk of viral transmission due to frequent necessity of blood product transfer as well as use of contaminated dialysate or dialysis materials. Additionally, health professionals may cause viral spread via contaminated hands and carelessness against hygiene rules. The frequency of chronic HBV infection may be as high as 80% in patients on renal replacement therapies. This is because HBV vaccination is essential to eliminate chronic HBV infection. However, response rates of HD patients to HBV vaccination vary between 10%-50%. Dialysis adequacy and early vaccination before the onset of dialysis therapy seem to be major determinants of high seroconversion rates. Older age, male gender, duration of dialysis therapy and nutritional status are other well-known factors associated with seroconversion rate. There are controversial reports regarding the role of the presence of diabetes mellitus, HCV positivity, erythropoietin resistance, hyperparathyroidism, and vitamin D inadequacy. The role of genetic alteration in the functions or production of cytokines still needs to be elucidated.

Keywords: Hepatitis B virus, Vaccine, Hemodialysis, Response, End stage renal disease

Core tip: Due to immunesuppresive effect of uremia and dialyser membranes, chronicity of hepatitis B virus (HBV) infection is frequently observed. Rates of seroconversion induced by HBV vaccine is diminished in chronic kidney disease patients when compared to the general population, which gradually decrease as renal functions deteriorates. Efficient dialysis is a major determinant of response to HBV vaccination. In contrast to three doses of 20 μg HBV vaccine for the general population, patients on hemodialysis or peritoneal dialysis usually require four doses of 40 μg HBV vaccine.