HDCN Article Review/Hyperlink

Fernandez E, Betriu MA, Gomez R, Montoliu J

Response to the hepatitis B virus vaccine in haemodialysis patients: influence of malnutrition and its importance as a risk factor for morbidity and mortality

Nephrol Dial Transplant (Aug) 11:1559-1563 1996

The fact that the response to hepatitis B vaccine is impaired in dialysis patients has motivated the search for the underlying causes of this "bad" response. Inherited (HLA genotype) and acquired factors (HCV infection, hyperparathyrodism, epoetin treatment) have been implicated, although not in a consistent manner. The authors of this paper analyze the influence of malnutrition (assessed with biochemical, kinetic and anthropometric measurements) on the antibody response to hepatitis B virus vaccine (3 IM doses of 40 mcg) in 64 hemodialysis patients.

An older age, lower serum albumin and lower predialysis serum urea were associated with poorer responses. The PCR, however, was not lower in the non responder group. Patients with serum albumin levels between 3-3.5 g/dL were non responders in a higher percentage (87.5%) than those with serum albumin levels between 4.5-5 g/dL (18.5%). Moreover, morbidity and mortality at 4-year follow-up was markedly increased in non responder patients. The authors conclude that malnutrition unfavourably influence the response to the HBV vaccine and that these lack of response could be considered as risk factor for morbidity and mortality.

Comment: These results are significant in that they suggest that the correction of malnutrition could improve the response to HBV vaccine, and strength the utility of simple biochemical parameters (serum albumin and urea) as good predictors of outcome. However, these results have not been confirmed by other groups (Nephron, 1992; 61 (S3) 266-268; Presse Med, 1995; 803-806; Nephrol Dial Transplant, 1996; 11 A-217). Whether or not these results are applicable to other dialysis units needs to be thoroughly investigated with larger series of patients. (Roberto Alcazar Arroyo MD, Hospital Alarcos, Ciudad Real, Spain)

The full text of this abstract is available from Oxford Press at this site.