Accelerated Hepatitis B Vaccination Appears Safe, Effective in CKD

Completing hepatitis B virus vaccination (HBV) in 8 weeks rather than the standard 24 weeks improves seroconversion rates among patients with advanced chronic kidney disease (CKD), investigators report. Other research suggests that patients with IgA nephropathy with hepatitis B infection are at increased risk for progression.

“Hepatitis B virus vaccination is crucial for seronegative patients with advanced chronic kidney disease for protection during dialysis while preparing for transplantation,” according to Natavudh Townamchai, MD, of Chulalongkorn University and King Chulalongkorn Memorial Hospital in Bangkok, Thailand, and colleagues.

The investigators conducted a randomized controlled trial of patients with an estimated glomerular filtration rate (GFR) less than 30 mL/min/m², including those on dialysis. The standard HBV vaccination group received the Engerix B (40 μg) at 0, 4, 8, and 24 weeks. The accelerated group received the same 40 μg dose at 0, 1, 4, and 8 weeks. The 40 μg dose is double the standard dosage given to the general population and is recommended in CKD guidelines.

Seroconversion was defined as titers of hepatitis B surface antibodies (anti-HBs) of 10 IU/L or higher. In intent-to-treat analyses of 133 patients, the accelerated group had significantly higher rates of seroconversion at 12 weeks compared with the standard group (83.08% vs 63.24%), Dr Townamchai’s team reported in Kidney International Reports. The accelerated group also exhibited a significantly higher seroconversion rate at 12 weeks (85.71% vs. 69.35%) in the per-protocol analysis of 125 patients. Based on the per-protocol analysis, for every 100 accelerated vaccinations, an additional 16 seroconversions would be expected compared with the standard vaccination schedule.

By 28 and 52 weeks, the seroconversion rates were similar between groups showing that the accelerated regimen produced a durable response. Rates of anti-HBs of 100 IU/L or greater correlate with longer protection. The investigators suggested that patients with anti-HBs titers below 100 IU/L should consider a booster HBV vaccination after 28 weeks.

No serious adverse events, such as anaphylaxis, occurred in the accelerated group.

“Seroconversion of anti-HBs in response to the vaccination can protect patients from HBV infection during dialysis and enable them to receive a kidney from an HBsAg-positive donor,” Dr Townamchai’s team pointed out.

IgA Nephropathy Progression

In a separate study of 1961 patients with biopsy-proven IgA nephropathy published in Kidney International Reports, Xu-jie Zhou, MD, of Peking University First Hospital, Peking University Institute of Nephrology, in Beijing, China, and colleagues reported that chronic hepatitis B infection significantly increased the risk for disease progression by 74%.

Use of antiviral medications against hepatitis B and resolved infection were not associated with the outcome. The presence of hepatitis B virus deposits in the kidney also did not appear prognostic.

“Our findings highlight the importance of considering HBV infection status when managing patients with IgAN and call for further research to elucidate underlying mechanisms and investigate potential benefits of targeted antiviral therapy in individuals with concomitant HBV infection and IgAN,” the investigators concluded.