Increasing serum creatinine and age reduce the response to hepatitis B vaccine in renal failure patients

The relationship between diminished response to hepatitis B vaccine in renal failure patients and serum creatinine level, age and other factors is unknown. The immune response to patients with renal failure of varying severity to hepatitis B vaccine was determined in this study. Sixty-eight patients with renal failure of varying severity who were negative for hepatitis B markers received four doses of hepatitis B vaccine, and anti-HBs titers were determined at 0,1,2,3,6,8 and 12 months. Maximum anti-HBs titers were seen at 8 months. At this time 86% of patients with creatinine ≤4 mg/dl but only 37% with creatinine >4.0 mg/dl had a protective titer of ≥10 mIU/ml (p<0.002). Age was inversely related to anti-HBs titer (p=0.045) and was independent of serum creatinine in predicting antibody response. We conclude that all patients with chronic renal failure should be immunized against hepatitis B as early as possible in the development of their disease, to ensure maximum response, and to minimize the effects of elevated serum creatinine and increasing age.