Publication: Factors associated with nonresponse to the hepatitis B vaccine in dialysis patients

Factors associated with nonresponse to the hepatitis B vaccine in dialysis patients.
Leather N, Gunnarsson R, Barraclough K, Mantha M, Hardaker E, Kellahan S, Killen J.
Canberra: Australian and New Zealand Society of Nephrology Annual Scientific Meeting; 2015.



To analyse patient factors associated with nonresponse and to analyse factors associated with maintenance of antibody response to the hepatitis B vaccination in dialysis patients. Background: Patients undergoing dialysis have suboptimal antibody response to the hepatitis B vaccine in comparison to the general population. The existing literature is suggestive of a variety of contradictory evidence in relation to patient factors with a poor response.


We retrospectively reviewed all incident and prevalent dialysis patients between 2007 and 2012 in a single centre, who received a hepatitis B vaccine schedule. Patients who were hepatitis B core antibody positive were excluded. Data collected included baseline demographics, biochemistry, comorbidities and medications. Correlations between patient factors and nonresponse were evaluated using univariate logistic regression analysis. Patient factors included: age, gender, ethnicity, smoking, diabetes, body mass index, albumin, vitamin B12 levels, erythropoietin use, pre-dialysis status and type of dialysis. Nonresponse is defined as having a hepatitis B surface antibody (HBsAb) level below 10IU/L.


129 patients were included. The overall response rate (defined as HBsAb level >10IU/L) was 63.8%. 26% of patients had a low response (defined as HBsAb levels 10-100IU/L), 25.2% had a moderate response (HBsAb 100-1000IU/L) and 12.6% had a high response (HBsAb >1000IU/L). The only variable predicting nonresponse to vaccination was smoking, both prior to and at commencement of dialysis (OR 4.9, 95% CI 1.9-13, p=0.0012).


Smoking is associated with a nonresponse to the hepatitis B vaccine in this population.

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