BibTex RIS Kaynak Göster

-

Yıl 2013, Cilt: 35 Sayı: 3, 339 - 344, 16.02.2013

Ayşe Şeker Koçkara , Ferhan Candan , Can Hüzmeli , Mansur Kayataş

Öz

There is generally a failure in humoral and cellular immunity in most of the patients with chronic renal failure (CRF). In this study, the rate of response of CRF patients to a double-dose hepatitis vaccination and the effect of renal replacement type on the formation of antibodies have been investigated. In our centre, 51 hemodialysis (HD) and 19 continuous ambulatory peritoneal dialysis (CAPD) patients were vaccinated with recombinant hepatitis B in the 0th, 1st, 2nd and 6th months. Antibody titrates over 10 mIU/ml seen 1-3 months after the vaccination were considered as a response to the vaccine. As a result, no meaningful difference has been observed between the responses HD and CAPD patients gave to the vaccine (CAPD 84.2%, HD 78.4%, p=0.591). The effects of the duration of the dialysis, sex, age and hemoglobin, total protein, albumin, c-reactive protein (CRP), total cholesterol and triglyceride levels and the positivity of anti- HCV on hepatitis B seroconversion have also been evaluated. Of all these, only the age being over 50 has been seen to have a relationship with insufficient hepatitis B ceroconversion (p=0.037). The other parameters couldn’t be shown to have an effect on the hepatitis B seroconversion (p> 0.05).

Anahtar Kelimeler

Hepatitis B vaccination hemodialysis peritoneal dialysis

Kaynakça

  • Türk Nefroloji Derneği Ulusal Hemodiyaliz, Transplantasyon ve nefroloji kayıt sistemi raporu 2011.
  • Unger JK, Peters H. Hepatitis B in chronic kidney disease: moving toward effective prevention. Kidney Int 2008; 73: 799-801.
  • Liu YL, Kao MT, Huang CC. A comparison of responsiveness to hepatitis B vaccination in patients on hemodialysis and peritoneal dialysis. Vaccine 2005; 23: 3957-60.
  • Peces R, de la Torre M, Alcázar R, Urra JM. Prospective analysis of the factors influencing the antibody response to hepatitis B vaccine in hemodialysis patients. Am J Kidney Dis 1997; 29: 239-45.
  • Navarro JF, Teruel JL, Mateos M, Ortuno J. Hepatitis C virus infection decreases the effective antibody response to hepatitis B vaccine in hemodialysis patients. Clin Nephrol 1994; 41: 113-6.
  • Stevens CE, Alter HJ, Taylor PE, Zang EA, Harley EJ, Szmuness W. Hepatitis B vaccine in patients receiving hemodialysis. Immunogenicity and efficacy. N Engl J Med 1984; 311: 496-501.
  • Fabrizi F, Martin P, Dixit V, Bunnapradist S, Dulai G. Meta-analysis: the effect of age on immunological response to hepatitis B vaccine in end-stage renal disease. Aliment Pharmacol Ther 2004; 20: 1053-62.
  • Khan AN, Bernardini J, Rault RM, Piraino B. Low seroconversion with hepatitis B vaccination in peritoneal dialysis patients. Perit Dial Int 1996; 16: 370-3.
  • Bel'eed K, Wright M, Eadington D, Farr M, Sellars L. Vaccination against hepatitis B infection in patients with end stage renal disease. Postgrad Med J 2002; 78: 538-40.
  • Mitwalli A. Responsiveness to hepatitis B vaccine in immunocompromised patients by doubling the dose scheduling. Nephron 1996; 73: 417-20.
  • Rodby RA, Trenholme GM. Vaccination of the dialysis patient. Semin Dial 1991; 4: 102-5.
  • Dinits-Pensy M, Forrest GN, Cross AS, Hise MK. The use of vaccines in adult patients with renal disease. Am J Kidney Dis 2005; 46: 997.
  • Eleftheriadis T, Antoniadi G, Liakopoulos V, Kartsios C, Stefanidis I. Disturbances of acquired immunity in hemodialysis patients. Semin Dial 2007; 20: 440-51.
  • Litjens NH, Huisman M, van den Dorpel M, Betjes MG. Impaired immune responses and antigen-specific memory CD4+ T cells in hemodialysis patients. J Am Soc Nephrol 2008; 19: 1483-90.
  • Agrawal S, Gollapudi P, Elahimehr R, Pahl MV, Vaziri ND. Effects of end-stage renal disease and haemodialysis on dendritic cell subsets and basal and LPSstimulated cytokine production. Nephrol Dial Transplant 2010; 25: 737-46.
  • Buti M, Viladomiu L, Jardi R, Olmos A, Rodriguez JA, Bartolome J, Esteban R, Guardia J. Long-term immunogenicity and efficacy of hepatitis B vaccine in hemodialysis patients. Am J Nephrol 1992; 12: 144-7.
  • Seaworth B, Drucker J, Starling J, Drucker R, Stevens C, Hamilton J. Hepatitis B vaccines in patients with chronic renal failure before dialysis. J Infect Dis 1988; 157: 332-7. el-Reshaid K, al-Mufti S, Johny KV, Sugathan TN. Comparison of two immunization schedules with recombinant hepatitis B vaccine and natural immunity acquired by hepatitis B infection in dialysis patients. Vaccine 1994; 12: 223Marangi AL, Giordano R, Montanaro A, De Padova F, Schiavone MG, Dongiovanni G, Basile C. Hepatitis B virus infection in chronic uremia: longterm follow-up of a two-step integrated protocol of vaccination. Am J Kidney Dis 1994; 23: 537-42.
  • Donati D, Gastaldi L. Controlled trial of thymopentin in hemodialysis patients who fail to respond to hepatitis B vaccination. Nephron 1988; 50: 133-6.
  • Propst T, Propst A, Lhotta K, Vogel W, König P. Reinforced intradermal hepatitis B vaccination in hemodialysis patients is superior in antibody response to intramuscular or subcutaneous vaccination. Am J Kidney Dis 1998; 32: 1041
  • Evans TG, Schiff M, Graves B, Agosti J, Barritt ML, Garner D, Holley JL. The safety and efficacy of GM-CSF as an adjuvant in hepatitis B vaccination of chronic hemodialysis patients who have failed primary vaccination. Clin Nephrol 2000; 54: 138-42.
  • Charest AF, McDougall J, Goldstein MB. A randomized comparison of intradermal and intramuscular vaccination against hepatitis B virus in incident chronic hemodialysis patients. Am J Kidney Dis 2000; 36: 976-82.
  • Barraclough KA, Wiggins KJ, Hawley CM, van Eps CL, Mudge DW, Johnson DW, Whitby M, Carpenter S, Playford EG. Intradermal versus intramuscular hepatitis B vaccination in hemodialysis patients: A prospective open-label randomized controlled trial in nonresponders to primary vaccination. Am J Kidney Dis 2009; 54: 95-103.
  • Kong NC, Beran J, Kee SA, Miguel JL, Sánchez C, Bayas JM, Vilella A, CalboTorrecillas F, López de Novales E, Srinivasa K, Stoffel M, Hoet B. A new adjuvant improves the immune response to hepatitis B vaccine in hemodialysis patients. Kidney Int 2008; 73: 856-62.
  • Surquin M, Tielemans CL, Kulcsár I, Ryba M, Vörös P, Mat O, Treille S, Dhaene M, Stolear JC, Kuriyakose SO, Leyssen MX, Houard SA. Rapid, enhanced, and persistent protection of patients with renal insufficiency by AS02(V)-adjuvanted hepatitis B vaccine. Kidney Int 2010; 77: 247-55.
  • Alavian SM, Tabatabaei SV. Effects of oral levamisole as an adjuvant to hepatitis B vaccine in adults with end-stage renal disease: a meta-analysis of controlled clinical trials. Clin Ther 2010; 32: 1-10.
  • Tung J, Carlisle E, Smieja M, Kim PT, Lee CH. A randomized clinical trial of immunization with combined hepatitis A and B versus hepatitis B alone for hepatitis B seroprotection in hemodialysis patients. Am J Kidney Dis 2010; 56: 713Doğukan A, Taşkapan H, Güven M, Tokgöz B, Oymak O, Utaş C. Prediyaliz, hemodiyaliz ve sürekli ayaktan periton diyalizi hastalarında çift doz hepatit B aşısına yanıt. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 1999; 4: 192-4. Alçelik A, Bicik Z, Bahçebaşı T, Açıkgöz E, Yıldırım M, Önder E. Hemodiyaliz ve ayaktan periton diyalizi hastalarının hepatit B aşısına karşı immün yanıtlarının değerlendirilmesi. İstanbul Tıp Fakültesi Dergisi 2007; 70: 39-43.
  • Kara IH, Yılmaz ME, Suner A, Kadiroglu AK, Işıkoğlu B. The evaluation of immune responses that occur after HBV infection and HBV vaccination in hemodialysis patients. Vaccine 2004; 22: 3963-7.
  • Fernandez E, Betriu MA, Gómez 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 1996; 11: 1559Centers for Disease Control and Prevention (CDC) Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep, 50 (RR-5) 2001; pp: 1-43.

Hemodiyaliz ve periton diyalizi hastalarının Hepatit B aşısına karşı cevaplarının karşılaştırılması

Yıl 2013, Cilt: 35 Sayı: 3, 339 - 344, 16.02.2013

Ayşe Şeker Koçkara , Ferhan Candan , Can Hüzmeli , Mansur Kayataş

Öz

Özet

Kronik böbrek hastalığı (KBH) olan hastaların çoğunda hem humoral hem de hücresel immünitede yetersizlik söz konusudur. Bu çalışmada KBH hastalarında çift doz rekombinant hepatit B aşısına karşı yanıt oranları ve renal replasman türünün antikor oluşumunda etkisi araştırılmıştır. Cumhuriyet Üniversitesi Tıp Fakültesi Hastanesi diyaliz merkezinde 51 hemodiyaliz (HD), 19 sürekli ayaktan periton diyalizi (SAPD) hastası rekombinant hepatit B aşısı ile 0,1,2 ve 6. ayda toplam dört kez aşılandı. Antikor yanıtları Anti-HBs titrasyon düzeylerine göre belirlendi. Aşının son dozundan 1-3 ay sonra bakılan 10 mIU/mL’nin üstündeki antikor titreleri aşıya yanıt olarak kabul edildi. Sonuçta HD ve SAPD hastalarının hepatit B aşısına verdikleri yanıtlar arasında anlamlı bir fark görülmedi (SAPD hastalarında %84,2, HD hastalarında %78,4 , p=0,591). Diyaliz süresinin, cinsiyetin, yaşın, hemoglobin, total protein, albümin, c-reaktif protein (CRP), total kolesterol, trigliserid düzeyinin ve Anti-HCV(+)’liğinin hepatit B serokonversiyonuna etkisi de değerlendirildi. Bunlar arasında sadece yaşın >50 (yıl) olmasının yetersiz hepatit B serokonversiyonu ile ilişkili olduğu görüldü (p=0,037). Diğer parametrelerin hepatit B serokonversiyonu üzerine etkisi gösterilemedi (p>0,05).

Anahtar sözcükler: Hepatit B, aşılama, hemodiyaliz, periton diyalizi

 

Abstract

There is generally a failure in humoral and cellular immunity in most of the patients with chronic renal failure (CRF). In this study, the rate of response of CRF patients to a double-dose hepatitis vaccination and the effect of renal replacement type on the formation of antibodies have been investigated. In our centre, 51 hemodialysis (HD) and 19 continuous ambulatory peritoneal dialysis (CAPD) patients were vaccinated with recombinant hepatitis B in the 0th, 1st, 2nd and 6th months. Antibody titrates over 10 mIU/ml seen 1-3 months after the vaccination were considered as a response to the vaccine. As a result, no meaningful difference has been observed between the responses HD and CAPD patients gave to the vaccine (CAPD 84.2%, HD 78.4%, p=0.591). The effects of the duration of the dialysis, sex, age and hemoglobin, total protein, albumin, c-reactive protein (CRP), total cholesterol and triglyceride levels and the positivity of anti- HCV on hepatitis B seroconversion have also been evaluated. Of all these, only the age being over 50 has been seen to have a relationship with insufficient hepatitis B ceroconversion (p=0.037). The other parameters couldn’t be shown to have an effect on the hepatitis B seroconversion (p> 0.05).

Keywords: Hepatitis B, vaccination, hemodialysis, peritoneal dialysis

Anahtar Kelimeler

Hepatit B aşılama hemodiyaliz periton diyalizi

Kaynakça

  • Türk Nefroloji Derneği Ulusal Hemodiyaliz, Transplantasyon ve nefroloji kayıt sistemi raporu 2011.
  • Unger JK, Peters H. Hepatitis B in chronic kidney disease: moving toward effective prevention. Kidney Int 2008; 73: 799-801.
  • Liu YL, Kao MT, Huang CC. A comparison of responsiveness to hepatitis B vaccination in patients on hemodialysis and peritoneal dialysis. Vaccine 2005; 23: 3957-60.
  • Peces R, de la Torre M, Alcázar R, Urra JM. Prospective analysis of the factors influencing the antibody response to hepatitis B vaccine in hemodialysis patients. Am J Kidney Dis 1997; 29: 239-45.
  • Navarro JF, Teruel JL, Mateos M, Ortuno J. Hepatitis C virus infection decreases the effective antibody response to hepatitis B vaccine in hemodialysis patients. Clin Nephrol 1994; 41: 113-6.
  • Stevens CE, Alter HJ, Taylor PE, Zang EA, Harley EJ, Szmuness W. Hepatitis B vaccine in patients receiving hemodialysis. Immunogenicity and efficacy. N Engl J Med 1984; 311: 496-501.
  • Fabrizi F, Martin P, Dixit V, Bunnapradist S, Dulai G. Meta-analysis: the effect of age on immunological response to hepatitis B vaccine in end-stage renal disease. Aliment Pharmacol Ther 2004; 20: 1053-62.
  • Khan AN, Bernardini J, Rault RM, Piraino B. Low seroconversion with hepatitis B vaccination in peritoneal dialysis patients. Perit Dial Int 1996; 16: 370-3.
  • Bel'eed K, Wright M, Eadington D, Farr M, Sellars L. Vaccination against hepatitis B infection in patients with end stage renal disease. Postgrad Med J 2002; 78: 538-40.
  • Mitwalli A. Responsiveness to hepatitis B vaccine in immunocompromised patients by doubling the dose scheduling. Nephron 1996; 73: 417-20.
  • Rodby RA, Trenholme GM. Vaccination of the dialysis patient. Semin Dial 1991; 4: 102-5.
  • Dinits-Pensy M, Forrest GN, Cross AS, Hise MK. The use of vaccines in adult patients with renal disease. Am J Kidney Dis 2005; 46: 997.
  • Eleftheriadis T, Antoniadi G, Liakopoulos V, Kartsios C, Stefanidis I. Disturbances of acquired immunity in hemodialysis patients. Semin Dial 2007; 20: 440-51.
  • Litjens NH, Huisman M, van den Dorpel M, Betjes MG. Impaired immune responses and antigen-specific memory CD4+ T cells in hemodialysis patients. J Am Soc Nephrol 2008; 19: 1483-90.
  • Agrawal S, Gollapudi P, Elahimehr R, Pahl MV, Vaziri ND. Effects of end-stage renal disease and haemodialysis on dendritic cell subsets and basal and LPSstimulated cytokine production. Nephrol Dial Transplant 2010; 25: 737-46.
  • Buti M, Viladomiu L, Jardi R, Olmos A, Rodriguez JA, Bartolome J, Esteban R, Guardia J. Long-term immunogenicity and efficacy of hepatitis B vaccine in hemodialysis patients. Am J Nephrol 1992; 12: 144-7.
  • Seaworth B, Drucker J, Starling J, Drucker R, Stevens C, Hamilton J. Hepatitis B vaccines in patients with chronic renal failure before dialysis. J Infect Dis 1988; 157: 332-7. el-Reshaid K, al-Mufti S, Johny KV, Sugathan TN. Comparison of two immunization schedules with recombinant hepatitis B vaccine and natural immunity acquired by hepatitis B infection in dialysis patients. Vaccine 1994; 12: 223Marangi AL, Giordano R, Montanaro A, De Padova F, Schiavone MG, Dongiovanni G, Basile C. Hepatitis B virus infection in chronic uremia: longterm follow-up of a two-step integrated protocol of vaccination. Am J Kidney Dis 1994; 23: 537-42.
  • Donati D, Gastaldi L. Controlled trial of thymopentin in hemodialysis patients who fail to respond to hepatitis B vaccination. Nephron 1988; 50: 133-6.
  • Propst T, Propst A, Lhotta K, Vogel W, König P. Reinforced intradermal hepatitis B vaccination in hemodialysis patients is superior in antibody response to intramuscular or subcutaneous vaccination. Am J Kidney Dis 1998; 32: 1041
  • Evans TG, Schiff M, Graves B, Agosti J, Barritt ML, Garner D, Holley JL. The safety and efficacy of GM-CSF as an adjuvant in hepatitis B vaccination of chronic hemodialysis patients who have failed primary vaccination. Clin Nephrol 2000; 54: 138-42.
  • Charest AF, McDougall J, Goldstein MB. A randomized comparison of intradermal and intramuscular vaccination against hepatitis B virus in incident chronic hemodialysis patients. Am J Kidney Dis 2000; 36: 976-82.
  • Barraclough KA, Wiggins KJ, Hawley CM, van Eps CL, Mudge DW, Johnson DW, Whitby M, Carpenter S, Playford EG. Intradermal versus intramuscular hepatitis B vaccination in hemodialysis patients: A prospective open-label randomized controlled trial in nonresponders to primary vaccination. Am J Kidney Dis 2009; 54: 95-103.
  • Kong NC, Beran J, Kee SA, Miguel JL, Sánchez C, Bayas JM, Vilella A, CalboTorrecillas F, López de Novales E, Srinivasa K, Stoffel M, Hoet B. A new adjuvant improves the immune response to hepatitis B vaccine in hemodialysis patients. Kidney Int 2008; 73: 856-62.
  • Surquin M, Tielemans CL, Kulcsár I, Ryba M, Vörös P, Mat O, Treille S, Dhaene M, Stolear JC, Kuriyakose SO, Leyssen MX, Houard SA. Rapid, enhanced, and persistent protection of patients with renal insufficiency by AS02(V)-adjuvanted hepatitis B vaccine. Kidney Int 2010; 77: 247-55.
  • Alavian SM, Tabatabaei SV. Effects of oral levamisole as an adjuvant to hepatitis B vaccine in adults with end-stage renal disease: a meta-analysis of controlled clinical trials. Clin Ther 2010; 32: 1-10.
  • Tung J, Carlisle E, Smieja M, Kim PT, Lee CH. A randomized clinical trial of immunization with combined hepatitis A and B versus hepatitis B alone for hepatitis B seroprotection in hemodialysis patients. Am J Kidney Dis 2010; 56: 713Doğukan A, Taşkapan H, Güven M, Tokgöz B, Oymak O, Utaş C. Prediyaliz, hemodiyaliz ve sürekli ayaktan periton diyalizi hastalarında çift doz hepatit B aşısına yanıt. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 1999; 4: 192-4. Alçelik A, Bicik Z, Bahçebaşı T, Açıkgöz E, Yıldırım M, Önder E. Hemodiyaliz ve ayaktan periton diyalizi hastalarının hepatit B aşısına karşı immün yanıtlarının değerlendirilmesi. İstanbul Tıp Fakültesi Dergisi 2007; 70: 39-43.
  • Kara IH, Yılmaz ME, Suner A, Kadiroglu AK, Işıkoğlu B. The evaluation of immune responses that occur after HBV infection and HBV vaccination in hemodialysis patients. Vaccine 2004; 22: 3963-7.
  • Fernandez E, Betriu MA, Gómez 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 1996; 11: 1559Centers for Disease Control and Prevention (CDC) Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep, 50 (RR-5) 2001; pp: 1-43.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Dahili Tıp Bilimleri Araştırma Yazıları
Yazarlar

Ayşe Şeker Koçkara

Ferhan Candan

Can Hüzmeli

Mansur Kayataş

Yayımlanma Tarihi 16 Şubat 2013
Yayımlandığı Sayı Yıl 2013Cilt: 35 Sayı: 3

Kaynak Göster

AMA Şeker Koçkara A, Candan F, Hüzmeli C, Kayataş M. Hemodiyaliz ve periton diyalizi hastalarının Hepatit B aşısına karşı cevaplarının karşılaştırılması. CMJ. Eylül 2013;35(3):339-344.