Can IL-1β, IL-6, TNF-α, CRP and ESR Be the Marker of Unresponsiveness of Antibody Against Hepatitis B Vaccine in Hemodialysis Patients?

AIM: The hepatitis B infection is a subject that still keeps its significance for hemodialysis staff members and hemodialysis patients at present. In this study, our aim was to evaluate whether the infections occurring during the hepatitis B vaccination programme have some negative effects on antibody response and also to examine the increased proinflammatory cytokins, interleukin-1β (IL- 1β), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as inflammation markers in the hemodialysis patients.

MATERIAL and METHODS: The patients who have hemodialysis adequacy, who are on rHuEPO therapy, whose hepatitis markers were HBsAg (-), antiHBs (-), antiHBcIgG (-) and anti HCV (+) or (-)and the patients who had sufficient antibody response at the begining of the hemodialysis but then the antibody titers fell below the 10 mIU/mL were enrolled in the study in Hemodialysis Center of Dicle University Faculty of Medicine. The patients were divided into two groups according to vaccination procedures. Group A: The 40 μg hepatitis B vaccine was injected intramuscularly into the left shoulder of patients who were HBsAg (-) and antiHBs (-) at months 0, 1, 2 and 6. Group B: The 40 μg booster dose of hepatitis B vaccine was injected intramuscularly into the left shoulder of the patients who had sufficient antibody response at the beginning of the hemodialysis but then the antibody titers fell below 10 mIU/mL. Then, the Group A was divided into two subgroups as Group A1 and Group A2 according to antibody response. Recombinant hepatitis B vaccine (Hepavax - Gene-inj (R) recombinant 20 μg/ml, Green Cross Vaccine Corp., Korea) was administered.

RESULTS: Twenty-eight patients completed the study (Group A: n=21, mean age 41±11 years, mean period of HD time 15.1±14.7 months, mean URR 68.7±7.4, mean Kt/V 1.45±0.23; Group B: n=7, mean age 55±16 years, mean period of HD time 22.2±26.8 months, mean URR 68.2±8.1, mean Kt/V 1.41±0.34). The positive antibody rate was 71.4% and the negative antibody response was 28.6% in group A. The positive antibody response rate was 100% in group B. There were not significant differences between the parameters of demographics, hematologic characteristics and nutritional status of the groups (p>0.05). The inflammation markers were similar in both groups except TNF-α because TNF-α was higher in group B. It was established that the majority of infections occured in group A1 during the study.

CONCLUSION: The patients whose HBV serologic markers were negative should be vaccinated with recommended vaccination schedule, while starting the HD therapy. Also the booster dose should be applied to the vaccinated patients whose antibody titers fell below the 10 mIU/mL. The acute infections that occured during this period and inflammations did not negatively affect the antibody response. It was considered that the acute phase markers did not reflect the negative antibody response.