Hepatitis B vaccination in predialysis chronic renal failure patients a comparison of two vaccination schedules

To improve seroconversion to hepatitis B vaccination, it is recommended that patients suffering with chronic renal failure be vaccinated as soon as dialysis is anticipated. We compared seroconversion rates in 121 predialysis patients with moderate chronic renal failure using either 40 or 20 μg of Engerix B recombinant hepatitis B vaccine administered at 0, 1 and 6 months. Seroconversion was not significantly higher after three doses of 40 μg (67%) compared to 20 μg (57%, p = 0.27). Multivariable analysis using dose of vaccine, eGFR (MDRD equation), calculated creatinine clearance (Cockcroft–Gault), and age as independent continuous variables showed that neither dose nor degree of renal function contributed to seroconversion. Younger age was weakly associated with improved seroconversion (p = 0.052). Seroconversion was attained in 13% of non-responders after a fourth dose of vaccine.