Success of hepatitis B vaccination in children who followed up with chronic kidney disease and the factors affecting it

Objective: Hepatitis B infection is one of the most important causes of morbidity and mortality in chronic kidney disease and can be prevented by effective vaccination. The aim of this study is to determine the response to hepatitis B virus (HBV) vaccination, to identify the factors that affect response to hepatitis B vaccine and to achieve results that will guide alternative vaccination schedules. Methods: In this retrospective study, 66 patients who were followed up with the diagnosis of chronic kidney disease in Dokuz Eylul University Faculty of Medicine, Department of Pediatric Nephrology and whose vaccination card and Anti-HBs level records could be accessed were included. Vaccination cards of the patients were obtained during their outpatient follow-ups or by contacting them by phone call. Demographic data such as age, gender, anthropometric measurements (body mass index), cause and stage of chronic kidney disease, presence of comorbidity, treatments, and anti-HBs levels of the patients were recorded in the Data Registration Form from the patient files and PROBEL system. Data were evaluated in a computer environment by frequency, percentage distribution, mean, median, and comparative analysis. Results: 54.5% of the patients included in the study were male and 45.5% were female. The most common cause of chronic kidney disease was found to be congenital anomalies of the kidneys and urinary tract (%30,3). It was observed that patients with chronic kidney disease presented to the pediatric nephrology outpatient clinic most frequently in stage 3 (24.2%). All the patients had previously completed primary hepatitis B vaccination series according to Turkish Ministry of Health childhood vaccination schedule. All sixty-six patients had at least one anti-HBs test (first anti-HBs level). Second anti-HBs level was measured in 39 of 66 patients. The first anti-HBs level seropositivity rate was 62.1%, the second anti-HBs level seropositivity rate was 82.1%. When we grouped the patients according to age, gender, body mass index, stage and additional diseases, no statistically significant difference was found in the seropositivity rates in the first anti-HBs levels. According to the treatments administered, the patients were examined in five groups as those who were followed up with medical supportive treatment or without treatment, those who were given immunosuppressive treatment, those who underwent hemodialysis, those who underwent peritoneal dialysis, and those who underwent renal transplantation. In the first anti-HBs levels and in the second anti-HBs levels, the seropositivity rate of the patient group follow up with medical supportive treatment or without treatment was found to be higher than the patient group who received other treatments, but there was no statistically significant difference. Conclusions: The success of vaccination with hepatitis B vaccine in chronic kidney disease is lower than in the healthy population. Thus, it is extremely important to evaluate HBV serological tests of the patients before the diagnosis of chronic kidney disease, if they have negative results of anti-HBs then vaccinate against HBV until the protective antibody titers are reached and to follow up the patients closely by checking the annual anti-HBs level.