William R Mulley1,2, Suong T T Le3,4, Kathryn E Ives5. 1. Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia. 2. Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, VIC, Australia. 3. Department of Gastroenterology and Hepatology, Monash Medical Centre, Clayton, VIC, Australia. 4. School of Clinical Sciences, Monash University, Clayton, VIC, Australia. 5. Department of Anaesthesia, Pain and Perioperative Medicine, Barwon Health-University Hospital Geelong, Geelong, VIC, Australia.
Abstract
Background: Clinical guidelines recommend double-dose hepatitis B vaccination for patients requiring dialysis, due to an increased risk of hepatitis B infection and reduced vaccine responsiveness. There are no recommendations for patients with chronic kidney disease (CKD) prior to dialysis. Methods: We performed a systematic review and meta-analysis of randomized and quasi-randomized trials comparing efficacy (seroresponses) and harms of double-dose compared with standard-dose hepatitis B vaccination in patients with CKD, including those requiring dialysis. A systematic literature search (CENTRAL, MEDLINE and EMBASE) was performed using a predetermined search strategy. Relative risks were calculated from pooled data using a random-effects model with subgroup analysis by dialysis requirement and vaccine type. Results: Seven studies (501 patients) fulfilled review criteria: four in patients receiving dialysis and three in patients not receiving dialysis. The incidence of seroconversion was not increased with double-dose vaccination overall [risk ratio (RR) 1.17, 95% confidence interval (CI) 0.98-1.39], by dialysis requirement or vaccine type. The incidence of seroprotection (reported by only four studies) was increased with double-dose vaccination overall (RR 1.53, 95% CI 1.17-2.00) but not by dialysis requirement. Adverse events were not reported by treatment arm, precluding comparison. The overall quality of included studies was moderate to low. Conclusions: The current data do not support clinical guideline recommendations for administering double-dose vaccination for patients with CKD as seroconversion was not improved and seroprotection was inadequately assessed. Large high-quality studies are required to overcome the current evidence gap regarding vaccine dosing in CKD.
Background: Clinical guidelines recommend double-dose hepatitis B vaccination for patients requiring dialysis, due to an increased risk of hepatitis B infection and reduced vaccine responsiveness. There are no recommendations for patients with chronic kidney disease (CKD) prior to dialysis. Methods: We performed a systematic review and meta-analysis of randomized and quasi-randomized trials comparing efficacy (seroresponses) and harms of double-dose compared with standard-dose hepatitis B vaccination in patients with CKD, including those requiring dialysis. A systematic literature search (CENTRAL, MEDLINE and EMBASE) was performed using a predetermined search strategy. Relative risks were calculated from pooled data using a random-effects model with subgroup analysis by dialysis requirement and vaccine type. Results: Seven studies (501 patients) fulfilled review criteria: four in patients receiving dialysis and three in patients not receiving dialysis. The incidence of seroconversion was not increased with double-dose vaccination overall [risk ratio (RR) 1.17, 95% confidence interval (CI) 0.98-1.39], by dialysis requirement or vaccine type. The incidence of seroprotection (reported by only four studies) was increased with double-dose vaccination overall (RR 1.53, 95% CI 1.17-2.00) but not by dialysis requirement. Adverse events were not reported by treatment arm, precluding comparison. The overall quality of included studies was moderate to low. Conclusions: The current data do not support clinical guideline recommendations for administering double-dose vaccination for patients with CKD as seroconversion was not improved and seroprotection was inadequately assessed. Large high-quality studies are required to overcome the current evidence gap regarding vaccine dosing in CKD.
Authors: André Weigert; Marie-Louise Bergman; Lígia A Gonçalves; Iolanda Godinho; Nádia Duarte; Rita Abrantes; Patrícia Borges; Ana Brennand; Vanessa Malheiro; Paula Matoso; Onome Akpogheneta; Lindsay Kosack; Pedro Cruz; Estela Nogueira; Magda Pereira; Ana Ferreira; Marco Marques; Telmo Nunes; João Faro-Viana; Jocelyne Demengeot; Carlos Penha-Gonçalves Journal: Front Med (Lausanne) Date: 2021-12-24
Authors: Jacob Hettenbaugh; Ryan Mullane; Gayle Gillispie; Valerie Shostrom; Linda Flores; Jennifer A Fillaus; Marius C Florescu; Denise Murcek; Ketki K Tendulkar Journal: Infect Dis Rep Date: 2021-12-06