The influence of nutritional status, dialysis adequacy, and residual renal function on the response to hepatitis B vaccination in peritoneal dialysis patients.

Little is known about the factors contributing to the reduced antibody response to hepatitis B vaccination in peritoneal dialysis patients. The influence of nutritional status [as assessed by serum albumin and nitrogen protein appearance (nPNA)], residual renal function, and dialysis adequacy (weekly Kt/V(urea)) on the development of hepatitis B antibodies was examined in 32 continuous ambulatory peritoneal dialysis/continuous cycling peritoneal dialysis patients. Vaccination with Engerix 40 micrograms given intramuscularly at 0, 1, 2, and 6 months resulted in a 63% response with 20 converters and 12 nonconverters. Patient age, sex, months on peritoneal dialysis, and race were not different among converters and nonconverters. Median serum albumin (3.75 vs 3.8 g/dL), nPNA (0.96 vs 0.94 g/kg/day initial and 0.78 vs 0.84 g/kg/day final), residual renal function (5.4 vs 4.0 mL/min), and final weekly Kt/V (2.12 vs 1.96) were not different among converters and nonconverters, respectively. Initial Kt/V was higher in converters (2.37 vs 2.01, p = 0.02). Nutritional status, residual renal function, and weekly Kt/V in nutritionally replete and well-dialyzed peritoneal dialysis patients do not predict response to hepatitis B vaccine. Patients with higher weekly Kt/V early in the course of peritoneal dialysis may be more likely to respond to hepatitis B vaccination.