RESPONSE TO THE HEPATITIS-B VIRUS-VACCINE IN HEMODIALYSIS-PATIENTS - INFLUENCE OF MALNUTRITION AND ITS IMPORTANCE AS A RISK FACTOR FOR MORBIDITY AND MORTALITY

Objective, To assess if malnutrition influences the response to the he patitis B virus vaccine in haemodialysis patients and whether this cor relates with morbidity and mortality in these patients. Design. A 4-ye ar prospective open study. Setting. Haemodialysis unit of a 434-bed Un iversity Hospital. Patients, Sixty-four patients with end-stage chroni c renal failure on maintenance haemodialysis. Interventions, Three-dos e vaccination series with recombinant hepatitis B virus vaccine. Measu rements, Antibody formation against the vaccine, predialysis serum ure a, serum albumin and prealbumin, dialysis efficacy (Kt/V), protein cat abolic rate (PCR), arm muscle circumference, triceps skinfold, serum p arathyroid hormone concentration, mortality and morbidity (hospital da ys per year of dialysis), Results. Increase in age negatively influenc es the formation of antibodies (P=0.01), whereas serum albumin (P=0.00 8) and predialysis blood urea concentration (P=0.004) are positively c orrelated with the formation of antibodies. Responders had significant ly higher levels of serum albumin and prealbumin and predialysis blood urea than non-responders. The percentage of non-responders was higher (70%) in the group with predialysis blood urea concentration between 90 and 125 mg/dl than in those with predialysis blood urea concentrati ons between 176 and 225 mg/dl (14.2%). Patients with serum albumin lev els between 3 and 3.5 g/dl were non-responders in a higher percentage (87.5%) than those with serum albumin levels between 4.5 and 5 g/dl (1 8.8%). After a 4-year follow-up, survival was 20% higher in the respon der group (P < 0.05). Morbidity, expressed as hospital days per year o f haemodialysis, was markedly lower in the responder group (10.4 +/- 2 versus 32 +/- 14 days, P = 0.03). Conclusions, Malnutrition negativel y influences the response to the hepatitis B virus vaccine in haemodia lysis patients, Non-responders have higher morbidity and mortality tha n responders, and therefore the absence of response to the hepatitis B vaccine can be considered as a risk factor in the haemodialysis popul ation.