OBJECTIVES: There is a rising incidence of end stage renal disease (ESRD) throughout the world. Hepatitis B virus (HBV) infection remains a major issue among dialysis patients and may pose major problems for healthcare system and economy. Management of HBV in these patients is challenging.Compared with a response rate of >90 % in patients without renal failure, only 50 to 60 % of those with ESRD develop antibodies following HBV vaccination.Successful prevention of HBV transmission requires effective vaccination along with infection control measures. We conducted this study to assess the effectiveness of hepatitis B vaccination in ESRD patients in a tertiary care.

METHODS: A retrospective observational study carried out at our dialysis center from January 2015 to 2016. All patients who were completely vaccinated before initiation of dialysis were included. Anti HBs titers at the end of vaccination were noted.Patients were divided into responders and nonresponders if titers were ≥ 10 and < 10 IU/ml respectively. Patients with initial non protective titers were given repeat vaccination. Repeat titers after 12 months were noted. RESULTS: Of 69 patients included in the study mean age was 56 years with males constituting 75.36%. Diabetic nephropathy was the most common cause for ESRD.60.87% (42) patients were responders and 39.13% (27) non responders. Among responders 35.71% (15) patients had titres between 10-100 and 64.29% (27) >100. After 12 months 90.48% (38) had protective titers among responders where as 74.07% (20) of nonresponders had non-protective titres despite repeat vaccination with significant p value <0.05. 54.76% (23) of the responders had declining but protective titers.

CONCLUSIONS:  Non-responder rate in ESRD population for Hepatitis B vaccination is significantly high if done just prior to initiation as in our study. So early vaccination and regular monitoring of titres is necessary in this high risk population to maintain seroprotective levels.