Seroconversion after Hepatitis B vaccination in chronic kidney disease patients on maintenance hemodialysis: Does diabetes affect seroconversion response?

Background and aims: Patients with chronic kidney disease (CKD) on maintenance hemodialysis (MHD) have a higher prevalence of Hepatitis B. Hepatitis B is preventable by vaccination, however, the seroconversion response is less effective in patients of CKD. Since diabetes is an important cause of CKD, this study aimed to compare seroconversion rates after Hepatitis B vaccination in normal individuals, patients with non-diabetic CKD (NDCKD) on MHD and patients with diabetic chronic kidney disease (DCKD) on MHD. We also aimed to determine whether an association existed between seroconversion rates and the duration of diabetes. Materials and methods: This was a case-control study conducted on the following subjects who had completed the Hepatitis B immunization schedule – normal subjects, patients with NDCKD stage 5, and patients with DCKD stage 5 on MHD. Anti-HBS levels were measured in the three groups and seroconversion rates were measured and compared. Result: Of 132 subjects, 44 each were normal controls, NDCKD, and DCKD on MHD. 100% of normal individuals seroconverted. Among the subjects on MHD, more NDCKD (72.7%) seroconverted when compared to DCKD (52.3%, p-value 0.048). Non-responders had diabetes for more than 10 years. Conclusion: Among patients on MHD, those with DCKD have lower rates of seroconversion compared to those with NDCKD. Older age, less dialysis, and longer duration of diabetes adversely influenced seroconversion.