PMID- 16686308
OWN - NLM
STAT- MEDLINE
DCOM- 20060630
LR  - 20060511
IS  - 1197-8554 (Print)
IS  - 1197-8554 (Linking)
VI  - 21
DP  - 2005
TI  - Peritoneal dialysis is the better therapy choice for successful anti-hepatitis B 
      vaccination.
PG  - 151-3
AB  - Patients treated with renal replacement therapy (RRT) are considered to be at 
      higher risk for infection with hepatitis B virus (HBV). Immunoprophylaxis is 
      therefore deemed a standard of care. Active immunization in RRT patients leads to 
      a lower incidence of protective titers of HBV antibodies (HBAbs) than the titers 
      seen in healthy counterparts. Our hypothesis is that, for complex reasons, active 
      immunization is more effective in patients on peritoneal dialysis (PD) than in 
      patients on hemodialysis (HD), and that the effectiveness of immunization depends 
      on dialysis adequacy (Kt/V). We carried out a prospective multicenter study with 
      an enrollment period that ran from January 1998 to December 2004. Follow-up data 
      were analyzed as of August 2004. Inclusion criteria were an age of 18 years or 
      older and newly indicated RRT Exclusion criteria were a history of HBV or the 
      presence of either HBV antigen (HBAg) or HBAbs in the protective range. The 
      choice of RRT modality (HD or PD) was based on patient preference (preceded by 
      thorough counseling). Active immunization followed accepted guidelines for RRT 
      patients and began after clinical and laboratory steady state had been achieved. 
      The endpoints were the number of patients with a protective HBAb titer and the 
      number with newly diagnosed hepatitis B. In PD patients, we calculated Kt/V on 
      regular basis. We enrolled 211 patients, 171 of whom chose HD treatment, and 40 
      of whom chose PD. Positive response to immunization (defined as a serum level of 
      HBAbs above 10 mIU/mL) was achieved in 58 HD patients (34%) and 21 PD patients 
      (53%, p = 0.03). In subgroup of PD patients with a weekly Kt/Vgreater than 1.7 
      (n=28), the response rate rose to 71%--as compared with just 8% in patients with 
      a weekly Kt/V below 1.7 (p = 0.0003). In the PD cohort as a whole, the level of 
      HBAbs correlated with Kt/V No new cases of hepatitis B or HBAg positivity 
      occurred in either group. From the viewpoint of successful HBV immunoprophylaxis 
      in RRT patients, PD is the better modality choice. In PD patients, the success 
      rate of immunoprophylaxis depends on weekly Kt/V, which we propose should be 1.7 
      or higher
FAU - Svac, Juraj
AU  - Svac J
AD  - Logman A.S., Bratislava, Slovak Republic. svac@stonline.sk
FAU - Skladany, Lubomir
AU  - Skladany L
FAU - Sekerkova, Zuzana
AU  - Sekerkova Z
FAU - Javorsky, Peter
AU  - Javorsky P
FAU - Leskova, Luba
AU  - Leskova L
FAU - Mizla, Peter
AU  - Mizla P
FAU - Jankechova, Irena
AU  - Jankechova I
FAU - Pasminka, Tibor
AU  - Pasminka T
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - Canada
TA  - Adv Perit Dial
JT  - Advances in peritoneal dialysis. Conference on Peritoneal Dialysis
JID - 9104803
RN  - 0 (Hepatitis B Antibodies)
SB  - IM
MH  - Female
MH  - Hepatitis B/*prevention & control
MH  - Hepatitis B Antibodies/*biosynthesis
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Peritoneal Dialysis
MH  - *Renal Dialysis
MH  - *Vaccination
EDAT- 2006/05/12 09:00
MHDA- 2006/07/01 09:00
CRDT- 2006/05/12 09:00
PHST- 2006/05/12 09:00 [pubmed]
PHST- 2006/07/01 09:00 [medline]
PHST- 2006/05/12 09:00 [entrez]
PST - ppublish
SO  - Adv Perit Dial. 2005;21:151-3.