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

We measured the response to the hepatitis B virus vaccine in a group of 64 chronic hemodialysis patients and correlated the formation (responders) or lack of formation (non responders) of protecting antibodies with several parameters using multiple regression analysis. Formation of antibodies is Positively correlated with serum albumin (p: 0,008), prehemodialysis serum urea (p: 0,004), protein catabolic rate (p: 0,01) and tricipital skin fold (p: 0,01) and is adversely influenced by age (p: 0,01). Serum albumin, prealbumin and prehemodialysis serum urea levels were significantly higher in responders. The percentage of non responders was higher (70 %) in patients with prehemodialysis serum urea between 90 and 125 mg/dl than in those whose these levels ranged between 176 and 225 mg/dl (13,6 %). Similarly, patients with serum albumin between 3 and 3,5 g/dl failed to respond in a higher percentage (87,5 %) than those whose serum albumin ranged between 4,5 and 5 g/dl (18,8 %). After a four year follow up, survival in responders was 20 % higher in responders than in non responders (p < 0,05). Morbidity, measured as hospital days per year of hemodialysis was also lower in responders (10,4 +/- 2 days) than in non responders (32 +/- 14 days) (p. 0,03). We conclude that malnutrition influences negatively the response of hemodialysis patients to the hepatitis B virus vaccine and that the capability of forming antibodies against this vaccine is a good prognostic marker of morbidity and mortality in the hemodialysis population.