Modulation of the immune response to HBV vaccination by hemodialysis membranes

Seroconversion response to Hepatitis B virus (HBV) vaccination is limited in uremic patients because of impaired humoral and cellular immune activity. Recent studies show that high-flux (HF) hemodialysis (HD) membranes can improve T cell functions and decrease the proinflammatory cytokine activation more effectively than low-flux (LF) membranes. In regard to HF membranes may have immune modulator effects; we compared the antibody responses to hepatitis B vaccination between HF HD and LF HD membranes. One thousand four hundred and eight patients on HD programmed for 4 h three times a week at three different centers with HF or LF membranes were scanned. Anti-HBs levels of these patients who were vaccinated with recombinant DNA HBV vaccine on the 0, 1st, 2nd and 6th month from the beginning were recorded on the 0, 3rd, 6th, 9th and 12th month of vaccination schedule. Seroconversion rate was 84.2% in HF group and 52.7% in LF group on the 6th month (P < 0.01). Ratio of the patients who had > 100 IU/l antibody titers in HF group was 22.8%, while it was 10.9% in LF group (P < 0.01). Also on the 9th, 12th and 24th month; seroconversion rates in HF group were higher than LF group: 91.1-70.9% (P < 0.05), 95.0-81.8% (P < 0.05), 92.1-83.7% (P > 0.05), respectively. Ratio of the patients who did not show any seroconversion was higher in LF group than HF group; on the 6th month as 15.8-47.3% (P < 0.001), on the 9th month 8.9-29.1% (P < 0.05), on the 12th month as 5.0-18.2% (P < 0.05), and on the 24th month as 7.9-16.4% (P > 0.05), respectively. We showed that ratio of anti-HBs seroconversion response to hepatitis B vaccination in patients receiving HD with HF membranes was higher than LF membranes. This finding suggests that HF membranes may improve immune modulator effects.