Primary seroresponses to double-dose compared with standard-dose hepatitis B vaccination in patients with chronic kidney disease: a systematic review and meta-analysis

被引:24
作者
Mulley, William R. [1 ,2 ]
Le, Suong T. T. [3 ,4 ]
Ives, Kathryn E. [5 ]
机构
[1] Dept Nephrol, Monash Med Ctr, Clayton, Vic, Australia
[2] Monash Univ, Ctr Inflammatory Dis, Dept Med, Clayton, Vic, Australia
[3] Monash Med Ctr, Dept Gastroenterol & Hepatol, Clayton, Vic, Australia
[4] Monash Univ, Sch Clin Sci, Clayton, Vic, Australia
[5] Barwon Hlth Univ Hosp Geelong, Dept Anaesthesia Pain & Perioperat Med, Geelong, Vic, Australia
关键词
hepatitis B; pre-dialysis; seroconversion; seroprotection; vaccine; CHRONIC-RENAL-FAILURE; VIRUS-VACCINE; RANDOMIZED TRIAL; IMMUNOGENICITY; STAGE; IMMUNIZATION; AGE;
D O I
10.1093/ndt/gfv443
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. Clinical guidelines recommend double-dose hepatitis B vaccination for patients requiring dialysis, due to an increased risk of hepatitis B infection and reduced vaccine responsiveness. There are no recommendations for patients with chronic kidney disease (CKD) prior to dialysis. Methods. We performed a systematic review and meta-analysis of randomized and quasi-randomized trials comparing efficacy (seroresponses) and harms of double-dose compared with standard-dose hepatitis B vaccination in patients with CKD, including those requiring dialysis. A systematic literature search (CENTRAL, MEDLINE and EMBASE) was performed using a predetermined search strategy. Relative risks were calculated from pooled data using a random-effects model with subgroup analysis by dialysis requirement and vaccine type. Results. Seven studies (501 patients) fulfilled review criteria: four in patients receiving dialysis and three in patients not receiving dialysis. The incidence of seroconversion was not increased with double-dose vaccination overall [risk ratio (RR) 1.17, 95% confidence interval (CI) 0.98-1.39], by dialysis requirement or vaccine type. The incidence of seroprotection (reported by only four studies) was increased with double-dose vaccination overall (RR 1.53, 95% CI 1.17-2.00) but not by dialysis requirement. Adverse events were not reported by treatment arm, precluding comparison. The overall quality of included studies was moderate to low. Conclusions. The current data do not support clinical guideline recommendations for administering double-dose vaccination for patients with CKD as seroconversion was not improved and seroprotection was inadequately assessed. Large high-quality studies are required to overcome the current evidence gap regarding vaccine dosing in CKD.
引用
收藏
页码:136 / 143
页数:9
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