Intravenous iron attenuates postvaccination anti-HBsAg titres after quadruple hepatitis B vaccinatio

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http://www.blackwell-synergy.com/doi/abs/10.1111/j.1742-1241.2008.01732.x

International Journal of Clinical Practice

OnlineEarly Articles

doi:10.1111/j.1742-1241.2008.01732.x

Abstract

ORIGINAL PAPER

Intravenous iron attenuates postvaccination anti-HBsAg titres after quadruple

hepatitis B vaccination in dialysis patients with erythropoietin therapy

J.-H. Liu, Y.-L. Liu, H.-H. Lin, Y.-F. Yang, H.-L. Kuo, P.-W. Lin, C.-C.

HuangDivision of Nephrology, Department of Internal Medicine, China Medical

University Hospital, Taichung, Taiwan

Dr Chiu-Ching Huang,

Division of Nephrology, Department of Internal Medicine, China Medical

University Hospital, 2 Yu-Der Road, Taichung, Taiwan

Tel.: + 886 4 22052121-2902

Fax: + 886 4 22038883

Email: cch659@...

Disclosure None.

Summary

Background: Anaemia in patients with end-stage renal disease (ESRD) is commonly

treated with recombinant human erythropoietin (rHuEPO), often in combination

with an adjuvant iron supplement. There is much evidence that rHuEPO can

influence the immune response by its effect on lymphocytes. Also, iron catalyses

the formation of radicals and increases the risk of major infections by

negatively affecting the immune system. The relationship between antibodies to

hepatitis B surface antigen (anti-HBsAg) responsiveness after hepatitis B

vaccination and rHuEPO/adjuvant iron supplementation has not been reported

before.

Aim: To determine the effects of subcutaneous erythropoietin and intravenous

(i.v.) iron therapy on the responsiveness of anti-HBsAg after quadruple

hepatitis B vaccination among ESRD patients.

Methods: Retrospective medical records were reviewed in a hospital with a

tertiary teaching facility. Eighty-three ESRD patients, including 51 who

underwent haemodialysis and 32 who underwent peritoneal dialysis therapy,

received a quadruple recombinant hepatitis B vaccine. We investigated anti-HBsAg

titres in those patients who either received rHuEPO alone (n = 50) or rHuEPO in

combination with i.v. iron (n = 33).

Results: We found that the postvaccination anti-HBsAg titre was significantly

lower in the rHuEPO plus i.v. iron group when compared with the group with

rHuEPO alone (p < 0.05). The increment of anti-HBsAg between the initial month

and the seventh month was positively correlated with therapeutic rHuEPO dosages

in the group with rHuEPO alone (r = 0.303, p = 0.033). This relationship was not

present in the rHuEPO with i.v. iron group (r = −0.289, p = 0.229).

Conclusions: The levels of anti-HBsAg after hepatitis B vaccination are

positively correlated with the dose of rHuEPO treatment during the vaccinated

period among ESRD patients without i.v. iron supplementation. Also, i.v. iron

negatively impacts the responsiveness of anti-HBsAg titre after hepatitis B

vaccination in ESRD patients who have undergone rHuEPO therapy.

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[Guest guest]

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1742-1241.2008.01732.x

International Journal of Clinical Practice

OnlineEarly Articles

doi:10.1111/j.1742-1241.2008.01732.x

Abstract

ORIGINAL PAPER

Intravenous iron attenuates postvaccination anti-HBsAg titres after quadruple

hepatitis B vaccination in dialysis patients with erythropoietin therapy

J.-H. Liu, Y.-L. Liu, H.-H. Lin, Y.-F. Yang, H.-L. Kuo, P.-W. Lin, C.-C.

HuangDivision of Nephrology, Department of Internal Medicine, China Medical

University Hospital, Taichung, Taiwan

Dr Chiu-Ching Huang,

Division of Nephrology, Department of Internal Medicine, China Medical

University Hospital, 2 Yu-Der Road, Taichung, Taiwan

Tel.: + 886 4 22052121-2902

Fax: + 886 4 22038883

Email: cch659@...

Disclosure None.

Summary

Background: Anaemia in patients with end-stage renal disease (ESRD) is commonly

treated with recombinant human erythropoietin (rHuEPO), often in combination

with an adjuvant iron supplement. There is much evidence that rHuEPO can

influence the immune response by its effect on lymphocytes. Also, iron catalyses

the formation of radicals and increases the risk of major infections by

negatively affecting the immune system. The relationship between antibodies to

hepatitis B surface antigen (anti-HBsAg) responsiveness after hepatitis B

vaccination and rHuEPO/adjuvant iron supplementation has not been reported

before.

Aim: To determine the effects of subcutaneous erythropoietin and intravenous

(i.v.) iron therapy on the responsiveness of anti-HBsAg after quadruple

hepatitis B vaccination among ESRD patients.

Methods: Retrospective medical records were reviewed in a hospital with a

tertiary teaching facility. Eighty-three ESRD patients, including 51 who

underwent haemodialysis and 32 who underwent peritoneal dialysis therapy,

received a quadruple recombinant hepatitis B vaccine. We investigated anti-HBsAg

titres in those patients who either received rHuEPO alone (n = 50) or rHuEPO in

combination with i.v. iron (n = 33).

Results: We found that the postvaccination anti-HBsAg titre was significantly

lower in the rHuEPO plus i.v. iron group when compared with the group with

rHuEPO alone (p < 0.05). The increment of anti-HBsAg between the initial month

and the seventh month was positively correlated with therapeutic rHuEPO dosages

in the group with rHuEPO alone (r = 0.303, p = 0.033). This relationship was not

present in the rHuEPO with i.v. iron group (r = −0.289, p = 0.229).

Conclusions: The levels of anti-HBsAg after hepatitis B vaccination are

positively correlated with the dose of rHuEPO treatment during the vaccinated

period among ESRD patients without i.v. iron supplementation. Also, i.v. iron

negatively impacts the responsiveness of anti-HBsAg titre after hepatitis B

vaccination in ESRD patients who have undergone rHuEPO therapy.

_________________________________________________________________

Stay in touch when you're away with Windows Live Messenger.

http://www.windowslive.com/messenger/overview.html?ocid=TXT_TAGLM_WL_Refresh_mes\

senger_052008