Chronic Kidney Disease

Hepatitis B

Hepatitis B is a serious viral infection of which blood is one of the main transmission routes. The United Kingdom has a low rate of Hepatitis B carriage in the dialysis population, due to a careful application of universal precautions. However, the risk remains, particularly if patients dialyse in units abroad (especially Africa, India and the Far East) where rates are extremely high. Consequently, the Renal Association recommend vaccinating non immune patients to hepatitis B. Waiting until patients are on haemodialysis is not an appropriate strategy, and the recommendation is that patients are vaccinated in the predialysis phase. Late vaccination (at end stage) reduces success rates.

It is therefore recommended that patients with CKD stage 4, and those with progressive CKD stage 3 are vaccinated against Hepatitis B.

Vaccination should be carried out using the high strength vaccine as given in the BNF. A number of products are available. These are

Engerix B        40 mcg dose at 0,1,2 and 6 months (total 4 injections)

HBVaxPro        40 mcg dose at 0,1, and 6 months (total 3 injections)

Antibody levels should be checked at 2-4 months after the last dose of the vaccine. If possible, the renal unit should be notified of the result. An anti HBs level of 100 mIU/mL indicates a good response and the patient should be given a booster at 5 years. Poor responders (10-100 mIU/mL) should receive a booster after 1 and 5 years. Non responders should be given one further course - if they fail to respond the renal unit should be notified, so that they may be more closely monitored (3-6 monthly Hep B).