Clinical Practice Patterns in Hepatitis B Vaccination for Patients with Chronic Kidney Disease
Published: 2024-07-11
Page: 73-83
Issue: 2024 - Volume 7 [Issue 1]
Casey Light
*
Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia and Armadale Renal Service, Armadale Hospital, Armadale, Western Australia, Australia.
Karen Heslop
Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia.
Hemant Kulkarni
Armadale Renal Service, Armadale Hospital, Armadale, Western Australia, Australia.
*Author to whom correspondence should be addressed.
Abstract
Aim: To investigate the clinical practice patterns among renal professionals regarding hepatitis B vaccination in chronic kidney disease and to identify potential barriers affecting early initiation.
Background: Optimal hepatitis B vaccination requires a rigorous 6-month schedule for protective seroconversion. However, seroconversion rates are suboptimal in dialysis populations with declining immunity due to disease progression. While early vaccination is recommended, global consensus on the ideal stage of chronic kidney disease for initiation is lacking.
Study Design: A cross-sectional study, clinical practice pattern survey using the on-line “Qualtrics” platform.
Place and Duration of Study: On-line survey conducted from July 2023 to February 2024 across Australasia.
Method: A 14-question web-based survey was disseminated to renal professionals via the regular newsletters of the professional renal organizations and emails to the renal unit managers. Participation was anonymous, voluntary with informed consent.
Results: 125 responses (25 medical, 78 nurses, 22 either) from 133 received were eligible after eight exclusions without consent, with highest representation from Western Australia, New South Wales, and Victoria (28.42%, 22.11%, 22.11% respectively). Majority were nurses (62.41%) in the satellite settings (33.68%). A significant portion of respondents only initiate the vaccine at the start of dialysis: medical 21.74%, n=5; nursing 45.00%, n=27 (p=0.048). Lack of designated staff (35.34%) and established guidelines (15.52%) were major barriers for not commencing vaccination pre-dialysis, additionally, a total of 13.8% of the respondents demonstrated limited awareness of the “need” or “benefits” of pre-dialysis vaccination (6.90%, 6.90% respectively).
Conclusion: This pilot survey revealed diverse clinical practice patterns, highlighting barriers that influence the vaccination timing. Findings support the need for determining the optimal stage of chronic kidney disease to commence the hepatitis B vaccination and standardized management strategies as well as promoting staff awareness and understanding of the importance of initiating the hepatitis B vaccination earlier before reaching dialysis requirement.
Keywords: Chronic kidney disease, clinical practice pattern, haemodialysis, hepatitis B vaccination
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References
Fabrizi F, Messa P, Martin P. Transmission of hepatitis B virus in dialysis units: a systematic review of reports on outbreaks. Int J Artif Organs. 2015;38(1):1-7.
Reddy S, Chitturi C, Yee J. Vaccination in Chronic Kidney Disease. Adv Chronic Kidney Dis. 2019;26(1):72-8.
Syed-Ahmed M, Narayanan M. Immune Dysfunction and Risk of Infection in Chronic Kidney Disease. Adv Chronic Kidney Dis. 2019;26(1):8-15.
Hettenbaugh J, Nelson K, Contreras L, Guerra P, Coleman S, DeGiorgio S. Hepatitis B Vaccination in Advanced Chronic Kidney Disease: A Quality Improvement Project at a Veteran Affairs Chronic Kidney Disease Clinic. Infect Dis Rep. 2021;13(4):1036-42.
Mysore P, Khinkar RM, McLaughlin D, Desai S, McMahon GM, Ulbricht C, et al. Improving hepatitis B vaccination rates for advanced chronic kidney disease patients: a quality improvement initiative. Clin Exp Nephrol. 2021;25(5):501-8.
Krueger KM, Ison MG, Ghossein C. Practical Guide to Vaccination in All Stages of CKD, Including Patients Treated by Dialysis or Kidney Transplantation. Am J Kidney Dis. 2020;75(3):417-25.
CDC. Recommendation of the Immunization Practices Advisory Committee (ACIP) inactivated Hepatitis B virus vaccine. MMWR Morb Mortal Wkly Rep. 1982;31:317-22.
Bone J, Tonkin R, Davidson A, Marmion B, Robson J. Outbreak of dialysis associated hepatitis B in Edinburgh. Br Med J. 1970;4(5739):23-8.
Virus Reference Centre Network. Hepatitis B infection control in haemodialysis centres. 2017.
Bernieh B. Viral hepatitis in hemodialysis: An update. J Transl Int Med. 2015;3(3):93-105.
Light C, Kulkarni H. Booster Hepatitis B Vaccination in Haemodialysis Patients: Five-year Prospective Observational Study. Renal Soc Australas J. 2018; 14(1):9-13.
Bernieh B. Viral hepatitis in hemodialysis: An update. J Transl Int Med. 2015;3(3):93-105.
Kosmadakis G, Albaret J, Correia ED, Somda F, Aguilera D. Vaccination practices in dialysis patients: A narrative review. Semin Dial. 2018;31(5):507-18.
Eleftheriadis T, Kartsios C, Yiannaki E, Kazila P, Antoniadi G, Liakopoulos V. Factors affecting effectiveness of vaccination against hepatitis B virus in hemodialysis patients. World J Gastroenterol. 2014;20(34):12018-25.
Elhanan E, Manor Y, Dabach M, Ofer R, Epshtein R, Tsukrov O, et al. A randomized, controlled clinical trial to evaluate the immunogenicity of a PreS/S hepatitis B vaccine Sci-B-Vac™, as compared to Engerix B®, among vaccine naïve and vaccine non-responder dialysis patients. Clin Exp Nephrol. 2018;22(1):151-8.
Gasim GI, Bella A, Adam I. Immune response to hepatitis B vaccine among patients on hemodialysis. World J Hepatol. 2015;7(2):270-5.
Zitt E, Hafner-Giessauf H, Wimmer B, Herr A, Horn S, Friedl C, et al. Response to active hepatitis B vaccination and mortality in incident dialysis patients. Vaccine. 2017;35(5):814-20.
Somi MH, Hajipour B. Improving Hepatitis B Vaccine Efficacy in End-Stage Renal Diseases Patients and Role of Adjuvants. ISRN Gastroenterol. 2012;2012:960413.
Betjes MG. Immune cell dysfunction and inflammation in end-stage renal disease. Nat Rev Nephrol. 2013;9(5):255-65.
Grzegorzewska AE. Hepatitis B vaccination in chronic kidney disease patients: A call for novel vaccines. Expert Rev Vaccines. 2014;13(11):1317-26.
Du Y, Li N, Chen X, Chen X, Chen Y, Zhu B, et al. Association between hepatitis B virus infection and chronic kidney disease: A cross-sectional study from 3 million population aged 20 to 49 years in rural China. Medicine (Baltimore). 2019;98(5).
da Silva EN, Baker A, Alshekaili J, Karpe K, Cook MC. A randomized trial of serological and cellular responses to hepatitis B vaccination in chronic kidney disease. PLoS One. 2018;13(10).
Light C, Heslop K, Kulkarni H. Hepatitis B vaccination in patients with stage 4/5 chronic kidney disease – a scoping review. Renal Soc Australas J. 2023;19:68-76.
Afsar B. The relationship between erythropoietin resistance and antibody response to hepatitis B vaccine in hemodialysis patients. Nephrourol Mon. 2013;5(3):806-12.
Ghadiani MH, Besharati S, Mousavinasab N, Jalalzadeh M. Response rates to HB vaccine in CKD stages 3–4 and hemodialysis patients. J Res Med Sci. 2012;17(6):527-33.
Haddiya I. Current Knowledge of Vaccinations in Chronic Kidney Disease Patients. Int J Nephrol Renovasc Dis. 2020;13:179-85.
Nadeem M, Akhtar A, Husnain F, Safdar H, Shaikh M, Nadeem MA, et al. Vaccination against hepatitis B virus in hemodialysis patients: trends in dialysis centers of Northern Pakistan. F1000Res. 2021;10:55.
Zitt E, Hafner-Giessauf H, Wimmer B, Herr A, Horn S, Friedl C, et al. Response to active hepatitis B vaccination and mortality in incident dialysis patients. Vaccine. 2017;35(5):814-20.
Reddy S, Chitturi C, Yee J. Vaccination in chronic kidney disease. Adv Chronic Kidney Dis. 2019;26(1):72-8.
Burch HB, Burman KD, Cooper DS, Hennessey JV, Vietor NO, Garber JR. A 2013 Survey of Clinical Practice Patterns in the Management of Primary Hypothyroidism. J Clin Endocrinol Metab. 2014;99(6):2077-85.
Bansal B, Lee M, Hall A, Manning C, Satoskar A, Rovin BH, et al. Clinical Practice Patterns in IgA Nephropathy: A Global Questionnaire-Based Survey. Kidney Int Rep. 2023;8(12):2557-68.
Song Z, Tisminetzky M, Liu M, Dahrouge S, Peikes D, Colla CH, et al. Physician Practice Pattern Variations in Common Clinical Scenarios Within 5 US Metropolitan Areas. JAMA Health Forum. 2022;3(1).