HBV Vaccination in Chronic Renal Failure Patients

Hbv infection in chronic renal failure (crf) becomes chronic in 30 to 600/0 compared with less than 100/0 in nonuremicpatients.immunological dysfunction in patients on hemodialysis may be related to imbalanced cytokine systems, such as tumornecrosis factor (tnf-u) and interleukin (il) 6,1 by retention of renal metabolite in uremia and chronic inflammation andhave a poor immunological reaction to t-cell-dependent antigens, like hepatitis b vaccination.immunocompromised patients who are unresponsive to hepatitis b vaccination seem to be unable to enhance il-i0synthesis for control of monokine overproduction.moreover, human leukocyte antigen (hla) genes, which play a major role in the antigen presentation toimmunocompetent cells, have also been shown to modulate this immune response.unfortunately, seroconversion to anti-hbs has been reported to occur in only 40 to 500/0 of the vaccine, a significantlylower rate than that observed in healthy adults. various methods including adjutants such as zinc, gamma interferon,thymopentine, gm-csf and levamisol for improving immune responses have been advised.experience with prest/s2, third-generation vaccines is limited and they have not been proven more effective thanintradermally (10) administered second-generation 5 antigen vaccines.both intramuscular (1m) and intradermal (10) vaccinations against hepatitis b have variable efficiency in hemodialysisand non-responders should be retreated by 10 route.