{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T19:44:56Z","timestamp":1772567096913,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,12,6]],"date-time":"2021-12-06T00:00:00Z","timestamp":1638748800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Hepatitis B vaccination is recommended in all patients with end-stage kidney disease (ESKD). However, only 50\u201360% of these patients achieve protective antibody levels if immunized after starting dialysis. Strategies to overcome this low seroconversion rate include a 6-month vaccination schedule starting earlier [chronic kidney disease (CKD) stage 4 and 5] to ensure immunity when patients progress to ESKD. We conducted a quality improvement program to immunize pre-dialysis patients. Patients who were found to have a negative baseline serology with a negative hepatitis B surface antibody level (HBsAb) were offered vaccination on a 6-month schedule (0, 1 and 6 months) with one of two available vaccines within the VA system (Recombivax\u2122 or Engerix\u2122). HBsAb titers were checked 3\u20134 months later, and titers \u2265 12 mIU\/mL were indicative of immunity at VA. Patients who did not seroconvert were offered a repeat schedule of three more doses. We screened 198 patients (187 males and 11 females) with CKD 4 and 5 [glomerular filtration rate (GFR) &lt; 29 mL\/min\/1.73 m2]. The median age of this cohort was 72 years (range 38\u201392 years). During the study period of 5 years (2015\u20132020), 10 patients were excluded since their GFR had improved to more than 30 mL\/min\/1.73 m2, 24 others had baseline immunity and 2 refused vaccination. The hepatitis B vaccination series was not started on 106 patients. Of the remaining 56, 12 patients progressed to ESKD and started dialysis before completion of the vaccination schedule, 6 expired and 1 did not come to clinic in 2020 due to the pandemic. Of the 37 patients who completed the vaccination schedule, 16 achieved seroconversion with adequate HBsAb titers, 10 did not develop immunity despite a second hepatitis B vaccination series, while 11 did not get a second series. Given the low seroconversion rate, albeit in a small cohort, vaccination should be considered in patients with earlier stages of CKD. Other options include studies on FDA approved vaccines of shorter duration. We plan to increase awareness among nephrologists, patients and nursing staff about the importance of achieving immunity against hepatitis B.<\/jats:p>","DOI":"10.3390\/idr13040094","type":"journal-article","created":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T03:21:05Z","timestamp":1638847265000},"page":"1036-1042","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Hepatitis B Vaccination in Advanced Chronic Kidney Disease: A Quality Improvement Project at a Veteran Affairs Chronic Kidney Disease Clinic"],"prefix":"10.3390","volume":"13","author":[{"given":"Jacob","family":"Hettenbaugh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA"},{"name":"VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6760-3277","authenticated-orcid":false,"given":"Ryan","family":"Mullane","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA"},{"name":"VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gayle","family":"Gillispie","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA"},{"name":"VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie","family":"Shostrom","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA"},{"name":"VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Flores","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA"},{"name":"VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer A.","family":"Fillaus","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA"},{"name":"VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marius C.","family":"Florescu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA"},{"name":"VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Murcek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA"},{"name":"VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8988-564X","authenticated-orcid":false,"given":"Ketki K.","family":"Tendulkar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA"},{"name":"VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"960413","DOI":"10.5402\/2012\/960413","article-title":"Improving hepatitis B vaccine efficacy in end-stage renal diseases patients and role of adjuvants","volume":"2012","author":"Somi","year":"2012","journal-title":"ISRN Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2222","DOI":"10.1046\/j.1523-1755.2003.00017.x","article-title":"Patterns of hepatitis B prevalence and seroconversion in hemodialysis units from three continents: The DOPPS","volume":"63","author":"Burdick","year":"2003","journal-title":"Kidney Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S0140-6736(99)06154-1","article-title":"Cancer in patients on dialysis for end-stage renal disease: An international collaborative 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