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Objective: Hepatitis B virus (HBV) infection has high morbidity and mortality. Therefore vaccination for HBV is crucial, especially for risk groups. In this study, we aimed to determine the effect of paricalcitol on HBV immunization in maintenance hemodialysis (HD) patients.
Methods: Forty-two maintenance HD patients enrolled in the study. Group 1 was the control group who didn't receive paricalcitol treatment (n:28, control group). Group 2 was the paricalcitol treatment group for secondary hyperparathyroidism (n:14, paricalcitol group). Anti-HBs titers were measured with a three-month interval for two times.
Results: The mean age of the patients in Group 1 was 58.50(18-80) years, while of the patients in Group 2 was 46.50 (23-81) years. There was no statistically significant difference between the groups in terms of age and gender (p = 0.200, p = 0.508, respectively). Baseline anti-HBs titer in the control group was 190.32 IU/L (20.18-1000), and 187.89 IU/L (38.77-1000) in the paricalcitol treated group. After 3 months of follow-up, anti-HBs titers decreased to 114.72 IU/L (13.68-1000) from 190.32 IU/L (20.18-1000) in the control group and to the 175.27 IU/L (14.25-1000) from 187.89 IU/L (38.77-1000) in the paricalcitol group. The decrease in anti-HBs titers was significant in the control group, whereas it was not significant in the paricalcitol group (P = 0.001, 0.209, respectively).
Conclusion: The protective effect of paricalcitol on hepatitis B seroconversion in HD patients was observed. We think that paricalcitol may be used as an adjuvant for hepatitis B seroconversion.
2. Chang MS, Nguyen MH. Epidemiology of hepatitis B and the role of vaccination. Best Pract Res Clin Gastroenterol. 2017;31(3):239-47.
3. Van Damme P. Long-term protection after hepatitis B vaccine. J Infect Dis. 2016;214:1–3.
4. Gasim GI, Bella A, Adam I. Immune response to hepatitis B vaccine among patients on hemodialysis. World J Hepatol. 2015;7:270-5.
5. Imam MH. The accelerated hepatitis B virus vaccination schedule among hemodialysis patients, does it work? A randomized controlled trialJ Nephrol. 2017;30:803–9
6. Asan A, Demirhan H, Sorkun HC, Ozkan S, Aydin M, Akin D, et al. Factors affecting responsiveness to hepatitis B immunization in dialysis patients. International urology and nephrology. 2017;49(10):1845-50
7. Sit D, Esen B, Atay AE, Kayabaşı H. Is hemodialysis a reason for unresponsiveness to hepatitis B vaccine? Hepatitis B virus and dialysis therapy. World J Hepatol. 2015;7(5):761-8.
8. Fabrizi F, Tarantino A, Castelnovo C, Martin P, Messa P. Recombinant Hepatitis B Vaccine Adjuvanted With AS04 in Dialysis Patients: A Prospective Cohort Study. Kidney Blood Press Res. 2015;40(6):584–92.
9. Zitt E, Hafner-Giessauf H, Wimmer B, et al. Response to active hepatitis B vaccination and mortality in incident dialysis patients. Vaccine 2017;35:814-20.
10. Moe SM, Zekonis M, Harezlak J et al. A placebo-controlled trial to evaluate immunomodulatory effects of paricalcitol. Am J Kidney Dis. 2001; 38: 792–802.
11. Grzegorzewska AE, Jodłowska E, Mostowska A, et al. Single nucleotide polymorphisms of vitamin D binding protein, vitamin D receptor and retinoid X receptor alpha genes and response to hepatitis B vaccination in renal replacement therapy patients. Expert Rev Vaccines 2014; 13: 1395-403.
12. Caprio M, Infante M, Calanchini M, Mammi C, Fabbri A. Vitamin D: not just the bone. Evidence for beneficial pleiotropic extraskeletal effects. Eat Weight Dis. 2017; 22:27–41.
13. Lucisano, S.; Arena, A.; Stassi, G.; Iannello, D.; Montalto, G.; Romeo, A.; Costantino, G.; Lupica, R.; Cernaro, V.; Santoro, D.; Buemi, M. Role of paricalcitol in modulating the immune response in patients with renal disease. Int. J. Endocrinol. 2015, 765364.
14. Zitt, E., Sprenger-Mahr, H., Knoll, F. et al. Vitamin D deficiency is associated with poor response to active hepatitis B immunisation in patients with chronic kidney disease. Vaccine 2012;30:931–35.
15. Van Biesen W, Dequidt C, Vijt D, Vanholder R, Lameire N: Analysis of the reasons for transfers between hemodialysis and peritoneal dialysis and their effect on survivals. Adv Perit Dial. 1998;14: 90 –4.
16. Mathew, R.O.; Mason, D.L.; Song, R.; Tryniszewski, T.; Kennedy, J.S. Role of T-regulatory cells in the response to hepatitis B vaccine in hemodialysis patients. Hemodial Int. 2016; 20(2):242–52.
17. González-Mateo GT, Fernández-Millara V, Bellón T, et al. Paricalcitol reduces peritoneal fibrosis in mice through the activation of regulatory T cells and reduction in IL-17 production. PLoS ONE 2014;9(10): e108477.
18. Fabrizi F, Ganeshan SV, Dixit V, Martin P. Meta-analysis: the adjuvant role of granulocyte macrophage-colony stimulating factor on immunological response to hepatitis B virus vaccine in end-stage renal disease. Aliment Pharmacol Ther. 2006;24(5):789–96.
19. Koeffler HP, Aslanian N, O’Kelly J. Vitamin D2 analog (Paricalcitol; Zemplar) for treatment of myelodysplastic syndrome. Leukemia Res. 2005;29 :1259 – 62.
20. Cañas CA, Bonilla-Abadía F, Anaya JM, Tobón GJ. Is primary hyperparathyroidism a pathogenic factor in some conditions mediated by B lymphocytes hyperactivity? Med Hypotheses 2013; 81(1): 111-3.
21. Yasunaga C, Nakamoto M, Matsuo K, Nishihara G, Yoshida T, Goya T: Effects of a parathyroidectomy on the immune system and nutritional condition in chronic dialysis patients with secondary hyperparathyroidism. Am J Surg. 1999;178: 332–6.