Vitamin D deficiency is associated with poor response to active hepatitis B immunisation in patients with chronic kidney disease

Vitamin D deficiency is highly prevalent in patients suffering from chronic kidney disease. At present it is not known whether this condition is associated with poor response to hepatitis B vaccination in these patients. We performed a retrospective analysis of 200 patients with chronic kidney disease stages 3-5D, who had undergone hepatitis B vaccination with three 40 μg recombinant hepatitis B vaccine doses in a single centre. Anti-HBs antibody titres and 25-hydroxyvitamin D (25(OH)D) levels were measured by chemiluminescence immunoassays. Vitamin D deficiency with serum levels <10 ng/mL was found in 35.5% of patients. These patients had a lower seroconversion rate than did patients with levels ≥10 ng/mL (45% vs 64%; P = 0.011) and their median (25th, 75th percentile) anti-HBs antibody titres were lower (0 (0, 117) IU/L vs 48 (0, 236.5) IU/L). Non-responders had lower 25(OH)D concentrations than did responders (12.9 ± 6.5 ng/mL vs 15.1 ± 7.4 ng/mL; P = 0.034). Treatment with a vitamin D receptor activator had no influence on the immune response. In a multiple logistic regression analysis vitamin D deficiency (OR 0.480; P = 0.023) and diabetes (OR 0.496; P = 0.038) remained independent and significant negative predictors of seroconversion. In conclusion, in patients with chronic kidney disease vitamin D deficiency is associated with a poor antibody formation upon hepatitis B vaccination.