Optimizing hepatitis B vaccination in chronic kidney disease: a comprehensive scoping review of strategies across CKD stages, dialysis, and transplant populations

Abstract

This scoping review aims to comprehensively map and critically analyze existing evidence regarding the optimal HBV vaccination strategies—including vaccine types, schedules, immunogenicity, duration of protection, factors influencing seroresponses, and safety—primarily in adults with pre-dialysis and dialysis-dependent chronic kidney disease (CKD) populations. Patients with CKD are at increased risk of hepatitis B virus (HBV) infection due to the immune dysfunction with frequent blood exposure during invasive procedures, including hemodialysis. Although HBV vaccination is crucial for CKD patients due to the high transmission efficacy of HBV, enhanced regimens or adjuvants are often required because of CKD-induced immune dysfunction. This scoping review followed Joanna Briggs Institute guidelines and the PRISMA-ScR checklist through searching on PubMed, EMBASE, and SCOPUS for English-language studies until August 2024, demonstrated 329 unique records, and 17 studies were included. Accordingly, 4 times of either double-dose simple recombinant vaccine (Engerix-B 40 mcg) or adjuvanted vaccines (e.g., Fendrix^®, Heplisav-B^® 20 mcg) demonstrated higher seroprotection rates than the standard conventional schedule (3 times of Engerix-B 20 mcg). Vaccination at pre-dialysis stages (eGFR > 15 mL/min/1.73 m²) yielded higher short-term seroprotection (SPR: 63–100% at 1-2 months after the last dose), than in dialysis patients (SPR: 50–89.3% at 1–2 months after the last dose) and the antibody titers were more prominent with adjuvant vaccines than with the nonadjuvant one. In conclusion, the higher doses of vaccination are required in adult patients with CKD; however, data on transplant recipients and pediatric patients are very limited. Large-scale, high-quality randomized controlled trials with long-term immunity monitoring are needed.