Hepatitis B vaccination in patients with stage 4/5 chronic kidney disease--a scoping review

Aim This scoping review aims to identify and map the extent of published literature on Hepatitis B vaccination in stage 4/5 chronic kidney disease (CKD) and dialysis patients, the availability of standardised practice guidelines, the optimal CKD stage to commence the vaccination for efficient response, and seroconversion rate. Background Hepatitis B vaccination remains 'standard-of-care' in the haemodialysis (HD) population despite immunological challenges. CKD patients have decreasing immunity as the disease progresses, prompting further research to investigate the response of Hepatitis B vaccination in earlier stages of CKD for better response rate prior to requiring dialysis. Method This scoping review was conducted using the Arksey and O'Malley (2005) five-stage approach: 1) identifying the research question; 2) identifying the relevant studies; 3) selecting the studies; 4) data charting; and 5) collating, summarising and reporting the results. Medline, PubMed, PubMed Central (PMC) and Cochrane databases were used to access research literature published between 2012-2022. Results Of the 602 eligible articles,183 full text papers were identified. There were 41 studies retained for this review which were sorted out into domains relating to the vaccine immunogenicity, vaccine response and clinical practice guidelines. Although there were studies suggesting immunosuppression in declining renal function leads to low vaccine response, most of the studies were focused on HD patients. There have been no large, randomised control trials on optimal vaccination policy in CKD patients. This scoping review provided important knowledge for future studies to explore the efficiency of commencing vaccination at an earlier stage of CKD before reaching dialysis. Keywords chronic kidney disease, Hepatitis B virus, clinical practice guidelines, stage 4/5 CKD, Hepatitis B vaccination