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Success of Hepatitis B vaccination in renal patients- the role of the Advanced Kidney Care
Watkins, Melai Attukunnel, Alex Phillips, Juliette Small, Judith Lucas, Benjamin Carden, Siobhan
Watkins, Melai
Attukunnel, Alex
Phillips, Juliette
Small, Judith
Lucas, Benjamin
Carden, Siobhan
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University Hospitals Birmingham NHS Foundation Trust
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Publication date
2025-06-10
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AKCv4_Melai Watkins.pdf
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Abstract
Background: Hepatitis B is a viral infection of the liver that can cause acute or chronic disease. Chronic infection significantly raises the risk of liver cirrhosis and hepatocellular carcinoma. The disease is transmitted through contact with infected bodily fluids, such as blood. Fortunately, an effective and safe vaccine exists for prevention. According to the World Health Organization (WHO, 2024), vaccination is the most effective measure against Hepatitis B.
Patients with chronic kidney disease (CKD) are at an elevated risk for Hepatitis B due to their increased susceptibility to infections and the potential for exposure to virus through dialysis machines and organ transplantation. Studies, such as those by Johnson and Fleming (1992), show that CKD patients who receive the vaccine before requiring dialysis exhibit higher rates of seroprotection and stronger antibody titers.
Methods: In previous years, General Practitioners (GPs) were responsible for vaccinating renal patients. However, this approach faced challenges due to poor communication, which often led to confusion among patients regarding the vaccinations they had received. To address these issues, the AKC team implemented a more structured approach by vaccinating patients within a dedicated clinic at our hospital and satellite unit. This shift in strategy allowed for better tracking, more consistent administration, and improved patient education regarding the Hepatitis B vaccination series.
The targeted vaccination program focused on patients with an estimated glomerular filtration rate (eGFR) of less than 20 or those with a Kidney Failure Risk Equation (KFRE) score greater than 20%. Over a span of two years, the program emphasized early identification, patient education, and the timely administration of the full vaccine series to ensure optimal protection against Hepatitis B for those at the highest risk.
Results: The vaccination program yielded the following distribution among participants:
128 (40%) patients achieved full immunity.
135 (42%) patients are still in the process of completing the vaccination series.
30 (9%) patients required annual boosters.
12 (4%) patients were identified as non-responders to the vaccine.
13 (4%) patients refused the vaccination.
Additionally, none of the patients in the program were vaccinated by their general practitioner, and no patients tested positive for Hepatitis B. Two patients (1%) were placed on referral hold due to complications unrelated to vaccination.
These results highlight the overall success of the program, with a high percentage of participants achieving or progressing toward immunity, while also identifying areas for focused follow-up, such as managing non-responders and addressing patient refusal.
Discussion:
The AKC Clinic's targeted Hepatitis B vaccination program has successfully improved immunity levels among high-risk renal patients while maintaining low refusal rates and preventing any Hepatitis B infections. This initiative demonstrates the value of structured, patient-centred vaccination strategies in specialised renal care settings. It provides a model for integrating preventative healthcare measures into routine patient management, ultimately contributing to better health outcomes and reduced disease burden. Continued evaluation will help refine the program and inform broader application in renal care services.
Citation
Watkins, M., Attukunnel, A., Phillips, J., Small, J., Lucas, B. and Carden, S. (2025) 'Success of Hepatitis B vaccination in renal patients- the role of the Advanced Kidney Care'. University Hospitals Birmingham NHS Foundation Trust.
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Internal Poster