The effect of diabetes mellitus on immunological response to hepatitis B virus vaccine in individuals with chronic kidney disease: A meta-analysis of current literature

Background: Patients with chronic kidney disease (CKD) often fail to produce protective antibodies to hepatitis B virus (HBV) surface antigen after vaccination. Diabetes mellitus (DM) is the most common cause of CKD; however it is not clear whether it affects immunological response to HBV vaccine in these patients.

Aims: We aimed to evaluate the immunological response to HBV vaccine in diabetic patients with CKD by conducting a meta-analysis of the current literature.

Methods: Only studies that evaluated the seroprotection rate for diabetic against non-diabetic CKD patients or the immunological response of these groups to HBV vaccine were included. We applied the random effects model of DerSimonian and Laird, with heterogeneity (Q statistic), publication bias (Egger and Begg test) and sensitivity analyses. The rate of patients showing seroprotective anti-HBsAg titers (>10IU/mL) at completion of HBV vaccination schedule in the diabetic versus the non-diabetic CKD patients was set as our end-point of interest.

Results: We identified seven studies that fulfilled our inclusion criteria involving 15,073 unique patients with CKD. Aggregation of study results showed a significant decrease in response rates among the diabetic versus the non-diabetic patients [pooled odds ratio=0.58 (95% CI 0.37-0.89), Q(6)=11.3, I(2)=50%]. The P-value was 0.07 for our test of heterogeneity.

Conclusions: Our meta-analysis determined that HBV vaccination's seroprotection rate in diabetic CKD patients is significantly lower than that in non-diabetic CKD patients. Therefore, using vaccine adjuvants such as oral levamisole, granulocyte macrophage-colony stimulating factor or intradermal injection might be advisable in these patients.