Prospective Analysis of Factors Influencing the Antibody Response to Hepatitis B Vaccine in Hemodialysis Patients

Abstract Background. Patients on maintenance hemodialysis typically show a suboptimal immune response to hepatitis B (HB) virus vaccination compared to the non-uremic population. The aim or our study was the identification of factors implicated in the vaccine response of our hemodialysis patients. Methods. We studied prospectively 63 hemodialysis patients who were seronegative for HB (37 males, 26 females). Their mean age was 62.2±11.28 years (range 35-80) and hemodialysis. Duration 55.96±50.1 months (range 6-225) fourteen of them (22.2%) were diabetics. Our patients followed a four-dose vaccination schedule (0, 1, 2 and 6 months) with 40 μg of a recombinant DNA HB vaccine. The antibody response was determined 1 month after the fourth dose of vaccination by assessing the titre of antiHBs antibodies (ab). Immune response was defined as sufficient when the antiHBs ab level was ≥ 12 mIU/ml. During the 6-month vaccination period we also monitored monthly and time-averaged Kt/V, residual renal function (RRF), BMI, serum creatinine, albumin, transferrin, ferritin, CRP, iPTH and the dose of erythropoietin and Vitamin D that they received. Results. An optimal immune response was achieved in 34 patients (54%, responders) (antiHBs: 295.95±341.67 mIU/ml), whereas 29 patients (46%, non-responders) showed a suboptimal response (antiHBs: 1.98±2.92 mIU/ml) (p=1.75x10 -5 ). There was a statistically significant negative correlation between the antiHBs ab titre and BMI (r=-0.28, p=0.024). A significant difference was also found between the BMI of responders and non-responders as groups (24.8±5.5 vs. 27.2±4.5, p=0.02). Grouping our patients according to the existence of diabetes, age (cut off 60 years), and hemodialysis efficiency (Kt/V≥1.2) we found a statistically significant difference in the antiHBs ab titre between diabetics and non-diabetics (8.43±12.3 vs. 200.2±317.7 mIU/ml, p=0.03), younger and older patients (262±365.09 vs. 84.36±189.1 mIU/ml, p=0.0145) and patients with efficient and inefficient hemodialysis (234.71±337.1 vs. 79.14±200.99 mIU/ml, p=0.032). Treatment with vitamin D analogues, RRF and hypoalbuminemia were not found to be implicated in the immune response of our patients

Are There Any Cognitive and Behavioral Changes Potentially Related to Quarantine Due to the COVID-19 Pandemic in People with Mild Cognitive Impairment and AD Dementia? A Longitudinal Study

The aim of the study was to examine potential cognitive, mood (depression and anxiety) and behavioral changes that may be related to the quarantine and the lockdown applied during the COVID-19 pandemic in Greek older adults with mild cognitive impairment (MCI), and AD dementia in mild and moderate stages. Method: 407 older adults, diagnosed either with MCI or AD dementia (ADD), were recruited from the Day Centers of the Greek Association of Alzheimer Disease and Related Disorders (GAADRD). Neuropsychological assessment was performed at baseline (at the time of diagnosis) between May and July of 2018, as well as for two consecutive follow-up assessments, identical in period, in 2019 and 2020. The majority of participants had participated in non-pharmacological interventions during 2018 as well as 2019, whereas all of them continued their participation online in 2020. Results: Mixed measures analysis of variance showed that participants’ ‘deterioration difference—D’ by means of their performance difference in neuropsychological assessments between 2018–2019 (D1) and 2019–2020 (D2) did not change, except for the FUCAS, RAVLT, and phonemic fluency tests, since both groups resulted in a larger deterioration difference (D2) in these tests. Additionally, three path models examining the direct relationships between performance in tests measuring mood, as well as everyday functioning and cognitive measures, showed that participants’ worsened performance in the 2019 and 2020 assessments was strongly affected by NPI performance, in sharp contrast to the 2018 assessment. Discussion: During the lockdown period, MCI and ADD patients’ neuropsychological performance did not change, except from the tests measuring verbal memory, learning, and phonemic fluency, as well as everyday functioning. However, the natural progression of the MCI as well as ADD condition is the main reason for participants’ deterioration. Mood performance became increasingly closely related to cognition and everyday functioning. Hence, the role of quarantine and AD progression are discussed as potential factors associated with impairments