Clinical Practice Patterns in Hepatitis B Vaccination for Patients with Chronic Kidney Disease

Abstract

Aim: To investigate the clinical practice patterns among renal professionals regarding hepatitis B vaccination in chronic kidney disease and to identify potential barriers affecting early initiation. Background: Optimal hepatitis B vaccination requires a rigorous 6-month schedule for protective seroconversion. However, seroconversion rates are suboptimal in dialysis populations with declining immunity due to disease progression. While early vaccination is recommended, global consensus on the ideal stage of chronic kidney disease for initiation is lacking. Study Design: A cross-sectional study, clinical practice pattern survey using the on-line “Qualtrics” platform. Place and Duration of Study: On-line survey conducted from July 2023 to February 2024 across Australasia. Method: A 14-question web-based survey was disseminated to renal professionals via the regular newsletters of the professional renal organizations and emails to the renal unit managers. Participation was anonymous, voluntary with informed consent. Results: 125 responses (25 medical, 78 nurses, 22 either) from 133 received were eligible after eight exclusions without consent, with highest representation from Western Australia, New South Wales, and Victoria (28.42%, 22.11%, 22.11% respectively). Majority were nurses (62.41%) in the satellite settings (33.68%). A significant portion of respondents only initiate the vaccine at the start of dialysis: medical 21.74%, n=5; nursing 45.00%, n=27 (p=0.048). Lack of designated staff (35.34%) and established guidelines (15.52%) were major barriers for not commencing vaccination pre-dialysis, additionally, a total of 13.8% of the respondents demonstrated limited awareness of the “need” or “benefits” of pre-dialysis vaccination (6.90%, 6.90% respectively). Conclusion: This pilot survey revealed diverse clinical practice patterns, highlighting barriers that influence the vaccination timing. Findings support the need for determining the optimal stage of  chronic kidney disease  to commence the hepatitis B vaccination and standardized management strategies as well as promoting staff awareness and understanding of the importance of initiating the hepatitis B vaccination earlier before reaching dialysis requirement.