Lipid peroxidation marker malondialdehyde is an independent determinant of hepatitis B vaccine response in hemodialysis patients

BACKGROUND: Hemodialysis (HD) patients demonstrate impaired adaptive immune function, as evidenced by reduced vaccine responses. Chronic inflammation, aberrant lymphocyte activation, and increased oxidative stress have all been implicated. We investigated the associations of markers of chronic inflammation, lymphocyte activation, and oxidative stress and the levels of antibodies against hepatitis B surface antigen (anti-HBs Ab) in vaccinated HD patients. METHODS: In 70 HD patients, anti-HBs Ab titers, oxidative stress markers malondialdehyde (MDA) and advanced oxidation protein products (AOPP), inflammatory markers CRP and neutrophil-to-lymphocyte ratio, and neutrophil, T-cell, and B-cell activation markers calprotectin, soluble CD25, and soluble CD23 were assessed, along with routine laboratory tests. Patients' demographic and clinical data were also recorded. RESULTS: Unexpectedly, only MDA was strongly correlated with anti-HBs Ab levels (Rho = 0.801, p < 0.001). In multivariable regression, MDA remained an independent predictor of anti-HBs Ab levels (B coefficient = 92.71; p < 0.001). Furthermore, MDA levels differed between patients with anti-HBs Ab levels below or above 10 IU/L (3.009 (1.631-4.101) vs. 4.174 (1.903-14.771) nmol/mL, p < 0.001) or 100 IU/L (3.183 (1.631-4.512) vs. 5.287 (2.859-14.771) nmol/mL, p < 0.001). Binary logistic regression confirmed that MDA is an independent predictor of anti-HBs Ab levels exceeding 10 IU/L (odds ratio 2.464, p < 0.001) or 100 IU/L (odds ratio 7.767, p < 0.001). CONCLUSION: Lipid peroxidation, as indicated by serum MDA, is independently associated with the response to hepatitis B vaccination in HD patients. Future studies should investigate whether preserved redox-dependent immune signaling may underlie effective vaccine responses in HD.