[Simultaneous vaccination against influenza and invasive pneumococcal disease in chronic dialysis patients]. / Simultánní ockování proti chripce a invazivnímu pneumokokovému onemocnení pacientu v pravidelné dialyzacní lécbe.

STUDY OBJECTIVE: To evaluate the antibody response to simultaneous vaccination against influeza and pneumococcal disease in chronic dialysis patients. METHODS: Fifty-four chronic dialysis patients were vaccinated with subunit influenza vaccine Influvac. Thirty-five of these patients were vaccinated with both influenza vaccine and Pneumo 23 vaccine while 19 patients received influenza vaccine alone. Antibodies against influenza vaccine antigens were determined in paired sera by the hemagglutination inhibition test. The geometric mean titre (GMT) of antibodies, protection level (PR), seroconversion (SC) and conversion factor (CF) were calculated. The levels of antibodies against pneumococcal vaccine antigens were detected by the EIA and the geometric mean concentrations of antibodies were calculated from the results. RESULTS: Simultaneous vaccination did not induce adequate PR for antigens A H1N1 and A H3N2, SC and CF for A H3N2 and B. Influenza vaccination alone resulted in inadequate PR and SC for A H3N2, with CF being adequate for all of the antigens. The geometric mean titres of antibodies were higher in the patients vaccinated with influenza vaccine alone, the difference not being statistically significant. Good responsiveness to the pneumococcal vaccine was observed, with the geometric mean concentrations of antibodies increasing 4.8 times after vaccination but decreasing to 1/3 a year later. CONCLUSION: The antibody response to influenza vaccine was negatively influenced by immunodeficiency due to underlying diseases in dialysis patients. Although poorer results were achieved in patients vaccinated with influenza vaccine alone compared to those vaccinated with the two vaccines, the difference was not significant. An adjuvant influenza vaccine is expected to be more promising.

[Optimal therapy with erythropoietin (EPO) in patients with renal anemia on hemodialysis therapy]. / Optimalizace lécby EPO u pacientu s renální anémií v pravidelném hemodialyzacním lécení.

Treatment of anaemia of renal origin by recombinant erythropoietin (EPO) is well established and is considered to be an integral part of therapy in patients with chronic renal failure. An open, non-controlled and multicenter study was designed with aim to verify the dosage of EPO, necessary to reach and maintain rational correction of renal anaemia in a representative group of patients in chronic haemodialysis (HD) treatment. Target range of haemoglobin (Hb) was defined to be 100-120 g/l in adult patient, length of maintenance phase of follow-up 6 months. 183 patients from z 8 HD centres were included to the study, in this number 83 (45.4%) men and 100 (54.6%) women, aged 59.8 +/- 14.4 years (min. 20 and max. 87 years). During the next 6 months haemoglobin levels raised from baseline value Hb0 100 g/l to Hb1 102.9, resp. Hb2-104.9, Hb3 106.1, Hb4 107.5, Hb5 108.2 and Hb6 108.1 g/l; while mean total weekly doses of EPO/kg (TWD/kg) in the respective period corresponded to TWD/kg0 62 IU, resp. TWD/kg1 66 IU, TWD/kg2 67 IU, TWD/kg3 62 IU, TWD/kg4 64 IU, TWD/kg5 60 IU, TWD/kg6 56 IU. Clinical complications (inflammatory state, bleeding...) that could in different extent reduce the effectivity of EPO treatment were observed in 50 cases. No serious clinical complications that could be attributed to EPO treatment were found. On basis of results of our study, it is justified to assume that target range of Hb between 100-120 g/l can be reached with relatively modest increase of EPO dosage in comparison to current praxis in HD centres in CR, and that following cautious dosing of EPO (comparable to the dosing schema in our study) the treatment should not be connected with the development of major clinical complications.

[Hepatitis B vaccination in patients with chronic renal failure]. / Ockování proti virové hepatitide B u pacientu s chronickým renálním selháním.

In the submitted review the authors present basic information on immunization against viral hepatitis B (VHB) in patients with chronic renal failure. These patients have a significantly lower response to the vaccine against VHB, due in particular to secondary immunodeficiency. Possible correction of this adverse situation can be achieved by modification of the immunization pattern (type and dosage of vaccine, the period and early time of vaccination, route of administration) and adjuvant immunomodulating therapy.