Lipid parameters but not inflammatory indices predict hepatitis B vaccine responses in hemodialysis patients

Hepatitis B virus (HBV) vaccination is essential in hemodialysis (HD) populations, yet seroprotection remains suboptimal. Inflammation-related hematologic indices are frequently used in clinical practice, but their ability to predict HBV vaccine response in HD patients is uncertain. We evaluated clinical and laboratory determinants of HBV vaccine response, with a focus on lipid-derived indices and inflammatory ratios.

In this multicenter retrospective study, adult HD patients followed between 2015 and 2025 who received at least three doses of HBV vaccine and had available anti-HBs measurements were included (n = 341). Vaccine response was defined as anti-HBs ≥10 IU/L; non-response as <10 IU/L. Neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), monocyte-to-lymphocyte (MLR), neutrophil percentage-to-albumin ratio (NPAR), and lipid ratios (TG/HDL, TC/HDL, LDL/HDL) were calculated. Additional analyses using percentile-based categorization of NPAR confirmed the absence of a significant association with vaccine response. Multivariable logistic regression and receiver operating characteristic analyses were performed.

After the primary vaccination series, seroprotection was 77.4% and increased to 88.6% after revaccination/boosters; it declined to 78.3% at 1 year and 69.2% at 2 years. Non-responders were older and had higher triglyceride levels and lower HDL cholesterol levels. In contrast, inflammatory indices (NLR, PLR, MLR, and NPAR) did not differ significantly between groups. These indices also demonstrated limited discriminative ability for predicting vaccine response. In multivariable analysis, HDL cholesterol remained positively associated with vaccine response [odds ratio (OR): 1.046, 95% confidence interval (CI): 1.006-1.086, P = .022], and triglyceride levels were negatively associated with vaccine response (OR: 0.992, 95% CI: 0.984-0.999, P = .024). The TG/HDL ratio showed borderline statistical significance (OR: 1.235, 95% CI: 0.983-1.551, P = .070), suggesting a potential but limited contribution to vaccine response prediction.

In HD patients, hematologic inflammatory indices were not informative for HBV vaccine response, whereas an atherogenic lipid profile-particularly lower HDL and higher triglycerides-showed a consistent association. Lipid parameters may support risk stratification and tailored post-vaccination monitoring strategies.