An interventional study of Recombinant Hepatitis B Vaccine - 3-Dose Schedule and Recombinant Hepatitis B Vaccine - 4-Dose Schedule in Hepatitis B, ESRD (End Stage Renal Disease) and Kidney Failure, sponsored by Jinnah Hospital. Completed at 1 site in Pakistan. Open to participants aged 20 Years to 65 Years. Per ClinicalTrials.gov, last updated 2026-08-25.
Sponsored by Jinnah Hospital · Not applicable, Interventional, and Prevention
People with kidney failure who are on dialysis have a weaker immune response to the hepatitis B vaccine than healthy people. Even after vaccination, many dialysis patients do not develop enough protection against hepatitis B infection. Doctors do not agree on whether giving 3 doses or 4 doses of the vaccine works better for these patients.
This study will compare two vaccination schedules using a stronger (double) dose of the hepatitis B vaccine in people on maintenance hemodialysis:
Group 1 will receive 3 doses of the vaccine, given at the start of the study, 1 month later, and 6 months later.
Group 2 will receive 4 doses of the vaccine, given at the start of the study, 1 month later, 2 months later, and 6 months later.
One month after finishing their vaccine schedule, participants will have a blood test to check their antibody levels against hepatitis B. A blood level of 10 mIU/mL or higher will be considered evidence of protection (called seroprotection). The study will compare how many people in each group reach this protective level.
The goal of this study is to find out which vaccination schedule (3 doses or 4 doses) gives better protection against hepatitis B in people on dialysis. The results may help doctors choose more effective vaccination strategies for dialysis patients in the future.
Hepatitis B virus (HBV) infection remains a significant concern in hemodialysis units due to repeated vascular access, blood exposure, and the shared dialysis environment. While routine screening, infection control practices, and vaccination programs have reduced HBV transmission in dialysis settings, patients with end-stage renal disease (ESRD) mount a markedly blunted immune response to hepatitis B vaccination compared to the general population. Whereas over 90% of healthy individuals achieve protective antibody levels after standard vaccination, only 50-85% of dialysis patients reach seroprotection, even when higher vaccine doses are used. This immune hyporesponsiveness has been attributed to uremia-associated defects in antigen presentation, T-cell function, and B-cell antibody production.
Several strategies have been investigated to improve seroconversion rates in this population, including increased antigen dose, additional booster doses, intradermal administration, and adjuvanted vaccines. Among these, modifying the number of doses in the immunization schedule (commonly 3-dose vs. 4-dose regimens) has shown inconsistent results across studies. Some trials report significantly higher seroprotection with a 4-dose schedule compared to 3 doses, while others report no statistically significant difference between the two approaches. This inconsistency, combined with a lack of locally generated data from Pakistani dialysis populations, has created uncertainty for clinicians in selecting the optimal immunization strategy for hemodialysis patients.
This randomized controlled trial is designed to directly compare a 3-dose and a 4-dose schedule of double-dose (40 mcg) recombinant hepatitis B vaccine administered intramuscularly to patients undergoing maintenance hemodialysis. Randomization will be performed using the lottery method to allocate eligible participants into one of the two vaccination groups. Both groups will receive the same 40 mcg antigen dose per injection; the schedules differ only in timing and number of doses (0, 1, and 6 months for the 3-dose group vs. 0, 1, 2, and 6 months for the 4-dose group).
At baseline, demographic and clinical data will be collected, including age, gender, body mass index, and duration on maintenance hemodialysis, along with relevant comorbidities (diabetes mellitus, hypertension, and ischemic heart disease), as these factors are known to influence vaccine immunogenicity in dialysis populations. Anti-HBs antibody titers will be measured 30 days after completion of the assigned vaccination schedule using a quantitative chemiluminescence immunoassay. Seroprotection will be defined as an Anti-HBs titer ≥10 mIU/mL. Participants who do not achieve this threshold will be offered an additional vaccine dose as part of routine clinical care.
Post-hoc stratified analysis will be performed by age, gender, BMI, and duration on hemodialysis to evaluate whether these variables modify the relationship between vaccination schedule and seroprotection. Findings from this trial are intended to generate the first local evidence from a Pakistani dialysis cohort on the comparative efficacy of these two immunization schedules, with the aim of informing more effective, evidence-based hepatitis B vaccination protocols in hemodialysis units.
1,045 studies on the registry are indexed under Hepatitis B; 139 are open to participants now.
This study's enrollment of 104 is below the median of 147 across 756 interventional studies indexed under Hepatitis B.
Browse Hepatitis B studies →Jinnah Hospital is the lead sponsor of 7 studies on the registry; 2 are open to participants now.
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Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.
Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.
Read whether the line is about a condition or about medicines, and which medicines and doses it means.
The human immunodeficiency virus, which weakens the immune system.
Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.
Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.
Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.
Hepatitis B tests
Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.
Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hypersensitivity
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Immunosuppression
A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.
Read whether the line is about a condition or about medicines, and which medicines and doses it means.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
HIV
The human immunodeficiency virus, which weakens the immune system.
Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Cancer (malignancy)
Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.
Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Participants in this arm will receive 40 mcg recombinant hepatitis B vaccine administered intramuscularly (deltoid muscle of the arm without AV fistula) at 0, 1, and 6 months. Anti-HBs antibody titers will be measured 30 days after completion of the schedule to assess seroprotection.
Biological: Recombinant Hepatitis B Vaccine - 3-Dose Schedule
Participants in this arm will receive 40 mcg recombinant hepatitis B vaccine administered intramuscularly (deltoid muscle of the arm without AV fistula) at 0, 1, 2, and 6 months. Anti-HBs antibody titers will be measured 30 days after completion of the schedule to assess seroprotection.
Biological: Recombinant Hepatitis B Vaccine - 4-Dose Schedule
40 mcg double-dose recombinant hepatitis B vaccine administered intramuscularly in the deltoid muscle of the arm without an arteriovenous fistula, given at 0, 1, and 6 months. Anti-HBs antibody titers will be measured 30 days after completion of the schedule using a quantitative chemiluminescence immunoassay, with seroprotection defined as a titer ≥10 mIU/mL. Participants not achieving seroprotection will be offered an additional vaccine dose as part of routine care.
40 mcg double-dose recombinant hepatitis B vaccine administered intramuscularly in the deltoid muscle of the arm without an arteriovenous fistula, given at 0, 1, 2, and 6 months. Anti-HBs antibody titers will be measured 30 days after completion of the schedule using a quantitative chemiluminescence immunoassay, with seroprotection defined as a titer ≥10 mIU/mL. Participants not achieving seroprotection will be offered an additional vaccine dose as part of routine care.
Proportion of Participants Achieving Seroprotection (Anti-HBs Titer ≥10 mIU/mL)
Seroprotection will be assessed by measuring serum Hepatitis B surface antibody (Anti-HBs) titers using a quantitative chemiluminescence immunoassay. A titer of ≥10 mIU/mL will be defined as seroprotection. The proportion of participants achieving seroprotection will be compared between the 3-dose and 4-dose vaccination schedule groups.
Time frame: 30 days after completion of the assigned vaccination schedule (Month 7 for 3-dose group; Month 7 for 4-dose group)
Plan to share: No — Individual participant data will not be shared outside the research team. This is a single-center study conducted without an established institutional data-sharing infrastructure or agreement. De-identified aggregate results will be made available through publication in a peer-reviewed journal and/or presentation at academic forums.
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This study is completed, as verified in Aug 2026. You cannot join it, but the record below documents what was studied.
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Jinnah Hospital