Some nephrologists give a high dose (40 mcg) of hepatitis B vaccine (2 adult doses of Engerix-B, or Recombivax HB Dialysis Formulation) to all patients with renal failure with glomerular filtration rates (GFRs) of less than 30 ml/min even if the patient is not on dialysis. Is this practice advisable?

When using Engerix-B or Recombivax HB brands of HepB to vaccinate hemodialysis or other immunocompromised people, a higher dose is recommended, so to the extent these patients are immunocompromised, this is within ACIP recommendations (note that “immunocompromised” is not defined in the recommendations). Regardless, this practice is appropriate for several reasons, including that these patients may be starting hemodialysis soon, and because use of the higher dose is not harmful. This is somewhat of a gray area but the clinician can use clinical judgment. Heplisav-B and PreHevbrio have not been evaluated for use in dialysis or pre-dialysis patients.