Hepatitis B Kidney Failure, Chronic Article type: Letter to Editor Please cite this paper as:

In their recent interesting published manuscript, Ahmadi et al. showed that in predialysis patients with chronic renal failure (CRF) doubling the dose of Hepatitis B virus (HBV) vaccine from 20mcg to 40mcg was not ben-efit regarding the seroconvertion rate (1). Although some-what provocative, the above highlights the complexity of the immune system and the difficulties in interfering ef-fectively and safely with its function. In CRF patients the impaired immune function is mul-tifactorial. The impaired interaction between antigen presenting cells (APCs) and T-cells is indicated by the de-creased T-cell proliferation and ζ-chain phosphorylation after a major histocompatibility complex (MHC) depen-dent T-cell receptor (TCR) stimulation and certainly con-tributes to the impaired immune function. Decrease