Patients with end-stage renal disease have an impaired immune response to vaccination against Hepatitis B. The efficacy of different vaccines and vaccine schedules was studied in a group of patients receiving long-term hemodialysis. All patients received an initial 6 month course of intramuscular vaccine with either three doses of Recombivax (48 patients) or four doses of Engerix B (50 patients). This was successful in 71% and 74% of patients, respectively. In 10 patients unresponsive to 4 doses of Engerix B, a second course (2-4 doses) was successful in 5, thus increasing the overall success rate to 84%. Repetitive doses of vaccine intradermally were used as an alternative approach in eight patients who were unresponsive to intramuscular vaccination resulting in seroconversion in six. Finally, booster doses of intramuscular Engerix B have been used in 26 patients who lost their antibodies after successful vaccination.