• Occurrence of adverse events and local and systemic reaction rates [ Time Frame: 28 weeks ] [ Designated as safety issue: Yes ]
  

• Portion of subjects who have a seroprotective immune response (anti-HBsAg ≥ 10 mIU/ml) [ Time Frame: 50 weeks ] [ Designated as safety issue: No ]
  

Infection with hepatitis B virus (HBV) is a major global health problem. Worldwide, it is estimated that 2 billion people have been infected previously and 350 million are chronically infected. While acute HBV infection is associated with significant illness, the risk of chronic infection is of great importance since 5-10% of infected adults will not clear the infection after the initial phase of the illness. About 25% of people who do not initially clear the infection will later develop chronic active hepatitis.

This study will evaluate the safety and immunogenicity of HEPLISAV™ when administered to adults who have end-stage renal disease (glomerular filtration rate [GFR] ≤ 45 mL/min). Once subjects have been consented, screened, and randomized to treatment, subjects will receive a total of three injections over a 24-week period, with follow-up visits at 28 and 50 weeks. Subjects will receive 1 of the following 2 regimens:

• HEPLISAV™ single dose at Day 0, 4 weeks (1 month) and 24 weeks (6 months)
• HEPLISAV™ double dose at Day 0, 4 weeks (1 month) and 24 weeks (6 months)

Safety and tolerability will be evaluated by occurrence of adverse events, periodic laboratory tests, vital signs, and local and systemic reactogenicity.

Immunogenicity will be evaluated by the proportion of subjects exhibiting a seroprotective immune response (anti-hepatitis B surface antigen antibodies [anti-HBsAg] ≥ 10 mIU/mL) at Weeks 4, 12, 24, 28 and 50.

Inclusion Criteria:

• Willing and able to give written informed consent
• Have a glomerular filtration rate (GFR) ≤ 45 mL/min
• Have an expectation of going on hemodialysis or are already on hemodialysis
• Is serum negative for hepatitis B virus (HBV) antibodies, hepatitis C virus (HCV), and human immunodeficiency virus (HIV)
• Have repeated resting blood pressure measurements ≤ 165/105 mmHg
• Women of childbearing potential must be consistently using a highly effective method of birth control

Exclusion Criteria:

• Women who are pregnant, breastfeeding or planning a pregnancy
• Any previous HBV infection
• Previous vaccination (1 or more doses) with any HBV vaccine
• Any previous autoimmune diseases
• Have a diagnosis of chronic renal failure due to autoimmune disease
• Are at high risk for recent exposure to HBV, HCV or HIV
• Received any antibodies within 3 months prior to study entry
• Ever received an injection with DNA plasmids or oligonucleotides
• Received any vaccines within 4 weeks prior to study entry
• Received any other investigational medicinal agent within 4 weeks prior to study entry