Original Investigation
Dialysis
Mortality of Dialysis Patients According to Influenza and Pneumococcal Vaccination Status

https://doi.org/10.1053/j.ajkd.2012.04.018Get rights and content

Background

Data from an immunocompromised subpopulation in which both vaccine recipients and nonrecipients have frequent opportunities for vaccination can help determine the associations between vaccination against seasonal influenza and pneumococcal disease and all-cause mortality.

Study Design

We surveyed dialysis centers and performed a retrospective analysis of health status at dialysis therapy initiation, vaccination for influenza and pneumococcal disease, laboratory results, and mortality associated with the 2005-2006 influenza season for patients in 3 End-Stage Renal Disease Networks across the United States.

Setting & Participants

Of 1,033 dialysis facilities considered, 903 centers with a total patient population of 54,734 reported vaccination data. Analysis was limited to 36,966 patients on dialysis treatment for at least 1 year as of December 31, 2005.

Predictor

Vaccination status.

Outcomes

OR for all-cause mortality (vaccinated vs unvaccinated patients).

Results

The estimated adjusted OR for mortality was significantly less than 1.0 for patient who received either vaccination and was lower for patients who had received both vaccinations than for those who had received either. Survival analysis confirmed these findings.

Limitations

Possible misclassification due to self-report of vaccination for some patients. Lack of vaccination date.

Conclusions

Vaccination against influenza and pneumococcal disease is associated with improved survival in dialysis patients. The 2 vaccinations have independent effects on mortality.

Section snippets

Methods

The patient population for this study included hemodialysis and peritoneal dialysis patients in ESRD Networks 6 (North Carolina, South Carolina, and Georgia), 11 (Michigan, Minnesota, North Dakota, South Dakota, and Wisconsin), and 15 (Arizona, Colorado, Nevada, New Mexico, Utah, and Wyoming). These 3 Networks, which serve more than 65,000 patients in 1,033 dialysis facilities, collected the data used here as part of an ad hoc working group, the Safe and Timely Immunization Coalition (STIC).

Results

Of patients who had been receiving dialysis since at least January 1, 2005, a total of 41.8% were vaccinated against influenza during the 2005-2006 season and also had been vaccinated against pneumococcal disease. Compared with patients who had received neither vaccine, dual recipients were significantly less likely to be black (37.9% vs 57.6%), older on average, and more likely to receive hemodialysis (rather than peritoneal dialysis; Table 1). They also had generally worse baseline health

Discussion

Infection-related complications carry a high burden in this population.5, 6 Patients with ESRD—especially hemodialysis patients—are more likely than other patients to be hospitalized for bacteremia or septicemia (102.0 admissions/1,000 patient-years) and pneumonia (73.4 admissions/1,000 patient-years), and when hospitalized, these patients have lower 6-month survival rates.1, 7 The issue of influenza/pneumonia and mortality in this population extends beyond the assignment of a primary cause of

Acknowledgements

Support: The analyses upon which this publication is based were performed under contract HHSM-500-2006-NW006C entitled ESRD Networks Organization for the states of North Carolina, South Carolina, and Georgia, sponsored by the CMS, Department of Health and Human Services (DHHS). The content of this publication does not necessarily reflect the views or policies of the DHHS, nor does mention of trade names, commercial products, or organizations imply endorsement by the US. Government. This article

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    Risks of bias assessment of included studies were shown in Table 1 and Supplementary Table 2. The quality of the included observational studies was moderate to high according to the NOS criteria (three studies with high quality [15,16,19] and three studies with moderate quality [17,18,20]). The common issues identified included lack of representativeness of the exposed cohort [17–20], no description on variables considered in analysis [17,18,20] and short duration of follow-up [15,18].

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Originally published online June 13, 2012.

Current affiliation: DaVita Clinical Research, Minneapolis, MN.

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