Effectiveness of influenza vaccination in patients with end-stage renal disease receiving hemodialysis: a population-based study

PLoS One. 2013;8(3):e58317. doi: 10.1371/journal.pone.0058317. Epub 2013 Mar 13.

Abstract

Background: Little is known on the effectiveness of influenza vaccine in ESRD patients. This study compared the incidence of hospitalization, morbidity, and mortality in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) between cohorts with and without influenza vaccination.

Methods: We used the insurance claims data from 1998 to 2009 in Taiwan to determine the incidence of these events within one year after influenza vaccination in the vaccine (N = 831) and the non-vaccine (N = 3187) cohorts. The vaccine cohort to the non-vaccine cohort incidence rate ratio and hazard ratio (HR) of morbidities and mortality were measured.

Results: The age-specific analysis showed that the elderly in the vaccine cohort had lower hospitalization rate (100.8 vs. 133.9 per 100 person-years), contributing to an overall HR of 0.81 (95% confidence interval (CI) 0.72-0.90). The vaccine cohort also had an adjusted HR of 0.85 [95% CI 0.75-0.96] for heart disease. The corresponding incidence of pneumonia and influenza was 22.4 versus 17.2 per 100 person-years, but with an adjusted HR of 0.80 (95% CI 0.64-1.02). The vaccine cohort had lowered risks than the non-vaccine cohort for intensive care unit (ICU) admission (adjusted HR 0.20, 95% CI 0.12-0.33) and mortality (adjusted HR 0.50, 95% CI 0.41-0.60). The time-dependent Cox model revealed an overall adjusted HR for mortality of 0.30 (95% CI 0.26-0.35) after counting vaccination for multi-years.

Conclusions: ESRD patients with HD receiving the influenza vaccination could have reduced risks of pneumonia/influenza and other morbidities, ICU stay, hospitalization and death, particularly for the elderly.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Female
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Incidence
  • Influenza Vaccines / immunology*
  • Influenza, Human / prevention & control*
  • Kidney Failure, Chronic / epidemiology*
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Morbidity
  • Population Surveillance
  • Proportional Hazards Models
  • Renal Dialysis
  • Risk
  • Taiwan / epidemiology
  • Vaccination
  • Young Adult

Substances

  • Influenza Vaccines

Grant support

Executive Yuan National Science Council (grant number NSC 100-2621-M-039 -001), the Department of Health (grant numbers DOH101-TD-B- 111-004 and DOH101-TD-C-111-005) and the China Medical University Hospital (grant number 1MS1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.