Influenza immunization in patients with chronic renal disease

Ortbals, David W.; Marks, Eric S; Liebhaber, Harvey

doi:10.1001/jama.239.24.2562

Cited by 24 publications

(6 citation statements)

References 13 publications

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“…Reduced effectiveness of influenza vaccine in advanced CKD may be due to poorer antibody response to influenza vaccination compared to non-CKD [71–76]. Chang et al studied antibody response to a single dose H1N1/09 vaccine among 110 hemodialysis patients and 173 healthy controls, and found that the seroconversion rate was 24.5% among hemodialysis patients compared to 86.7% among healthy controls [71].…”

Section: Prevention Strategiesmentioning

confidence: 99%

“…Chang et al studied antibody response to a single dose H1N1/09 vaccine among 110 hemodialysis patients and 173 healthy controls, and found that the seroconversion rate was 24.5% among hemodialysis patients compared to 86.7% among healthy controls [71]. However, some studies reported less evident difference between dialysis patients and control groups [76]. Further studies are needed to assess antibody response to influenza vaccination in advanced CKD.…”

Section: Prevention Strategiesmentioning

confidence: 99%

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Clinical epidemiology of infectious disease among patients with chronic kidney disease

2018

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Infectious disease is recognized as an important complication among patients with end-stage renal disease, contributing to excess morbidity and health care costs. However, recent epidemiological studies have revealed that even mild to moderate stages of chronic kidney disease (CKD) substantially increase risk of infection. Regarding underlying mechanisms, evidence suggests various aspects of altered immune response in patients with CKD including impaired function of T cells, B cells and neutrophil. Multiple conditions surrounding CKD, such as older age, diabetes, and cardiovascular disease are important contributors in the increased susceptibility to infection in this population. In addition, several mechanisms impairing immune function have been hypothesized including accumulated uremic toxins, increased oxidative stress, endothelial dysfunction, low-grade inflammation, and mineral and bone disorders. In terms of prevention strategies, influenza and pneumococcal vaccines are most feasible and important. Nevertheless, the extent of vaccine utilization in CKD has not been well documented. In addition, antibody response to vaccination may be reduced in CKD patients, and thus a vaccine delivery strategy (e.g., dose and frequency) may need to be optimized among patients with CKD. Through this review, we demonstrate that infection is a major but underrecognized complication of CKD. As CKD is recognized as a serious public health issue, dedicated research is needed to better characterize the burden of infectious disease associated with CKD, understand the pathophysiology of infection in patients with CKD, and develop effective strategies to prevent infection and its sequela in this high risk population.

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Section: Prevention Strategiesmentioning

confidence: 99%

Section: Prevention Strategiesmentioning

confidence: 99%

Clinical epidemiology of infectious disease among patients with chronic kidney disease

2018

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“…There are conflicting data on response rates to vaccination . Response rates to influenza vaccination may be similar to or lower than those in the general population , although the antibody response to influenza vaccination is generally adequate . For example, in one study, the response rate to H1N1 vaccination in hemo‐dialysis patients was only 33%, much lower than the seroconversion rate of over 80% in healthy controls.…”

Section: Hepatitis Bmentioning

confidence: 99%

Immunization in End‐Stage Renal Disease: Opportunity to Improve Outcomes

Soni

Horowitz

Unruh

2013

Seminars in Dialysis

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Infection is the second most common cause of death in patients with end-stage renal disease (ESRD), following cardiovascular causes. Immunization is a fairly simple, but underutilized, strategy for prevention of infectious morbidity and mortality in patients with kidney failure. It is imperative for nephrologists and primary care providers to have an understanding of immunization as an essential component of preventive healthcare measures in this high-risk population. Patients with ESRD represent a unique population due to their immunosuppressed state, dialysis-related exposures and suboptimal response to routine vaccines. While the Advisory Committee on Immunization Practices (ACIP) provides guidelines for vaccination of patients with renal disease against Hepatitis B, influenza and pneumococcal disease, the data on immunization against other commonly preventable infectious diseases are lacking. This article reviews the recent evidence on immunization in the ESRD population and synthesizes the related implications for maximizing prevention of infectious diseases in this high-risk population.

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“…It was reported that the influenza vaccine is successful in preventing influenza in approximately 70–90% of the healthy adults [6, 7], but the immune response is known to be weak in high-risk patients. Previous studies have shown a decrease in both the number of B cells and the IgG production among patients undergoing hemodialysis (HD); uremic toxins, malnutrition, blood transfusion, iron overload, dialysis membranes, and biological incompatibility adversely affect the immune response [6, 8]. Though these derangements should not preclude consideration for vaccination, the influenza vaccination efficacy of HD patients is still under debate.…”

Section: Introductionmentioning

confidence: 99%

“…Though these derangements should not preclude consideration for vaccination, the influenza vaccination efficacy of HD patients is still under debate. Previously, some studies reported comparable responses in HD patients and in healthy controls [3, 8], but others showed impaired responses [9]. The benefits of additional booster vaccination or higher vaccine dosage have been questioned also [10].…”

Section: Introductionmentioning

confidence: 99%

Active Influenza Immunization in Hemodialysis Patients: Comparison between Single-Dose and Booster Vaccination

Song

Cheong

et al. 2006

Am J Nephrol

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Background/Aims: Hemodialysis (HD) patients are recommended to be immunized against influenza annually, but the immune response after vaccination is known to be weakened in these patients. We intended to compare the efficacy of influenza vaccines in HD patients with that in healthy people, and we also evaluated the additive effect of a booster vaccination in HD patients. Methods: During the 2003–2004 influenza season, 100 patients on HD and 50 age-matched healthy controls were recruited from the Korea University Guro Hospital. The HD patients were divided into two groups: single-dose group (50 patients) and booster group (50 patients). Eight weeks following the influenza vaccination, the serum antibody responses were compared. Results: Although the antibody response of the HD patients was impaired in comparison with that of healthy controls, more than 90% of the HD patients showed protective antibody levels. Booster vaccination did not significantly increase the immune response in HD patients. Conclusions: Influenza vaccination in HD patients should be encouraged, but the immune response was comparatively impaired in subpopulations, including patients with a long-term HD history (>2.5 years), with a higher urea reduction rate, or with underlying diabetes. There was no effect of a booster vaccine dose on the antibody titers.

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Influenza immunization in patients with chronic renal disease

Cited by 24 publications

References 13 publications

Clinical epidemiology of infectious disease among patients with chronic kidney disease

Clinical epidemiology of infectious disease among patients with chronic kidney disease

Immunization in End‐Stage Renal Disease: Opportunity to Improve Outcomes

Active Influenza Immunization in Hemodialysis Patients: Comparison between Single-Dose and Booster Vaccination

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