Previous Vaccination and Age are More Important Predictors of Immune Response to Influenza Vaccine than Inflammation and Iron Status in Dialysis Patients

Abstract

Background/Aims: The immune response to influenza vaccine may be influenced by many factors, e.g. age, comorbidities or inflammation, and iron status. Methods: We studied the vaccine-induced production of hemagglutination-inhibition antibodies (HI) in 133 hemodialysis patients (HD) and 40 controls. To identify variables associated with the immune response, uni- and multivariate regression analyses were performed with seroconversion in HI titers as a dependent variable, with demographics, comorbidities, previous vaccination, inflammation, and iron status as independent variables. Results: Seroconversion rates were lower in HD than in controls [43% versus 73% (H1N1 strain; p < 0.05); 43% versus 53% (H3N2; P=NS); 36% versus 62% (B; p < 0.05)]. In both HD and control groups, the predictors of the inferior HI production were pre-vaccination seroprotection, vaccination in the previous season, and old age. We did not find associations between seroconversion rates and inflammation and iron status in the studied populations. This was also true for a subanalysis of patients without pre-vaccination seroprotection. Conclusion: The influenza vaccine-induced antibody production was lower in HD than in controls and was independent of inflammation and iron status in both groups. Besides dependence on dialysis, the variables associated with inferior seroconversion rates included pre-vaccination seroprotection, previous vaccination, and old age.

Immune response to influenza vaccination in ESRD patients undergoing hemodialysis vs. hemodiafiltration

“…In multivariate analysis, younger age was associated with seroconversion to all three vaccine strains. This supports previous studies which have also reported that age was a determinant factor in the immune response to influenza vaccine [24,27]. In our study, the HDF cohort was younger, with higher pre-dialysis BUN and creatinine, although marginally longer dialysis vintage, potentially suggesting that this group might have been healthier, although co-morbidity was similar to the HD patients.…”

“…In terms of the humoral immune response, we demonstrated that there were no significant differences in seroconversion at one month post-vaccination by HI assay. Our seroconversion rates to influenza vaccination were comparable to those previously reported in HD patients [24]. However, we observed the patients treated by HDF had a longer duration of seroprotection compared to those treated by HD at 12 months.…”

Longitudinal proteomic profiling of dialysis patients with COVID-19 reveals markers of severity and predictors of death

“…These observations support the notion that the state of ESKD per se is an important determinant of outcome in COVID-19. ESKD is well recognised as an immunosuppressed state [14][15][16], with defects in both innate and adaptive immunity [17][18][19][20]. Accordingly, ESKD confers increased vulnerability to viral infections including influenza and respiratory syncytial virus [21][22][23][24].…”

Excess Deaths Attributable to Influenza-Like Illness in the ESRD Population

“…[15][16][17] The duration and intensity of influenza seasons have been identified as contributors to this seasonal increase in health risks, [6][7][8][19][20][21][22][23] especially among vulnerable populations, such as patients with ESRD, in whom the effectiveness of influenza vaccinations is reduced. [24][25][26][27] However, the contribution of ILI to mortality in the ESRD population has not specifically been quantified. Given that viral infections are likely associated with hospitalizations and death attributed to ostensibly noninfectious causes, we hypothesized that seasonal patterns in ILI might be associated with mortality in patients with ESRD.…”