End-Stage Renal Disease: Does Vaccination Save Lives?

Jeannette Y. Wick, RPh, MBA, FASCP
Published Online: Monday, August 6, 2012
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Influenza and pneumococcal vaccination both appear to reduce the mortality rate of patients with end-stage renal disease, according to results of a recent study.

Patients who have end-stage renal disease (ESRD) usually need dialysis, and consequently see health care providers regularly. This affords many opportunities to stress the need for vaccination, which is extremely important for these patients because they face an elevated risk of serious infection requiring hospitalization and an elevated risk of mortality. Indeed, the Centers for Disease Control and Prevention designates ESRD patients a priority population for influenza and pneumococcal vaccination.
For a study published online on June 13, 2012, in the American Journal of Kidney Diseases, researchers at Emory University studied the effects of vaccination on the mortality of patients receiving peritoneal dialysis or hemodialysis in 3 ESRD networks that included patients in 14 states. The researchers included 36,966 dialysis patients and divided them into groups based on whether they had received the influenza vaccine in the 2005-2006 influenza season or the pneumococcal vaccine at any point in the past.
Overall 1-year mortality among all participants was 17%. The mortality rate for patients who received the influenza vaccine ranged from 15.7% (for those who were vaccinated at the treating facility) to 21.5% (for those who reported being vaccinated elsewhere). In the unvaccinated group, the rate ranged from 15.6% to 28.7%, depending on a number of factors. The adjusted odds ratio (OR) of mortality was 0.77 for those who received the influenza vaccine and 0.76 for those who received the pneumococcal vaccine. For influenza, the lowered risk of death was greatest from January through March (OR = 0.67), the months when influenza is most prevalent. For pneumococcal disease, the lowered risk of death was strongest from February through April (OR = 0.62); pneumococcal infection tends to follow influenza.
One study limitation was the poor quality of documentation in clinical records. All health care professionals who vaccinate need to improve their clinical record vaccine documentation.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.

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