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Immunogenicity of a standard trivalent influenza vaccine in patients on long-term hemodialysis: an open-label trial.

Abstract

BACKGROUND

Disturbances in acquired immunity are considered to be responsible, at least in part, for the high infection rate and inadequate response to vaccinations observed in hemodialysis (HD) patients. The present prospective trial aimed to: (1) evaluate the immunogenicity of a standard influenza vaccine in HD patients, and (2) identify determinants of the immune response.

STUDY DESIGN

Prospective interventional open-label study.

SETTING & PARTICIPANTS

201 long-term HD patients and 41 healthy volunteers.

INTERVENTION

Vaccination with a standard trivalent inactivated influenza vaccine.

OUTCOMES

The primary outcome was seroprotection rate, defined as percentage of participants with an antibody titer of 40 or greater 1 month after vaccination.

MEASUREMENTS

All antibody titers were determined in duplicate by using the hemagglutination inhibition assay. Regression analyses were performed to investigate the association between demographics, uremic retention solutes (including p-cresol), inflammation, nutrition, iron status, trace elements, and immune response in HD patients.

RESULTS

More than 80% of HD patients showed seroprotection after vaccination. The immune response of HD patients was similar to that of healthy volunteers. Booster vaccination did not improve the immune response. High serum ferritin level was the only parameter independently associated with a better vaccination-induced antibody response in HD patients.

LIMITATIONS

A high seroprotection rate at baseline undermined the power to identify clinical determinants of the immune response.

CONCLUSIONS

Influenza vaccination is as efficacious in HD patients as in healthy volunteers. With the exception of serum ferritin, none of the investigated parameters of nutrition, inflammation, and dialysis adequacy had a significant impact on the immune response. Our data support annual vaccination of HD patients and question the clinical relevance of disturbances in acquired immunity in contemporary HD patients.

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  • Authors+Show Affiliations

    ,

    Division of Nephrology, Department of Medicine, University Hospital Gasthuisberg, Leuven, Belgium.

    , , , , , , ,

    Source

    MeSH

    Aged
    Aged, 80 and over
    Antibodies, Viral
    Chronic Disease
    Female
    Ferritins
    Humans
    Influenza Vaccines
    Influenza, Human
    Kidney Diseases
    Male
    Middle Aged
    Orthomyxoviridae
    Outcome Assessment (Health Care)
    Prospective Studies
    Regression Analysis
    Renal Dialysis
    Treatment Outcome

    Pub Type(s)

    Controlled Clinical Trial
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19339089

    Citation

    Scharpé, Johan, et al. "Immunogenicity of a Standard Trivalent Influenza Vaccine in Patients On Long-term Hemodialysis: an Open-label Trial." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 54, no. 1, 2009, pp. 77-85.
    Scharpé J, Peetermans WE, Vanwalleghem J, et al. Immunogenicity of a standard trivalent influenza vaccine in patients on long-term hemodialysis: an open-label trial. Am J Kidney Dis. 2009;54(1):77-85.
    Scharpé, J., Peetermans, W. E., Vanwalleghem, J., Maes, B., Bammens, B., Claes, K., ... Evenepoel, P. (2009). Immunogenicity of a standard trivalent influenza vaccine in patients on long-term hemodialysis: an open-label trial. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 54(1), pp. 77-85. doi:10.1053/j.ajkd.2008.11.032.
    Scharpé J, et al. Immunogenicity of a Standard Trivalent Influenza Vaccine in Patients On Long-term Hemodialysis: an Open-label Trial. Am J Kidney Dis. 2009;54(1):77-85. PubMed PMID: 19339089.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Immunogenicity of a standard trivalent influenza vaccine in patients on long-term hemodialysis: an open-label trial. AU - Scharpé,Johan, AU - Peetermans,Willy E, AU - Vanwalleghem,Johan, AU - Maes,Bart, AU - Bammens,Bert, AU - Claes,Kathleen, AU - Osterhaus,André D, AU - Vanrenterghem,Yves, AU - Evenepoel,Pieter, Y1 - 2009/04/01/ PY - 2008/08/08/received PY - 2008/11/20/accepted PY - 2009/4/3/entrez PY - 2009/4/3/pubmed PY - 2009/7/10/medline SP - 77 EP - 85 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 54 IS - 1 N2 - BACKGROUND: Disturbances in acquired immunity are considered to be responsible, at least in part, for the high infection rate and inadequate response to vaccinations observed in hemodialysis (HD) patients. The present prospective trial aimed to: (1) evaluate the immunogenicity of a standard influenza vaccine in HD patients, and (2) identify determinants of the immune response. STUDY DESIGN: Prospective interventional open-label study. SETTING & PARTICIPANTS: 201 long-term HD patients and 41 healthy volunteers. INTERVENTION: Vaccination with a standard trivalent inactivated influenza vaccine. OUTCOMES: The primary outcome was seroprotection rate, defined as percentage of participants with an antibody titer of 40 or greater 1 month after vaccination. MEASUREMENTS: All antibody titers were determined in duplicate by using the hemagglutination inhibition assay. Regression analyses were performed to investigate the association between demographics, uremic retention solutes (including p-cresol), inflammation, nutrition, iron status, trace elements, and immune response in HD patients. RESULTS: More than 80% of HD patients showed seroprotection after vaccination. The immune response of HD patients was similar to that of healthy volunteers. Booster vaccination did not improve the immune response. High serum ferritin level was the only parameter independently associated with a better vaccination-induced antibody response in HD patients. LIMITATIONS: A high seroprotection rate at baseline undermined the power to identify clinical determinants of the immune response. CONCLUSIONS: Influenza vaccination is as efficacious in HD patients as in healthy volunteers. With the exception of serum ferritin, none of the investigated parameters of nutrition, inflammation, and dialysis adequacy had a significant impact on the immune response. Our data support annual vaccination of HD patients and question the clinical relevance of disturbances in acquired immunity in contemporary HD patients. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/19339089/Immunogenicity_of_a_standard_trivalent_influenza_vaccine_in_patients_on_long_term_hemodialysis:_an_open_label_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(09)00049-3 DB - PRIME DP - Unbound Medicine ER -