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The association of pneumococcal vaccination with hospitalization and mortality in hemodialysis patients.
Nephrol Dial Transplant. 2011 Sep; 26(9):2934-9.ND

Abstract

BACKGROUND

Few studies have examined the effectiveness of pneumococcal vaccination (alone or with influenza vaccination) in improving hemodialysis patient outcomes. We aimed to describe vaccination rates between 2003-2005 and to study the effects on outcomes.

METHODS

For 118,533 prevalent patients who initiated hemodialysis ≥90 days before 1 November 2003, had Medicare Part A and Part B and were aged ≥18 years, and alive through 31 October 2005, Cox proportional hazards models were used to assess pneumococcal vaccination effects on subsequent hospitalization and mortality, adjusting for demographics and comorbidity.

RESULTS

The 21% of patients who received vaccinations were older; a higher proportion were white, with diabetes as cause of end-stage renal disease and more comorbidity. Pneumococcal vaccination was associated with a statistically significant decreased mortality hazard [hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.90-0.98], cardiac death (HR 0.91, 95% CI 0.85-0.97) and hospitalization for bacteremia/viremia/septicemia (HR 0.95, 95% CI 0.91-1.00). The mortality hazard was 0.73 (95% CI 0.68-0.78) for patients who received pneumococcal and influenza vaccinations.

CONCLUSIONS

The small but significant association between pneumococcal vaccination and lower mortality risk was seen despite factors associated with poor outcomes in patients most likely to be vaccinated. Pneumococcal and influenza vaccines may have beneficial synergistic effects. Hemodialysis patients may benefit from revaccination more frequently than the recommended 5-year intervals.

Authors+Show Affiliations

Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA. dgilbertson@cdrg.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

21317410

Citation

Gilbertson, David T., et al. "The Association of Pneumococcal Vaccination With Hospitalization and Mortality in Hemodialysis Patients." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 26, no. 9, 2011, pp. 2934-9.
Gilbertson DT, Guo H, Arneson TJ, et al. The association of pneumococcal vaccination with hospitalization and mortality in hemodialysis patients. Nephrol Dial Transplant. 2011;26(9):2934-9.
Gilbertson, D. T., Guo, H., Arneson, T. J., & Collins, A. J. (2011). The association of pneumococcal vaccination with hospitalization and mortality in hemodialysis patients. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 26(9), 2934-9. https://doi.org/10.1093/ndt/gfq853
Gilbertson DT, et al. The Association of Pneumococcal Vaccination With Hospitalization and Mortality in Hemodialysis Patients. Nephrol Dial Transplant. 2011;26(9):2934-9. PubMed PMID: 21317410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association of pneumococcal vaccination with hospitalization and mortality in hemodialysis patients. AU - Gilbertson,David T, AU - Guo,Haifeng, AU - Arneson,Thomas J, AU - Collins,Allan J, Y1 - 2011/02/11/ PY - 2011/2/15/entrez PY - 2011/2/15/pubmed PY - 2012/1/20/medline SP - 2934 EP - 9 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol. Dial. Transplant. VL - 26 IS - 9 N2 - BACKGROUND: Few studies have examined the effectiveness of pneumococcal vaccination (alone or with influenza vaccination) in improving hemodialysis patient outcomes. We aimed to describe vaccination rates between 2003-2005 and to study the effects on outcomes. METHODS: For 118,533 prevalent patients who initiated hemodialysis ≥90 days before 1 November 2003, had Medicare Part A and Part B and were aged ≥18 years, and alive through 31 October 2005, Cox proportional hazards models were used to assess pneumococcal vaccination effects on subsequent hospitalization and mortality, adjusting for demographics and comorbidity. RESULTS: The 21% of patients who received vaccinations were older; a higher proportion were white, with diabetes as cause of end-stage renal disease and more comorbidity. Pneumococcal vaccination was associated with a statistically significant decreased mortality hazard [hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.90-0.98], cardiac death (HR 0.91, 95% CI 0.85-0.97) and hospitalization for bacteremia/viremia/septicemia (HR 0.95, 95% CI 0.91-1.00). The mortality hazard was 0.73 (95% CI 0.68-0.78) for patients who received pneumococcal and influenza vaccinations. CONCLUSIONS: The small but significant association between pneumococcal vaccination and lower mortality risk was seen despite factors associated with poor outcomes in patients most likely to be vaccinated. Pneumococcal and influenza vaccines may have beneficial synergistic effects. Hemodialysis patients may benefit from revaccination more frequently than the recommended 5-year intervals. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/21317410/The_association_of_pneumococcal_vaccination_with_hospitalization_and_mortality_in_hemodialysis_patients_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfq853 DB - PRIME DP - Unbound Medicine ER -