Patients on Dialysis Who Receive High-Dose Influenza Vaccine Have Fewer Hospitalizations

Patients with kidney failure and on dialysis who received the high-dose version of the influenza vaccine during the 2016-2017 flu season had lower rates of hospitalization, according to the results of a new study published in Clinical Journal of the American Society of Nephrology (CJASN).

About 30 million adults in the United States are living with chronic kidney disease, according to the US Centers for Disease Control and Prevention (CDC), although most cases are undiagnosed. Individuals with chronic diseases are at greater risk of becoming seriously ill from influenza infection, and those with kidney disease are recommended to stay up to date on vaccines including the seasonal flu vaccine to prevent severe flu illness, hospitalization, and death.

To study if the high-dose trivalent influenza vaccine benefits patients on dialysis, investigators compared the number of hospitalizations and deaths during the 2015—2016 and 2016–2017 influenza seasons among more than 9000 dialysis patients per season by vaccine type (standard trivalent, standard quadrivalent, and high-dose trivalent influenza vaccine).

For the 2015-2016 flu season, the standard dose trivalent, standard dose quadrivalent, and high-dose trivalent influenza vaccines were administered to 3057 (31%), 5981 (61%), and 805 (8%) patients, respectively. The adjusted rates of first hospitalizations by vaccine type during that influenza season were 8.43, 7.88, and 7.99 per 100 patient-months, respectively, and the adjusted rates of death were 1.00, 0.97, and 1.04, respectively.

For the 2016-2017 flu season, 3614 (39%) patients received the quadrivalent vaccine and 5700 (61%) received the high-dose trivalent vaccine. The adjusted rates of first hospitalization by vaccine type were 8.71 and 8.04 per 100 patient-months, respectively, and the adjusted rates of death were 0.98 and 1.02, respectively.

"We found that the administration of the high-dose influenza vaccine was associated with 8% fewer first hospitalizations than the standard dose vaccine in 2016-17,” said study author Dana Miskulin, MD, in a statement from the American Society of Nephrology, noting that the findings were consistent with comparisons between the standard and high-dose vaccines in older adults. “In 2015-2016 there was no difference by vaccine type, although, statistical power was limited, with only 8% of patients receiving high-dose that year, compared with 61% in 2016-2017.”

In response to the new study, the authors of an accompanying editorial noted that the investigators “offer a well-designed study that, although falling short of the rigor of a randomized, controlled trial, provides an important contribution to the literature on the impact of influenza vaccination among adults with the high-dose flu vaccine can also be beneficial for those with end-stage kidney disease.”

There are various forms of the flu vaccine, which can include trivalent or quadrivalent formulations to protect against circulating influenza A and B viruses, at different dosage levels. In August 2018 the CDC published the 2018-2019 influenza vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP), which recommends a high-dose inactivated trivalent formulation of the influenza vaccine for adults ages 65 and older, containing 4 times the antigen dose of the standard flu vaccine.