The overall influenza vaccination rate increased in the United States between 2010 and 2013, but the use of high-dose influenza shots was significantly low among patients with end-stage renal disease, who may not benefit as well from standard influenza vaccines, according to a study published in Vaccine.
The high-dose influenza vaccine, which is currently recommended for patients aged >65, would also benefit patients with end-stage renal disease, who are in need of a stronger immunological response. Researchers in this cohort study analyzed data on 421,482 adults who receive hemodialysis in the United States Renal Data System from 2010 to 2013. They used multivariate logistic regression to assess associations between individual variables, such as comorbidities and demographics, and facility-level variables, such as type and size of vaccine facility, with the type of vaccine received (standard or high-dose).
The number of patients with end-stage renal disease who received influenza vaccinations increased from 68.3% to 72.4% between 2010 and 2013, but only 0.9% of these vaccinations were the high-dose formulation. Of the administered high-dose vaccines in this time, 16.7% were given to patients younger than 65. Among individuals aged > 65 years, those older than 79 were more likely to receive high-dose flu shots (age >79 vs 65-69 years: odds ratio [OR] 1.29; 95% CI, 1.19-1.41), as were patients receiving dialysis at a hospital facility compared with a free-standing dialysis facility (OR 2.31; 95% CI, 2.13-2.45). Black patients were less likely to receive a high-dose vaccine than white patients (OR 0.66; 95% CI, 0.61-.71), as were patients with a longer duration of end-stage renal disease (>9 years with end-stage renal disease vs 0 years: OR 0.66; 95% CI, 0.55-0.78).
Study investigators concluded that the limited use of high-dose influenza vaccine among patients receiving hemodialysis “is likely associated with decisions made at the level of the dialysis facility. Further research on the comparative effectiveness and safety of this vaccine is needed to assist providers, patients, and the Centers for Disease Control and Prevention in deciding if a preferential recommendation is warranted to provide the most protection to this vulnerable population.”
McGrath LJ, Layton JB, Krueger WS, Kshirsagar AV, Butler AM. High-dose influenza vaccine use among patients receiving hemodialysis in the United States, 2010-2013. Vaccine. 2018;36(41):6087-6094.