title: 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.
  
  
  METHODS
  Prospective interventional open-label study.
  
  
  METHODS
  201 long-term HD patients and 41 healthy volunteers.
  
  
  METHODS
  Vaccination with a standard trivalent inactivated influenza vaccine.
  
  
  RESULTS
  The primary outcome was seroprotection rate, defined as percentage of participants with an antibody titer of 40 or greater 1 month after vaccination.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Nephrology, Department of Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Scharpé
authors.forename: Willy E
authors.initials: WE
authors.lastname: Peetermans
authors.forename: Johan
authors.initials: J
authors.lastname: Vanwalleghem
authors.forename: Bart
authors.initials: B
authors.lastname: Maes
authors.forename: Bert
authors.initials: B
authors.lastname: Bammens
authors.forename: Kathleen
authors.initials: K
authors.lastname: Claes
authors.forename: André D
authors.initials: AD
authors.lastname: Osterhaus
authors.forename: Yves
authors.initials: Y
authors.lastname: Vanrenterghem
authors.forename: Pieter
authors.initials: P
authors.lastname: Evenepoel