title: The association of pneumococcal vaccination with hospitalization and mortality in hemodialysis patients.
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.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA. dgilbertson@cdrg.org
authors.forename: David T
authors.initials: DT
authors.lastname: Gilbertson
authors.forename: Haifeng
authors.initials: H
authors.lastname: Guo
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Arneson
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D015995:Prevalence; D011379:Prognosis; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000472:pathogenicity; D015996:Survival Rate; D014611:Vaccination; D055815:Young Adult
chemical_list: D022242:Pneumococcal Vaccines