title: Seasonal influenza vaccination is associated with reduced morbidity and mortality in peritoneal dialysis patients.
abstract: BACKGROUND
  Studies on the effectiveness of seasonal influenza vaccination in peritoneal dialysis (PD) patients are limited. The aim of the present study is to evaluate the effectiveness of seasonal influenza vaccination in reducing morbidity and mortality in incident end-stage renal disease patients on PD.
  
  
  METHODS
  From Taiwan's National Health Insurance Research Database, we identified 2089 incident PD patients with seasonal influenza vaccination and 2089 propensity score matched incident PD patients without the vaccination during 1998-2010. Each study subject was followed up to measure the 12-month incident cardiovascular and infectious diseases, and deaths. The effects of multi-year vaccinations were also estimated.
  
  
  RESULTS
  Compared with the non-vaccinated cohort, the vaccinated cohort had a lower hospitalization rate (68.5 versus 80.2 per 100 person-years) with an adjusted hazard ratio (aHR) of 0.85 [95% confidence interval (CI) = 0.78-0.92]. Hazards of hospitalization were significantly reduced for sepsis (aHR = 0.79, 95% CI = 0.65-0.96), heart disease (aHR = 0.74, 95% CI = 0.63-0.89) and intensive care (aHR = 0.85, 95% CI = 0.73-0.99). In addition, hazards of peritonitis (aHR = 0.84, 95% CI = 0.73-0.97) and overall mortality (aHR = 0.66, 95% CI = 0.55-0.78) were also reduced. The aHR of mortality was reduced much further to 0.28 (95% CI = 0.22-0.35) for those with multiple-year vaccinations.
  
  
  CONCLUSIONS
  Seasonal influenza vaccination for PD patients is associated with significant reduction in morbidities and a 34% reduction in mortality. Multi-year vaccinations could reduce the death hazard further to 72%.
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan.
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Division of Infection, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Po-Chang
authors.initials: PC
authors.lastname: Lin
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Shih-Ni
authors.initials: SN
authors.lastname: Chang
authors.affiliation: Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Che-Yi
authors.initials: CY
authors.lastname: Chou
authors.affiliation: Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.affiliation: Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chiz-Tzung
authors.initials: CT
authors.lastname: Chang
authors.affiliation: Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan Department of Health Services Administration, China Medical University, Taichung, Taiwan.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D009980:Influenza A virus / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010530:Peritoneal Dialysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012621:Seasons; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D014611:Vaccination / Q000379:methods*
chemical_list: D007252:Influenza Vaccines
keywords: end-stage renal disease; influenza vaccination; morbidity; mortality; peritoneal dialysis