[Immunizations for patients with kidney disease]

A cross-sectional survey study on influenza and pneumococcal vaccination rates and the factors affecting vaccination rates in hemodialysis patients in Kocaeli Province of Turkey

OBJECTIVE

This study aimed to investigate the rates of influenza and pneumococcal vaccinations and the factors affecting vaccination rates in hemodialysis patients.

METHODS

The study included 360 hemodialysis patients. Patients' data were collected via a questionnaire form applied during a face-to-face interview.

RESULTS

Of the patients, 51.4% vaccinated at least once with influenza vaccine and 14.4% vaccinated with pneumococcal vaccine. While 31.4% of the patients had annual vaccination regularly for influenza, 20% were vaccinated irregularly. Of the patients with missing vaccination, 76.2% reported the reason for not being vaccinated as lack of knowledge about the relevant vaccine. At initial evaluation in the beginning of the study, the percentage of patients vaccinated with both influenza and pneumococcal vaccines was 10.8%. After informing the patients in the face-to-face interview, 89.7% of them reported that they planned to have both vaccines (p < 0.001). The rate of vaccine refusal, which was 17.8% at the initial evaluation, reduced to 10.3% at the end of the interview (p < 0.001). The most common source of information about influenza and pneumococcal vaccines (44%-43.3%, respectively) was dialysis nurses. Majority of the patients (87%) were vaccinated in the hemodialysis units.

CONCLUSION

The rates of pneumococcal and influenza vaccinations in dialysis patients were observed to be below the targeted rates and the main reason for such low rates was lack of information/recommend. All health care professionals, providing the patients with information about vaccinations, using communication tools such as media, phone, mails that facilitate to reach large populations more easily may enhance vaccination rates.

Humoral Response after SARS-CoV-2 mRNA Vaccination in a Cohort of Hemodialysis Patients and Kidney Transplant Recipients

BACKGROUND

Kidney transplant recipients and patients receiving hemodialysis are immunocompromised populations that are prioritized for COVID-19 vaccination but were excluded from clinical trials of SARS-CoV-2 mRNA vaccines. Antibody titers and rates of seroconversion after vaccination are lower among patients with CKD and those taking immunosuppressants compared with controls. Data are lacking regarding their humoral response to vaccination to prevent COVID-19.

METHODS

This investigation of early serological response after COVID-19 vaccination with the Pfizer/BioNTech (BNT162b2) mRNA vaccine included 78 patients undergoing hemodialysis, 74 kidney transplant recipients, and seven healthy controls. We recorded data from the medical file for various clinical parameters, including response to hepatitis B vaccination, and measured antibody titers against SARS-CoV-2 at 0, 14, 28, 36, and 58 days after the first injection.

RESULTS

In controls, we detected antibodies at a positive level (>13 arbitrary units per ml; AU/ml) at day 14 postinjection, which increased progressively to peak at day 36 (1082 AU/ml; interquartile range [IQR], 735.0-1662.0). Patients undergoing hemodialysis had lower titers that peaked at day 58 (276 AU/ml; IQR, 83.4-526.0). We detected a positive antibody level in only three transplant recipients at day 36. In patients on hemodialysis, those aged <75 years had a higher antibody response versus those aged >75 years, and serum albumin and Kt/V were positively correlated with serological response (P<0.04 and P<0.0, respectively); nonresponders to HBV vaccine had the lowest anti-SARS-CoV-2 antibody titers.

CONCLUSIONS

Our results suggest that the postvaccination humoral response is strongly inhibited by immunosuppressant therapy in kidney transplant recipients, and is reduced by the uremic condition in patients undergoing hemodialysis.