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Hielscher F, Schmidt T, Enders M, Leyking S, Gerhart M, van Bentum K, Mihm J, Schub D, Sester U, Sester M. The inactivated herpes zoster vaccine HZ/su induces a varicella zoster virus specific cellular and humoral immune response in patients on dialysis. EBioMedicine 2024; 108:105335. [PMID: 39265505 PMCID: PMC11416227 DOI: 10.1016/j.ebiom.2024.105335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND To evaluate the immunogenicity of the inactivated herpes-zoster vaccine HZ/su in patients at increased risk for VZV-reactivation, we analysed the quantity and quality of the vaccine-induced cellular and humoral immunity in patients on dialysis with uremic immunodeficiency. METHODS In this observational study, 29 patients and 39 immunocompetent controls underwent standard dual-dose vaccination. Blood samples were analysed before and two weeks after each vaccination, and after one year. Specific T-cells were characterized after stimulation with VZV-gE-peptides based on induction of cytokines and CTLA-4-expression using flow-cytometry. Antibodies were analysed using ELISA. FINDINGS Both groups showed an increase in VZV-gE-specific CD4 T-cell levels over time (p < 0.0001), although median levels reached after second vaccination were lower in patients (0.17% (IQR 0.21%)) than in controls (0.24% (IQR 0.3%), p = 0.042). VZV-gE specific CD8 T-cells were only poorly induced. CTLA-4 expression on VZV-gE-specific CD4 T-cells was strongest after second dose with no differences between the groups (p = 0.45). Multifunctional cells co-expressing IFNγ, IL-2, and TNF were higher in patients after first vaccination (p = 0.028). Median VZV-specific IgG-levels reached a maximum after second vaccination with significantly lower levels in patients (10796 (IQR 12482) IU/l) than in controls (16899 (IQR 14019) IU/l, p = 0.009). Despite similar CD4 T-cell levels after one year (p = 0.415), antibody levels remained significantly lower in patients (p = 0.0008). INTERPRETATION VZV-gE vaccination induced specific antibodies and CD4 T-cells in both patients and controls, whereas CD8 T-cell-induction was poor. Quantitative and qualitative differences in immunity may indicate reduced duration of protection which may necessitate booster vaccinations in patients on dialysis. FUNDING HOMFORexzellent (to D.S.).
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Affiliation(s)
- Franziska Hielscher
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Tina Schmidt
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | | | | | - Markus Gerhart
- Nieren- und Dialysezentrum St. Wendel, St. Wendel, Germany
| | - Kai van Bentum
- Heimdialyse Saar e.V. Dialysezentrum Homburg, Homburg, Germany
| | - Janine Mihm
- Department of Nephrology, SHG-Klinikum Völklingen, Germany
| | - David Schub
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Urban Sester
- Department of Nephrology, SHG-Klinikum Völklingen, Germany
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany; Center for Gender-specific Biology and Medicine (CGBM), Saarland University; Homburg, Germany.
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Stefanizzi P, Moscara L, Palmieri C, Martinelli A, Di Lorenzo A, Venerito V, Germinario CA, Tafuri S. Safety profile of recombinant adjuvanted anti-herpes zoster vaccine (RZV) in high-risk groups: Data from active surveillance program. Puglia (Italy), 2021-23. Vaccine 2024; 42:2966-2974. [PMID: 38582693 DOI: 10.1016/j.vaccine.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Since 2021 a recombinant adjuvanted anti-Herpes Zoster vaccine(Recombinant Zoster Vaccine, RZV) is offered in Italy to high-risk patients. Few real-life data about RZV safety are available in target populations. OBJECTIVES This study investigates Adverse Events Following Immunization(AEFIs), baseline disease flare-ups, and Herpes Zoster (HZ) episodes occurring after RZV administration in a heterogeneous population of fragile patients to design its safety profile. METHODS This is a retrospective population-based study. RZV-vaccinated patients at Bari Policlinico General Hospital vaccination clinic from October 1st, 2021, to March 31st, 2023, were enrolled. Subjects were screened for reason of RZV eligibility and baseline chronic pathologies. AEFIs occurred in the first 7-days post-vaccination period were collected, and baseline disease flare-ups and post-vaccination HZ episodes were assessed via a 3-month follow-up. RESULTS Five-hundred-thirty-eight patients were included and total of 1,031 doses were administered. Most patients were vaccinated due to ongoing immunosuppressive therapy(54.65 %); onco-hematological and cardiovascular conditions were the most common chronic baseline pathologies. Out of 1,031 follow-ups, 441 AEFI cases were reported(42.7/100). The most common symptoms were injection site pain/itching(35.60/100), asthenia/malaise(11.44/100), and fever (10.09/100). Four serious AEFIs occurred(0.38/100). Older age, male sex, and history of cardiovascular diseases(OR:0.71; 95CI:0.52-0.98; p-value <0.05) were found to decrease AEFIs risk, while endocrine-metabolic illnesses(OR:1.61; 95CI:1.15-2.26; p-value <0.05) increased it. Twelve patients(2.23 %) reported a flare-up/worsening of their baseline chronic condition within the first three months after vaccination(mean interval 31.75 days, range 0-68 days). Patients with rheumatological illnesses had a higher risk of relapse(OR:16.56; 95CI:3.58-76.56; p-value <0.001), while male sex behaved as a protective factor. Twelve patients who completed the vaccination cycle(2.43%) had at least one HZ episode by the long-term follow-up. CONCLUSIONS The study demonstrates RZV safety in a significant number of high-risk patients. Hence, RZV should be actively offered as part of tailored vaccination programs to decrease the burden of HZ in fragile populations.
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Affiliation(s)
- Pasquale Stefanizzi
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | - Lorenza Moscara
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Claudia Palmieri
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Andrea Martinelli
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Antonio Di Lorenzo
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Vincenzo Venerito
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Cinzia Annatea Germinario
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Silvio Tafuri
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
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Shah P, Hanson M, Waller JL, Tran S, Baer SL, Taskar V, Bollag WB. The Assessment of Infection Risk in Patients with Vitiligo Undergoing Dialysis for End-Stage Renal Disease: A Retrospective Cohort Study. Pathogens 2024; 13:94. [PMID: 38276167 PMCID: PMC10821439 DOI: 10.3390/pathogens13010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Vitiligo is an autoimmune condition that causes patchy skin depigmentation. Although the mechanism by which vitiligo induces immunocompromise is unclear, other related autoimmune diseases are known to predispose those affected to infection. Individuals with vitiligo exhibit epidermal barrier disruption, which could potentially increase their susceptibility to systemic infections; patients with renal disease also show a predisposition to infection. Nevertheless, there is little research addressing the risk of infection in dialysis patients with vitiligo in comparison to those without it. A retrospective analysis was performed on patients with end-stage renal disease (ESRD) in the United States Renal Data System who started dialysis between 2004 and 2019 to determine if ESRD patients with vitiligo are at an increased risk of bacteremia, cellulitis, conjunctivitis, herpes zoster, or septicemia. Multivariable logistic regression modeling indicated that female sex, black compared to white race, Hispanic ethnicity, hepatitis C infection, and tobacco use were associated with an enhanced risk of vitiligo, whereas increasing age and catheter, versus arteriovenous fistula, and access type were associated with a decreased risk. After controlling for demographics and clinical covariates, vitiligo was found to be significantly associated with an increased risk of bacteremia, cellulitis, and herpes zoster but not with conjunctivitis and septicemia.
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Affiliation(s)
- Pearl Shah
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (P.S.); (M.H.); (S.T.); (S.L.B.); (V.T.)
| | - Mitchell Hanson
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (P.S.); (M.H.); (S.T.); (S.L.B.); (V.T.)
| | - Jennifer L. Waller
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA;
| | - Sarah Tran
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (P.S.); (M.H.); (S.T.); (S.L.B.); (V.T.)
| | - Stephanie L. Baer
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (P.S.); (M.H.); (S.T.); (S.L.B.); (V.T.)
- Charlie Norwood VA Medical Center, Augusta, GA 30904, USA
| | - Varsha Taskar
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (P.S.); (M.H.); (S.T.); (S.L.B.); (V.T.)
| | - Wendy B. Bollag
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (P.S.); (M.H.); (S.T.); (S.L.B.); (V.T.)
- Charlie Norwood VA Medical Center, Augusta, GA 30904, USA
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA
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Gobbi L, Martino FK, Sgrò E, Nalesso F, Calo’ LA. Varicella Zoster vaccination in hemodialysis patients: The state of the art. Hum Vaccin Immunother 2023; 19:2286689. [PMID: 38010087 PMCID: PMC10760358 DOI: 10.1080/21645515.2023.2286689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023] Open
Abstract
Varicella Zoster Virus (VZV) infection is a common childhood exanthematous disease, which in adults and immunocompromised people may result in severe neurologic complications. Up to one-third of infected subjects may have VZV clinical reactivation particularly if immunocompromised. Patients affected by end-stage renal disease on hemodialysis present immunodepression that contributes to their higher incidence of VZV infections and reactivation. While antiviral treatment in these patients shows low efficacy, the prevention of VZV through vaccination avoids the primary infection and the risk of reactivation. Two VZV vaccines are currently available: the live attenuate Zoster Vaccine (LZV) and a Recombinant Zoster Vaccine (RZV), with the latter appearing to provide greater efficacy. Given the higher incidence of VZV infection and reactivation, the lesser response to antivirals and the lower impact of VZ vaccine in hemodialysis patients in terms of side effects, a higher diffusion of VZV vaccination should be promoted by nephrologists in these patients in particular in those with future transplant opportunities.
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Affiliation(s)
- Laura Gobbi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Francesca Katiana Martino
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Elena Sgrò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Federico Nalesso
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Lorenzo A. Calo’
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
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Martino FK, Pini S, Scaparrotta G, Schirinzi M, Gnappi M, Fragasso A, Zanella R, Naso E, De Giorgi ML, Carraro G, Nalesso F, Calò LA. Recombinant Varicella Zoster vaccine in haemodialysis facilities: adherence and safety. J Nephrol 2023; 36:2155-2158. [PMID: 37392330 DOI: 10.1007/s40620-023-01690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/23/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Francesca K Martino
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Stefano Pini
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giuseppe Scaparrotta
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Marilena Schirinzi
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Maddalena Gnappi
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Antonio Fragasso
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Ruggero Zanella
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Elena Naso
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Maria Loreta De Giorgi
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Gianni Carraro
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Federico Nalesso
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Lorenzo A Calò
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
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Srimanan W, Panyakorn S. Orbital apex syndrome due to herpes zoster infection in a patient with chronic kidney disease: A case report. Clin Case Rep 2023; 11:e6839. [PMID: 36654694 PMCID: PMC9834609 DOI: 10.1002/ccr3.6839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
We report the case of an 89-year-old man with typical herpes zoster ophthalmicus on the left side of his face with delayed clinical presentation of orbital apex syndrome. After treatment with intravenous antiviral agents and corticosteroids, the patient fully recovered. Clinical suspicion should be concerned in immunocompromised cases.
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Wang YC, Juan SH, Li CH, Chou CL, Chen LY, Chien LN, Fang TC. Valacyclovir-associated neurotoxicity among patients on hemodialysis and peritoneal dialysis: A nationwide population-based study. Front Med (Lausanne) 2022; 9:997379. [PMID: 36203771 PMCID: PMC9530346 DOI: 10.3389/fmed.2022.997379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Whether valacyclovir-associated neurotoxicity (VAN) occurs more frequently in patients with end-stage renal disease (ESRD) on dialysis is unknown. This is the first population-based study to examine the risk of VAN associated with ESRD patients on dialysis. Among 2,284,800 patients diagnosed as having herpes zoster from 2002 to 2016, patients with ESRD on dialysis and individuals with normal renal function were enrolled in this study. Following propensity score matching, we compared the risk of altered mental status between valacyclovir users and non-users in the ESRD and normal renal function cohorts over a 30-day follow-up period. In the ESRD cohort, the incidence of altered mental status was 1.68 and 0.52 per 1,000 person-day in valacyclovir users and non-users, respectively, with an adjusted hazard ratio (HR) of 3.22 (95% confidence interval [CI]: 2.04–4.99, P < 0.001). The incidence of altered mental status of valacyclovir users on hemodialysis (HD) and peritoneal dialysis (PD) was higher than that of non-users. The adjusted HR was 3.20 (95% CI: 1.98–5.15, P < 0.001) for those on HD and 3.44 (95% CI: 1.13–10.49, P = 0.030) for those with PD. However, altered mental status was not observed in patients on HD receiving ≤500 mg of valacyclovir three times per week or in those on PD receiving ≤500 mg of valacyclovir per day. The findings demonstrate that adjusting the valacyclovir dosage and monitoring VAN in patients with HD and PD who have herpes zoster is crucial.
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Affiliation(s)
- Yi-Chun Wang
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shu-Hui Juan
- Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Hao Li
- Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chu-Lin Chou
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Li-Ying Chen
- Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Li-Nien Chien
- Institute of Health and Welfare Policy, College of Medicince, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
- Li-Nien Chien,
| | - Te-Chao Fang
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Te-Chao Fang,
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Ketteler M, Wiecek A, Rosenkranz AR, Ose C, Rekowski J, Lorenz H, Hellmann B, Karus M, Ruhmann M, Ammer R. Modified-release nicotinamide for the treatment of hyperphosphataemia in haemodialysis patients: 52-week efficacy and safety results of the phase III randomised controlled NOPHOS trial. Nephrol Dial Transplant 2022; 38:982-991. [PMID: 35751625 PMCID: PMC10064978 DOI: 10.1093/ndt/gfac206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We previously reported that modified-release nicotinamide (NAMR) was superior to placebo in reducing serum phosphate concentrations over 12 weeks in a large cohort of haemodialysis patients with hyperphosphataemia. Here, we report outcomes after 52 weeks of treatment. METHODS NOPHOS was a phase III, international, randomised, controlled, double-blind trial in parallel group design. NAMR (250-1500 mg/d) was investigated in comparison to placebo as an add-on therapy to an individual therapy with approved phosphate binders. RESULTS In the intention-to-treat population (NAMR: N = 539, placebo: N = 183), serum phosphate was significantly lower in the NAMR group compared to the placebo group at W24 (5.40 ± 1.55 mg/dl vs. 5.79 ± 1.37 mg/dl, P < 0.001) with a mean difference of -0.39 mg/dl [95% CI -0.66, -0.13], but was comparable between the groups at W52 (mean difference -0.08 [95% CI -0.36, 0.20]). In the completer population (N = 358), statistical significance in favour of NAMR was reached at W24 and W52. The treatment effect was reduced in patients with high baseline serum intact parathyroid hormone (iPTH) compared to patients with low baseline serum iPTH. Compliant patients in the NAMR group had a more pronounced and sustained reduction in serum phosphate than non-compliant patients. NAMR treatment was associated with a significantly increased risk of thrombocytopenia, pruritus, anaemia, and diarrhoea. Herpes zoster occurred exclusively in patients randomised to NAMR. CONCLUSIONS NAMR combined with phosphate binders significantly reduced serum phosphate over the first 24 weeks of treatment, but the treatment effect was not maintained up to W52. Non-compliance may have contributed to reduced long-term efficacy. Several newly identified safety signals warrant further evaluation.
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Affiliation(s)
- Markus Ketteler
- Robert Bosch Hospital, Department of General Internal Medicine and Nephrology, Stuttgart,Germany.,University of Split, School of Medicine, Split, Croatia
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Poland
| | - Alexander R Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Claudia Ose
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Rekowski
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Horst Lorenz
- BBS-Büro für Biometrie und Statistik, Neuberg, Germany
| | - Burkhard Hellmann
- Medical Department, MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Michael Karus
- Medical Department, MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Michaela Ruhmann
- Medical Department, MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Richard Ammer
- Medical Department, MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany.,Department of Nephrology, University Hospital Münster, Münster, Germany
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Mongy NNE, Hilal RF. How far is vitamin D implicated in cutaneous infections. Clin Dermatol 2021; 40:198-205. [PMID: 34893391 DOI: 10.1016/j.clindermatol.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Vitamin D is an important cornerstone in the immunologic cascade of many skin infections, systemic infections with cutaneous presentations, and other infectious dermatologic diseases where infections could be a culprit. Vitamin D supplementation is proposed as a protective measure against their occurrence and exacerbation, especially with the emergence of several viral pandemics in recent years. Vitamin D plays a key role in the maintenance of a balanced immunologic profile which could be reflected by a lowered incidence and morbidity of infections. Vitamin D screening and supplementation in patients with deficiencies or insufficiencies should be a part of the dermatologic approach to patients with these diseases.
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Affiliation(s)
- Naglaa Nabil El Mongy
- Professor of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| | - Rana Fathy Hilal
- Associate Professor of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, Egypt.
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Risk Factors for Herpes Zoster in Patients with Chronic Kidney Disease: A Case-Control Study. Vaccines (Basel) 2021; 9:vaccines9090963. [PMID: 34579200 PMCID: PMC8473266 DOI: 10.3390/vaccines9090963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Chronic kidney disease (CKD) increases the susceptibility to the presence of herpes zoster (HZ). Little is known about the risk factors of HZ in CKD patients; (2) Methods: This is a case-control study. CKD patients diagnosed with HZ between January 2015 and June 2021 in a tertiary hospital were identified. One age- and gender- matched control was paired for each case, matched to the date of initial HZ diagnosis. Conditional multiple logistic regression was used to evaluate the risk factors associated with the presence of HZ; (3) Results: Forty-seven HZ patients and controls were identified. In general, about 73.40% (69 out of 94) patients were classified at IV to V stages of CKD. Immunosuppressive agents (p = 0.0012) and dialysis therapy (p = 0.021) were reported more frequently in the HZ cohort. Compared with the control group, the total white cell count and lymphocyte count were significantly lower in the HZ group (p value of 0.032 and 0.003, respectively). The conditional logistics regression model revealed that previous immunosuppressants administration (odds ratio: 10.861, 95% CI: 2.092~56.392, p = 0.005) and dialysis therapy (odds ratio: 3.293, 95% CI: 1.047~10.355, p = 0.041) were independent risk factors of HZ in the CKD population; (4) Conclusions: Dialysis and immunosuppressants therapy were associated with greater risk of HZ disease in CKD patients. Further guideline may highlight the necessity of zoster vaccine for patients with CKD, who undertake associated treatment.
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Schwade MJ, Tien L, Waller JL, Davis LS, Baer SL, Mohammed A, Young L, Kheda MF, Bollag WB. Treatment of psoriasis in end-stage renal disease patients is associated with decreased mortality: A retrospective cohort study. Am J Med Sci 2021; 362:24-33. [PMID: 33798461 DOI: 10.1016/j.amjms.2021.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/18/2021] [Accepted: 03/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Psoriasis impairs the quality of life of approximately 7.5 million Americans and is associated with serious comorbidities. Because of chronic vascular access and epidermal dysfunction, end-stage renal disease (ESRD) patients with psoriasis may be at greater risk for infection, and psoriasis treatment could affect this risk. METHODS A retrospective cohort analysis was performed using the United States Renal Data System from 2004-2011 to investigate the association of psoriasis with infections common to ESRD patients, as well as the effect of psoriasis treatment on infection risk as well as mortality. RESULTS A total of 8,911 psoriasis patients were identified. Psoriasis was associated with a significantly increased risk for all queried infections, especially cellulitis (adjusted relative risk = 1.55), conjunctivitis (1.47), and onychomycosis (1.36). Psoriasis treatment (systemic, local, and light) was associated with a significantly decreased risk of some infections. Psoriasis treatment was also correlated with a significantly decreased risk of mortality, with systemic therapies (biologics and other immunosuppressants) showing the greatest reduction (adjusted hazard ratio = 0.55). CONCLUSIONS These results suggest that psoriasis-ESRD patients may have an increased risk of infection and treatment of psoriasis is associated with a reduced risk of some infections and improved survival.
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Affiliation(s)
- Mark J Schwade
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Lillie Tien
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Jennifer L Waller
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Loretta S Davis
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia; Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Stephanie L Baer
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia; Charlie Norwood VA Medical Center, Augusta, Georgia
| | - Azeem Mohammed
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Lufei Young
- Department of Physiological and Technological Nursing, Augusta University, Augusta, Georgia
| | | | - Wendy B Bollag
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia; Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia; Charlie Norwood VA Medical Center, Augusta, Georgia; Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia.
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12
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Lai SW, Kuo YH, Lin CL, Liao KF. Risk of herpes zoster among patients with predialysis chronic kidney disease in a cohort study in Taiwan. Int J Clin Pract 2020; 74:e13566. [PMID: 32479686 DOI: 10.1111/ijcp.13566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/02/2020] [Accepted: 05/26/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/OBJECTIVE Patients on chronic dialysis are at risk of developing herpes zoster, but little systematic research focuses on the association between predialysis chronic kidney disease and herpes zoster. The objective of the study was to explore the association between predialysis chronic kidney disease and herpes zoster in Taiwan. METHODS A nation-based retrospective cohort study was performed using the 2005-2012 database of the Taiwan National Health Insurance Program. There were 16 655 subjects aged 20-84 years with newly diagnosed predialysis chronic kidney disease as the study group and 33 310 randomly selected subjects without chronic kidney disease as the comparison group. Both groups were matched with sex, age, comorbidities and the year of the index date. The incidence rates of herpes zoster in both groups were calculated. The multivariable Cox proportional hazards regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for herpes zoster associated with predialysis chronic kidney disease. RESULTS The overall incidence rate of herpes zoster was 1.4-fold higher in the predialysis chronic kidney disease group than that in the non-chronic kidney disease group (8.76 vs 6.27 per 1000 person-years, 95% CI 1.27-1.54; P < .001). After controlling for co-variables, the adjusted HR of herpes zoster was 1.38 (95% CI 1.25-1.53; P < .001) for subjects with predialysis chronic kidney disease compared with non-chronic kidney disease subjects. The adjusted HR increased to 1.65 for subjects with predialysis chronic kidney disease and with any comorbidity (95% CI 1.42-1.92; P < .001). CONCLUSIONS Patients with predialysis chronic kidney disease correlate with approximately 1.4-fold increased hazard of developing herpes zoster.
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Affiliation(s)
- Shih-Wei Lai
- College of Medicine, and College of Public Health, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Hung Kuo
- Department of Research, Taichung Tzu Chi Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- College of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taichung, Taiwan
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13
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Wolthuis DFGJ, de Mare S, Verhave JC. Limited skin lesions in a haemodialysis patient. Eur J Intern Med 2020; 72:94-95. [PMID: 31901296 DOI: 10.1016/j.ejim.2019.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Affiliation(s)
- David F G J Wolthuis
- Department of Internal Medicine, Rijnstate Hospital, P.O. Box 9555, 6800 TA Arnhem, the Netherlands
| | - Saskia de Mare
- Department of Dermatology, Rijnstate Hospital, P.O. Box 9555, 6800 TA Arnhem, the Netherlands
| | - Jacobien C Verhave
- Department of Internal Medicine, Rijnstate Hospital, P.O. Box 9555, 6800 TA Arnhem, the Netherlands.
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14
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Marra F, Parhar K, Huang B, Vadlamudi N. Risk Factors for Herpes Zoster Infection: A Meta-Analysis. Open Forum Infect Dis 2020; 7:ofaa005. [PMID: 32010734 PMCID: PMC6984676 DOI: 10.1093/ofid/ofaa005] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/07/2020] [Indexed: 12/19/2022] Open
Abstract
Background The burden of herpes zoster (HZ) is significant worldwide, with millions affected and the incidence rising. Current literature has identified some risk factors for this disease; however, there is yet to be a comprehensive study that pools all evidence to provide estimates of risk. Therefore, the purpose of this study is to identify various risk factors, excluding immunosuppressive medication, that may predispose an individual to developing HZ. Methods The literature search was conducted in MEDLINE, EMBASE, and Cochrane Central, yielding case control, cohort, and cross-sectional studies that were pooled from January 1966 to September 2017. Search terms included the following: zoster OR herpe* OR postherpe* OR shingle* AND risk OR immunosupp* OR stress OR trauma OR gender OR ethnicity OR race OR age OR diabetes OR asthma OR chronic obstructive pulmonary disease OR diabetes. Risk ratios (RRs) for key risk factors were calculated via natural logarithms and pooled using random-effects modeling. Results From a total of 4417 identified studies, 88 were included in analysis (N = 3, 768 691 HZ cases). Immunosuppression through human immunodeficiency virus/acquired immune deficiency syndrome (RR = 3.22; 95% confidence interval [CI], 2.40–4.33) or malignancy (RR = 2.17; 95% CI, 1.86–2.53) significantly increased the risk of HZ compared with controls. Family history was also associated with a greater risk (RR = 2.48; 95% CI, 1.70–3.60), followed by physical trauma (RR = 2.01; 95% CI, 1.39–2.91) and older age (RR = 1.65; 95% CI, 1.37–1.97). A slightly smaller risk was seen those with psychological stress, females, and comorbidities such as diabetes, rheumatoid arthritis, cardiovascular diseases, renal disease, systemic lupus erythematosus, and inflammatory bowel disease compared with controls (RR range, 2.08–1.23). We found that black race had lower rates of HZ development (RR = 0.69; 95% CI, 0.56–0.85). Conclusions This study demonstrated a number of risk factors for development of HZ infection. However, many of these characteristics are known well in advance by the patient and clinician and may be used to guide discussions with patients for prevention by vaccination.
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Affiliation(s)
- Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kamalpreet Parhar
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bill Huang
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nirma Vadlamudi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Yamada S, Tatsumoto N, Nakamura N, Masutani K, Maeda T, Kitazono T, Tsuruya K. Bacterial meningitis and multiple abscess formation in the iliopsoas, erector spinae, and vastus lateralis muscle in a maintenance hemodialysis patient treated with continuous epidural anesthesia for herpes zoster-related pain control: a case report and review of the literature. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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16
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Rondaan C, de Joode AAE, van Assen S, Bos NA, Westerhuis R, Westra J. Increased incidence of herpes zoster in patients on renal replacement therapy cannot be explained by intrinsic defects of cellular or humoral immunity to varicella-zoster virus. Antiviral Res 2018; 158:206-212. [PMID: 30102958 DOI: 10.1016/j.antiviral.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients in need of long-term renal replacement therapy (RRT) are known to be at increased risk of herpes zoster, occurring when the latently present varicella-zoster virus (VZV) reactivates. In this study we investigated immunity to VZV in patients receiving RRT, with the aim of better understanding the mechanism behind the increased risk. METHODS Patients treated for at least three months with hemodialysis or peritoneal dialysis, and matched healthy controls (HC) were included. Cellular immunity to varicella-zoster virus (VZV) was studied using an interferon-γ (IFNγ) enzyme-linked immunospot (ELISpot) assay, flow-cytometric analysis of cytokine production and a proliferation assay. Humoral immunity was determined by measuring immunoglobulin (Ig)G antibody levels to VZV using an in-house glycoprotein enzyme-linked immunosorbent assay (ELISA). Multiple regression was used to assess variables of influence on measures of cellular and humoral immunity to VZV in patients receiving RRT. RESULTS Similar numbers of IFNγ spot-forming cells and levels of VZV-IgG were found in 97 patients and 89 HC. Age and transplantation history were negatively associated with cellular immunity (p = 0.001 and p = 0.012, respectively) while treatment modality, gender and urea levels were not. No variables were found to be associated with VZV-IgG levels. CONCLUSIONS Increased incidence of herpes zoster in patients receiving RRT cannot be explained by intrinsic defects of cellular or humoral immunity to VZV as measured by the methods used in this study, although older age and previous transplantation were associated with decreased cellular immunity to VZV. Herpes zoster susceptibility might be caused by a diminished function of otherwise capable T cells in a uremic environment.
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Affiliation(s)
- Christien Rondaan
- Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Anoek A E de Joode
- Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Sander van Assen
- Department of Internal Medicine (Infectious Diseases), Treant Care Group, Dr. G.H. Amshoffweg 1, 7909 AA, Hoogeveen, The Netherlands.
| | - Nicolaas A Bos
- Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Ralf Westerhuis
- Dialysis Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Johanna Westra
- Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
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17
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Ahn JH, Waller JL, Baer SL, Colombo RE, Kheda MF, Nahman NS, Turrentine JE. Mortality risk after herpes zoster infection in end-stage renal disease patients. Clin Kidney J 2018; 12:101-105. [PMID: 30746135 PMCID: PMC6366125 DOI: 10.1093/ckj/sfy058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/04/2018] [Indexed: 12/18/2022] Open
Abstract
Background End-stage renal disease (ESRD) patients have increased risk of developing herpes zoster (zoster) compared with the general population, but mortality risk is unknown. We assessed the risk of mortality in hospitalized ESRD patients with a diagnosis of zoster from the inpatient hospital files (as opposed to outpatient records) of the United States Renal Data System. Methods This study analyzed incident ESRD patients from 2006 to 2009. Based on an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of zoster infection, we determined 2-year mortality following an inpatient diagnosis. Cox proportional hazards models were used to examine the association of mortality and zoster, when controlling for demographic and other clinical risk factors. Results Zoster was diagnosed in 2784 patients, 51% of whom died within 2 years, with a mean time to death of 8.1 months. Patients who died were more likely to be white and older, score higher on the Charlson Comorbidity Index (CCI) and have other clinical diagnoses besides CCI. Increased risk of death within 2 years was associated with older age (adjusted hazard ratio 1.03), malnutrition (1.31), bacteremia/septicemia (1.16) and increasing CCI (1.10). Zoster vaccine was administered to 27 patients, but the small number precluded analysis of its impact. Conclusions Mortality in ESRD patients with an inpatient zoster diagnosis is increased with older age and higher severity of clinical comorbidities. The role of zoster vaccination on mortality in this population remains to be defined.
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Affiliation(s)
- John H Ahn
- Department of Medicine, Augusta University, Augusta, GA, USA
| | - Jennifer L Waller
- Department of Population Health Sciences, Augusta University, Augusta, GA, USA
| | - Stephanie L Baer
- Department of Medicine, Augusta University, Augusta, GA, USA.,Charlie Norwood VAMC, Augusta, GA, USA
| | | | | | - N Stanley Nahman
- Department of Medicine, Augusta University, Augusta, GA, USA.,Charlie Norwood VAMC, Augusta, GA, USA
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18
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Kawai K, Yawn BP. Risk Factors for Herpes Zoster: A Systematic Review and Meta-analysis. Mayo Clin Proc 2017; 92:1806-1821. [PMID: 29202939 DOI: 10.1016/j.mayocp.2017.10.009] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To systematically review studies examining risk factors for herpes zoster (HZ). METHODS We performed a literature search using PubMed, EMBASE, and Web of Science for articles published from January 1, 2003, to February 1, 2017. A random-effects model was used to summarize the risk ratio (RR) or odds ratio (OR) and 95% CI. RESULTS Of the 3450 studies screened, we included 84 studies in the systematic review and conducted meta-analysis in 62 studies. Women were at increased risk of HZ compared with men (pooled adjusted RR, 1.31; 95% CI, 1.27-1.34). Black individuals had almost half the risk of HZ as white individuals (pooled RR, 0.54; 95% CI, 0.47-0.63). Family history was found to be a risk factor for HZ (pooled OR, 3.59; 95% CI, 2.39-5.40). Autoimmune diseases, including rheumatoid arthritis (pooled RR, 1.67; 95% CI, 1.41-1.98) and systemic lupus erythematosus (pooled RR, 2.10; 95% CI, 1.40-3.15), were associated with an elevated risk of HZ. Other comorbidities were associated with an increased risk of HZ, with the pooled RRs ranging from 1.25 (95% CI, 1.13-1.39) for asthma to 1.30 (95% CI, 1.17-1.45) for diabetes mellitus and 1.31 (95% CI, 1.22-1.41) for chronic obstructive pulmonary disease. CONCLUSION Our review revealed that female sex, race/ethnicity, family history, and comorbidities are risk factors for HZ. Efforts are needed to increase the uptake of zoster vaccination.
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Affiliation(s)
- Kosuke Kawai
- Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, MA.
| | - Barbara P Yawn
- Department of Family Medicine and Community Health, University of Minnesota, Blaine, MN
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19
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Levin MJ, Bresnitz E, Popmihajlov Z, Weinberg A, Liaw KL, Willis E, Curtis JR. Studies with herpes zoster vaccines in immune compromised patients. Expert Rev Vaccines 2017; 16:1217-1230. [PMID: 29053937 DOI: 10.1080/14760584.2017.1395703] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The active component of the herpes zoster vaccine (ZVL), licensed for people ≥50 years of age, is a live attenuated varicella-zoster virus. ZVL is contraindicated for immune compromised individuals, with limited regard to the degree of immunosuppression. Areas covered: This review evaluates phase I and II and observational studies for ZVL, and published reports of the off-label use of ZVL, for conditions and therapies for which investigators considered the risk-benefit for using ZVL to be favorable. It also discusses exploratory trials of ZVL for additional immune compromising conditions, and summarizes clinical guidelines from many countries and professional societies that are based upon recent investigations. Studies in immune compromised patients of investigational vaccines that do not contain live virus are reviewed. Expert commentary: It is likely that past and ongoing research with ZVL will define immune compromising diseases and/or therapies for which the risk-benefit for using ZVL vaccine is favorable. The main variables to consider in this assessment in immune compromised patients are safety, immunogenicity, protection against herpes zoster, and persistence of protection. Vaccination against herpes zoster prior to suppressing immunity is an important clinical strategy, although efficacy of this approach has not been evaluated in a clinical trial.
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Affiliation(s)
- Myron J Levin
- a Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | | | | | - Adriana Weinberg
- a Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | | | | | - Jeffrey R Curtis
- c Division of Clinical Immunology and Rheumatology , University of Alabama , Birmingham , AL , USA
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20
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Kim SH, Choi SM, Kim BC, Choi KH, Nam TS, Kim JT, Lee SH, Park MS, Kim SJ. Risk Factors for Aseptic Meningitis in Herpes Zoster Patients. Ann Dermatol 2017; 29:283-287. [PMID: 28566903 PMCID: PMC5438933 DOI: 10.5021/ad.2017.29.3.283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 11/18/2022] Open
Abstract
Background Herpes zoster (HZ) is caused by reactivation of latent varicella-zoster virus (VZV) infection. HZ-associated aseptic meningitis, a rare complication of HZ, can require hospitalization and a long treatment period. Objective A retrospective study was performed to identify potential factors associated with HZ-associated aseptic meningitis development. Methods We included all outpatients and patients admitted in the neurology and dermatology departments of a single tertiary center, who were diagnosed with HZ for two years. Among 818 patients, 578 patients were eligible for analysis. Results The demographics and potential risk factors were compared between the uncomplicated HZ group (n=554) and aseptic meningitis group (n=24). Among the potential factors, the dermatological distribution of skin rash and gender showed statistically significantly different between the two groups. Patients with craniocervical distribution of HZ accounted for 87.5% (n=21) of the aseptic meningitis group and 54.3% (n=301) of the uncomplicated HZ group (p=0.043). The aseptic meningitis group had more men (66.7%, n=16) than the uncomplicated HZ group (42.8%, n=237, p=0.033). Patients with craniocervical distribution had an odds ratio (OR) of 5.884 (p=0.001) for developing aseptic meningitis when compared with the other dermatome involvements. Additional logistic regression analysis resulted in a fading between gender difference (p=0.050) and craniocervical involvement having an OR of 5.667 for aseptic meningitis (p=0.006). Conclusion In HZ patients, skin rash with craniocervical distribution and male gender were associated with a higher risk of aseptic meningitis.
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Affiliation(s)
- Sang-Hoon Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Seong-Min Choi
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Byeong C Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Tai-Seung Nam
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung-Han Lee
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Seong J Kim
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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Chen LK, Arai H, Chen LY, Chou MY, Djauzi S, Dong B, Kojima T, Kwon KT, Leong HN, Leung EMF, Liang CK, Liu X, Mathai D, Pan JY, Peng LN, Poblete ERS, Poi PJH, Reid S, Tantawichien T, Won CW. Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific. BMC Infect Dis 2017; 17:213. [PMID: 28298208 PMCID: PMC5353949 DOI: 10.1186/s12879-017-2198-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 01/09/2017] [Indexed: 02/05/2023] Open
Abstract
Background Herpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region. Methods We searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines. Results From 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand. HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years – lifetime risk is approximately one-third. Average incidence of 3–10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients’ quality of life and incur heavy healthcare utilisation. Conclusions Several countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2198-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan. .,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, 7-340 Morioka-cho, Obu, Aichi, 474-8511, Japan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan
| | - Ming-Yueh Chou
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386 Ta-Chun 1st Rd., Kaohsiung, 81362, Taiwan
| | - Samsuridjal Djauzi
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Salemba Raya No. 6, Jakarta, 10430, Indonesia
| | - Birong Dong
- The Center of Gerontology and Geriatrics, West China Medical School/West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Renmin Nan Lu, Chengdu, Sichuan, 610041, China
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Jongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ki Tae Kwon
- Division of Infectious Diseases, Daegu Fatima Hospital, 99 Ayang-ro, Dong-gu, Daegu, 710-600, Korea
| | - Hoe Nam Leong
- Rophi Clinic, 38 Irrawaddy Rd. #07-54/55, Mount Elizabeth Novena Specialist Centre, Singapore, 329563, Singapore
| | - Edward M F Leung
- Geriatric Medicine Centre (Healthy Ageing), Hong Kong Sanatorium and Hospital, 2 Village Rd. Happy Valley, Hong Kong S.A.R., China
| | - Chih-Kuang Liang
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386 Ta-Chun 1st Rd., Kaohsiung, 81362, Taiwan.,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Xiaohong Liu
- Division of Geriatrics, Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Dilip Mathai
- Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Jubilee Hills, Hyderabad, 500096, India
| | - Jiun Yit Pan
- National Skin Centre, 1 Mandalay Rd., Singapore, 308205, Singapore
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Eduardo Rommel S Poblete
- Geriatric Center, St. Luke's Medical Center, 279 E. Rodriguez Sr. Ave., Quezon City, 1102, Philippines
| | - Philip J H Poi
- Division of Geriatrics, Department of Medicine, University Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
| | - Stewart Reid
- Ropata Medical Centre, Lower Hutt, 5010, New Zealand
| | - Terapong Tantawichien
- Division of Infectious Diseases, Department of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, 1 Hoigi-dong, Dongdaemun-gu, Seoul, 130-720, Korea
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Al-Mula Abed YW. Varicella-zoster virus associated encephalitis in a patient undergoing haemodialysis. Qatar Med J 2016; 2015:19. [PMID: 26865994 PMCID: PMC4740353 DOI: 10.5339/qmj.2015.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/12/2016] [Indexed: 12/20/2022] Open
Abstract
We describe an elderly gentleman with end stage renal disease on haemodialysis who presented with ophthalmic zoster infection and was discharged on oral acyclovir. He presented again a few days later with confusion and expressive dysphasia. Differential diagnosis was mainly between varicella-zoster virus (VZV) associated encephalitis versus acyclovir toxicity. Cerebrospinal fluid analysis confirmed the diagnosis of VZV associated encephalitis and the patient was treated with intravenous acyclovir and steroids with full recovery back to pre-admission neurological status.
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Langan SM, Thomas SL, Smeeth L, Margolis DJ, Nitsch D. Zoster vaccination is associated with a reduction of zoster in elderly patients with chronic kidney disease. Nephrol Dial Transplant 2016; 31:2095-2098. [PMID: 26769683 PMCID: PMC5146705 DOI: 10.1093/ndt/gfv432] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 11/24/2015] [Indexed: 11/13/2022] Open
Abstract
Background Growing epidemiological evidence demonstrates increased zoster risks in people with chronic kidney disease (CKD). Study objectives were to determine zoster vaccine effectiveness in individuals with CKD in pragmatic use. Methods A population-based cohort study was undertaken in a 5% random sample of US Medicare from 2007 to 2009 involving 766 330 eligible individuals aged ≥65 years who were (29 785) and were not (736 545) exposed to the zoster vaccine. Incidence rates for zoster in vaccinated and unvaccinated individuals and hazard ratios for zoster comparing vaccinated with unvaccinated were determined for individuals with CKD. Time-updated Cox proportional hazards models were used, adjusting for relevant confounders. Results CKD was present in 183 762 (24%) of individuals (15% of vaccinees). Adjusted vaccine effectiveness [95% confidence intervals (CIs)] in individuals with CKD was 0.49 (0.36–0.65). The adjusted vaccine effectiveness in participants with both CKD and diabetes mellitus was 0.46 (95% CI 0.09–0.68). Vaccine effectiveness estimates were similar to those previously reported for the general population [vaccine effectiveness 0.48 (95% CI 0.39–0.56)]. Conclusions Zoster vaccine is effective against incident zoster in older individuals with CKD. Extra efforts are warranted to increase vaccine uptake in individuals with CKD given the known low uptake in these higher risk individuals.
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Affiliation(s)
- Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sara L Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David J Margolis
- Department of Dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Tseng HF, Luo Y, Shi J, Sy LS, Tartof SY, Sim JJ, Hechter RC, Jacobsen SJ. Effectiveness of Herpes Zoster Vaccine in Patients 60 Years and Older With End-stage Renal Disease. Clin Infect Dis 2015; 62:462-7. [PMID: 26671505 DOI: 10.1093/cid/civ930] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/21/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Unlike in a healthy population, the protection of herpes zoster (HZ) vaccine in end-stage renal disease (ESRD) patients might be insufficient, considering data demonstrating suboptimal response to other vaccines. The study evaluates the association between HZ vaccination and the subsequent HZ risk among ESRD patients. METHODS This cohort study included ESRD patients age ≥60 years who were enrolled in Kaiser Permanente Southern California. The vaccinated cohort included 582 patients who received HZ vaccine during 01/01/2007 through 12/31/2013. Each vaccinated patient was matched to five unvaccinated patients on age, sex, and dialysis duration. Subjects were passively followed through their electronic health records to identify HZ incidence. Cox regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) associated with vaccination. Kaplan-Meier estimates of the cumulative incidence were generated. RESULTS The number of HZ cases was 16 in 1373 person-years (11.7 per 1000 person-years; 95% CI, 7.1-19.0) among the vaccinated and 126 in 5644 person-years (22.3 per 1000 person-years; 95% CI, 18.7-26.6) among the unvaccinated. The 36-month cumulative risk of incident HZ was 4.1% and 6.6%, respectively. HZ vaccination was associated with a reduced risk of HZ (adjusted HR = 0.49; 95% CI, .29-.85). The reduced risk seems more prominent if the vaccine is given within two years of dialysis initiation. CONCLUSIONS Among ESRD patients age ≥60 years, receipt of HZ vaccine was associated with a lower incidence of HZ. In addition, HZ vaccination soon after the initiation of dialysis may provide greater protection.
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Affiliation(s)
- Hung Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Yi Luo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jiaxiao Shi
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Sara Y Tartof
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - John J Sim
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, California
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
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25
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Chao CT, Chiang CK, Huang JW, Hung KY. Vitamin D is closely linked to the clinical courses of herpes zoster: From pathogenesis to complications. Med Hypotheses 2015; 85:452-7. [DOI: 10.1016/j.mehy.2015.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 06/29/2015] [Indexed: 12/18/2022]
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High Risk of Herpes Zoster among Patients with Advance Acute Kidney Injury--A Population-Based Study. Sci Rep 2015; 5:13747. [PMID: 26333822 PMCID: PMC4558719 DOI: 10.1038/srep13747] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/03/2015] [Indexed: 12/23/2022] Open
Abstract
The risk for herpes zoster (HZ) in acute kidney injury (AKI) survivors was never explored. We identified 2,387 adults in the Taiwan National Health Insurance Research Database who recovered from dialysis-requiring AKI and matched them with non-recovery and non-AKI patients by propensity score. During a mean follow-up of 2.7 years, the incidences of HZ were 6.9, 8.2 and 4.8 episodes per 1,000 person-years in AKI-non-recovery, AKI-recovery and non-AKI group, respectively. The recovery group was more likely to develop herpes zoster than those without acute kidney injury [incidence-rate ratios 1.71, 95% confidence interval 1.16-2.52; p = 0.007]. Patients without acute kidney injury were less likely to develop herpes zoster than those AKI, recovered from dialysis or not (hazard ratio HR 0.66, 95% CI 0.46-0.95). Dialysis-requiring acute kidney injury poses a long-term risk of herpes zoster after hospital discharge. Even patients who have recovered from dialysis still carry a significantly higher risk of developing herpes zoster.
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Blein C, Gavazzi G, Paccalin M, Baptiste C, Berrut G, Vainchtock A. Burden of herpes zoster: the direct and comorbidity costs of herpes zoster events in hospitalized patients over 50 years in France. BMC Infect Dis 2015; 15:350. [PMID: 26286598 PMCID: PMC4545556 DOI: 10.1186/s12879-015-1059-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 07/23/2015] [Indexed: 11/21/2022] Open
Abstract
Background The objectives of this study were to describe hospital stays related to HZ and to evaluate the direct and indirect cost of hospitalizations due to HZ among patients aged over 50 years. Methods The hospitalizations of people aged over 50 years were selected from the French national hospital 2011 database (PMSI) using ICD-10 diagnosis codes for HZ. Firstly, stays with HZ as principal or related diagnostic were described through the patient characteristics, type of hospitalization and the related costs. Secondly, a retrospective case–control analysis was performed on stays with HZ as comorbidity in 5 main hospitalizations causes (circulatory, respiratory, osteo-articular, digestive systems and diabetes) to assess the impact of HZ as co-morbidity on the length of stay, mortality rate and costs. Results In the first analysis, 2,571 hospital stays were collected (60 % of women, mean age: 76.3 years and mean LOS: 9.5 days). The total health assurance costs were 10,8 M€. Mean cost per hospital stay was 4,206€. In the second analysis, a significant difference in LOS and costs was shown when HZ was associated as comorbidity in other hospitalization’s causes. Conclusions HZ directly impacts on the hospital cost. When present as comorbidity for other medical reasons, HZ significantly increases the length of hospital stay with subsequent economic burden for the French Health System.
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Affiliation(s)
| | - Gaetan Gavazzi
- Université de Grenoble-Alpes et GREPI, clinique universitaire de médecine gériatrique, CHU de Grenoble, la tronche, France.
| | - Marc Paccalin
- Geriatrics Department University Hospital La Milétrie, Poitiers, France.
| | | | - Gilles Berrut
- Hôpital Saint Jacques, CHU de Nantes, Nantes, France.
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Lee YC, Hung SY, Wang HK, Lin CW, Wang HH, Chen SW, Chang MY, Ho LC, Chen YT, Liou HH, Tsai TC, Tseng SH, Wang WM, Lin SH, Chiou YY. Sleep apnea and the risk of chronic kidney disease: a nationwide population-based cohort study. Sleep 2015; 38:213-21. [PMID: 25409108 DOI: 10.5665/sleep.4400] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 09/30/2014] [Indexed: 12/28/2022] Open
Abstract
STUDY OBJECTIVES Sleep apnea (SA) is characterized by apnea during sleep and is associated with cardiovascular diseases and an increase in all-cause mortality. Chronic kidney disease (CKD) is a global health problem that has placed a substantial burden on healthcare resources. However, the relationship between SA and the incidence of CKD is not clear. This study aimed to determine whether SA is an independent risk factor for the development of CKD. DESIGN Retrospective cohort study. SETTING National Health Insurance Research Database (NHIRD) of Taiwan. PATIENTS OR PARTICIPANTS A total of 4,674 adult patients (age ≥ 30 y) in whom SA was newly diagnosed from 2000 to 2010 were included, together with 23,370 non-SA patients as the comparison group. The two groups were frequency-matched for sex, age, and year of receiving medical service. Each individual was followed until 2011. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS These two groups were monitored and observed for the occurrence of CKD. Patients with SA experienced a 1.94-fold increase (95% confidence interval [CI], 1.52-2.46; P < 0.001) in the incidence of CKD, which was independent of sex, age, and comorbid medical conditions. Additionally, they showed a 2.2-fold increase (95% CI, 1.31-3.69; P < 0.01) in the incidence of end-stage renal disease (ESRD). CONCLUSIONS Patients with sleep apnea are at increased risk for chronic kidney disease and end-stage renal disease compared with the general population. As such, screening renal function and treatment of chronic kidney disease is an important issue in patients with sleep apnea.
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Affiliation(s)
- Yi-Che Lee
- Division of Nephrology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Yuan Hung
- Division of Nephrology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Hao-Kuang Wang
- Department of Neurosurgery, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Wei Lin
- Department of Medical Education, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Hsi-Hao Wang
- Division of Nephrology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Shih-Wei Chen
- Department of Family Medicine, Hsinchu Cathay General Hospital, Hsinchu, Taiwan
| | - Min-Yu Chang
- Division of Nephrology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Li-Chun Ho
- Division of Nephrology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Chen
- Division of Nephrology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan
| | - Tsuen-Chiuan Tsai
- Department of Pediatrics, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan
| | | | - Wei-Ming Wang
- Biostatistics Consulting Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Yow Chiou
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
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Serum vitamin D levels are positively associated with varicella zoster immunity in chronic dialysis patients. Sci Rep 2014; 4:7371. [PMID: 25487609 PMCID: PMC5376985 DOI: 10.1038/srep07371] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/03/2014] [Indexed: 12/27/2022] Open
Abstract
Uremia results in a relatively immunocompromised status, and patients under chronic dialysis have an elevated risk of developing herpes zoster (HZ). We sought to investigate the relationship between vitamin D status and immunity to varicella-zoster virus (VZV). A multicenter prevalent hemodialysis cohort was assembled between 2012 and 2013. We assayed the biochemical parameters, 25-hydroxy- (25-OH-D) and 1,25-dihydroxyvitamin D, vitamin D-binding protein levels in the sera. VZV immunity was quantitated using VZV-specific glycoprotein IgG and IgM titers. Eighty-eight patients were enrolled and their sera were analyzed. Chronic hemodialysis patients with 25-OH-D < 30 ng/ml (insufficiency or deficiency) had significantly lower VZV-IgG than those with sufficient 25-OH-D (p = 0.04). This discrepancy became more prominent if active vitamin D users alone were analyzed (p = 0.01). Generalized additive modeling showed that those with 25-OH-D higher than 27.8 ng/ml or bioavailable 25-OH-D higher than 3.88 ng/ml had significantly higher VZV-IgG levels than those with lower values. Linear regression suggested that both total and bioavailable 25-OH-D were significantly associated with higher VZV-IgG levels (p = 0.003 [total] and 0.01 [bioavailable]), whereas patients with cancer had lower VZV-IgG. Vitamin D may therefore be a potentially useful choice for raising VZV immunity in chronic dialysis patients.
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Chen JY, Cheng TJ, Chang CY, Lan KM, Weng SF, Sheu MJ, Tseng SF, Hu ML. Increased incidence of herpes zoster in adult patients with peptic ulcer disease: a population-based cohort study. Int J Epidemiol 2014; 42:1873-81. [PMID: 24536094 DOI: 10.1093/ije/dyt213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Peptic ulcer disease (PUD) has been linked to immunological dysfunctions and malnutrition—both are predictors of herpes zoster(HZ). We hypothesized that PUD patients might have a greater risk for developing HZ. METHODS Using the longitudinal National Health Insurance Research Database, we conducted a retrospective population-based cohort study to evaluate the incidence of HZ in adult PUD patients and controls matched by age and gender. Kaplan-Meier analysis and Cox regression were conducted to compare differences in the development of HZ. The effects of comorbidities on the risk of HZ and the associations between different risk factors of PUD and HZ were assessed by subgroup analyses. RESULTS We identified 41 229 adults PUD patients and 41 229 controls. Over an 8-year follow-up, the cumulative incidence of HZ in PUD patients(11.76/1000 person-years) was significantly higher than controls(6.56/1000 person-years) (P<0.001, by log-rank test). After adjusting for potential confounders, PUD was an independent predictor for HZ (adjusted hazard ratio: 1.77, 95% confidence interval 1.64–1.91, P<0.001). Major risk factors of PUD were non-selective nonsteroidal anti-inflammatory drugs (nsNSAID) usage and Helicobacter pylori infection. Subgroup analyses revealed that PUDis an independent predictor of HZ after excluding the potential confounding effects of the comorbidities; PUD associated with the combination of nsNSAID usage and Helicobacter pylori infection leads to greatest risk of HZ. CONCLUSIONS Adults with PUD are at increased risk of HZ independently compared with the general population. Further studies are required to clarify the nature of the associations between HZ and PUD.
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Schub D, Janssen E, Leyking S, Sester U, Assmann G, Hennes P, Smola S, Vogt T, Rohrer T, Sester M, Schmidt T. Altered phenotype and functionality of varicella zoster virus-specific cellular immunity in individuals with active infection. J Infect Dis 2014; 211:600-12. [PMID: 25180236 DOI: 10.1093/infdis/jiu500] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Varicella zoster virus (VZV) establishes lifelong persistence and may reactivate in individuals with impaired immune function. To investigate immunologic correlates of protection and VZV reactivation, we characterized specific immunity in 207 nonsymptomatic immunocompetent and 132 immunocompromised individuals in comparison with patients with acute herpes zoster. METHODS VZV-specific CD4 T cells were quantified flow cytometrically after stimulation and characterized for expression of interferon-γ, interleukin 2, and tumor necrosis factor α and surface markers for differentiation (CD127) and anergy (cytotoxic T lymphocyte antigen 4 [CTLA-4] and programmed death [PD]-1). Immunoglobulin G and A levels were quantified using an enzyme-linked immunosorbent assay. RESULTS In healthy individuals, VZV-specific antibody and T-cell levels were age dependent, with the highest median VZV-specific CD4 T-cell frequencies of 0.108% (interquartile range, 0.121%) during adolescence. VZV-specific T-cell profiles were multifunctional with predominant expression of all 3 cytokines, CD127 positivity, and low expression of CTLA-4 and PD-1. Nonsymptomatic immunocompromised patients had similar VZV-specific immunologic properties except for lower T-cell frequencies (P<.001) and restricted cytokine expression. In contrast, significantly elevated antibody- and VZV-specific CD4 T-cell levels were found in patients with zoster. Their specific T cells showed a shift in cytokine expression toward interferon γ single positivity, an increase in CTLA-4 and PD-1, and a decrease in CD127 expression (all P<.001). This phenotype normalized after resolution of symptoms. CONCLUSIONS VZV-specific CD4-T cells in patients with zoster bear typical features of anergy. This phenotype is reversible and may serve as adjunct tool for monitoring VZV reactivations in high-risk patients.
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Affiliation(s)
- David Schub
- Department of Transplant and Infection Immunology
| | | | | | | | | | | | - Sigrun Smola
- Institute of Virology, Saarland University, Homburg, Germany
| | | | | | | | - Tina Schmidt
- Department of Transplant and Infection Immunology
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Chettiar A. Management of primary care issues common to CKD and ESRD patients: a brief primer for the nephrology provider. Adv Chronic Kidney Dis 2014; 21:371-6. [PMID: 24969390 DOI: 10.1053/j.ackd.2014.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 11/11/2022]
Abstract
This article provides a brief overview of the diagnosis and management of selected primary care issues that are common to CKD and ESRD patients. The elements of diagnosis and management unique to kidney patients and controversies and updates in management will be presented. The topics reviewed are neuropathy, pruritus, zoster, hyperuricemia, gout, and gastroparesis.
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Association between herpes zoster and end stage renal disease entrance in chronic kidney disease patients: a population-based cohort study. Eur J Clin Microbiol Infect Dis 2014; 33:1809-15. [DOI: 10.1007/s10096-014-2143-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
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Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Langan SM. Quantification of risk factors for herpes zoster: population based case-control study. BMJ 2014; 348:g2911. [PMID: 25134101 PMCID: PMC4019782 DOI: 10.1136/bmj.g2911] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To quantify the effects of possible risk factors for herpes zoster at different ages. DESIGN Case-control study. SETTING UK Clinical Practice Research Datalink primary care data. PARTICIPANTS 144 959 adults diagnosed with zoster between 2000 and 2011; 549,336 age, sex, and practice matched controls. MAIN OUTCOME MEASURES Conditional logistic regression was used to generate adjusted odds ratios to estimate the strength of association of each potential risk factor with zoster and assess effect modification by age. RESULTS The median age of the cases and controls was 62 years. Factors associated with increased risk of zoster included rheumatoid arthritis (3111 (2.1%) v 8029 (1.5%); adjusted odds ratio 1.46, 99% confidence interval 1.38 to 1.55), inflammatory bowel disease (1851 (1.3%) v 5118 (0.9%); 1.36, 1.26 to 1.46), chronic obstructive pulmonary disease (6815 (4.7%) v 20 201 (3.7%); 1.32, 1.27 to 1.37), asthma (10 243 (7.1%) v 31 865 (5.8%); 1.21, 1.17 to 1.25), chronic kidney disease (8724 (6.0%) v 29 437 (5.4%); 1.14, 1.09 to 1.18), and depression (6830 (4.7%) v 22 052 (4.0%); 1.15, 1.10 to 1.20). Type 1, but not type 2, diabetes showed some association with zoster (adjusted odds ratio 1.27, 1.07 to 1.50). The relative effects of many assessed risk factors were larger in younger patients. Patients with severely immunosuppressive conditions were at greatest risk of zoster-for example, patients with lymphoma (adjusted odds ratio 3.90, 3.21 to 4.74) and myeloma (2.16, 1.84 to 2.53), who are not eligible for zoster vaccination. CONCLUSIONS A range of conditions were associated with increased risk of zoster. In general, the increased risk was proportionally greater in younger age groups. Current vaccines are contraindicated in people at the greatest risk of zoster, highlighting the need for alternative risk reduction strategies in these groups.
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Affiliation(s)
- Harriet J Forbes
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Sara L Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Tim Clayton
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Wu PH, Lin YT, Kuo CN, Chang WC, Chang WP. No increased risk of herpes zoster found in cirrhotic patients: a nationwide population-based study in Taiwan. PLoS One 2014; 9:e93443. [PMID: 24699628 PMCID: PMC3974756 DOI: 10.1371/journal.pone.0093443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/03/2014] [Indexed: 12/24/2022] Open
Abstract
Background The association between liver cirrhosis (LC) and herpes zoster has rarely been studied. We investigated the hypothesis that LC, known as an immunodeficiency disease, may increase the risk of herpes zoster using a national health insurance database in Taiwan. Materials and Methods The study cohort included cirrhotic patients between 1998 and 2005 (n = 4667), and a ratio of 1∶5 randomly sampled age- and gender-matched control patients (n = 23,335). All subjects were followed up for 5 years from the date of cohort entry to identify whether or not they had developed herpes zoster. Cox proportional-hazard regressions were performed to evaluate 5-year herpes zoster-free survival rates. Results Of all patients, 523 patients developed herpes zoster during the 5-year follow-up period, among whom 82 were LC patients and 441 were in the comparison cohort. The adjusted hazard ratio (AHR) of herpes zoster in patients with LC was not higher (AHR: 0.77, 95% confidence interval: 0.59–1.01, p = 0.06) than that of the controls during the 5-year follow-up. No increased risk of herpes zoster was found in LC patients after stratification by age, gender, urbanization level, income, geographic region, and all comorbidities. Conclusions This large nationwide population-based cohort study suggests that there is no increased risk for herpes zoster among people who have LC compared to a matching population.
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Affiliation(s)
- Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ting Lin
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chun-Nan Kuo
- Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taipei, Taiwan
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chiao Chang
- Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taipei, Taiwan
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
- * E-mail: (WCC); (WPC)
| | - Wei-Pin Chang
- Department of Healthcare Management, Yuanpei University, Hsinchu, Taiwan
- * E-mail: (WCC); (WPC)
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Chou CL, Hsieh TC, Wang CH, Hung TH, Lai YH, Chen YY, Lin YL, Kuo CH, Wu YJ, Fang TC. Long-term Outcomes of Dialysis Patients After Coronary Revascularization: A Population-based Cohort Study in Taiwan. Arch Med Res 2014; 45:188-94. [DOI: 10.1016/j.arcmed.2014.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 01/27/2014] [Indexed: 11/27/2022]
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Vikrant S. Long-term clinical outcomes of peritoneal dialysis patients: 9-year experience of a single center from north India. Perit Dial Int 2014; 34:426-33. [PMID: 24385327 DOI: 10.3747/pdi.2013.00050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE There is a paucity of published data on the outcome of maintenance peritoneal dialysis (PD) since the initiation of continuous ambulatory PD (CAPD) in India in 1991. The purpose of this study is to report long-term clinical outcomes of PD patients at a single center. DESIGN Retrospective study. SETTING A government-owned tertiary-care hospital in North India. PATIENTS Patients who were initiated on CAPD between October 2002 and June 2011, and who survived and/or had more than 6 months' follow-up on this treatment with last follow-up till December 31, 2011, were studied. RESULTS A total of 60 patients were included in the analysis. The mean age of the patients was 60.2 ± 9.2 years. The majority (65%) of the patients lived in rural areas. A high proportion (47%) were diabetic and 62% had ≥ 2 comorbidities. Total duration on peritoneal dialysis treatment was 1,773 patient-months (148 patient-years) with a mean duration of 29.6 ± 23 patient-months and median duration of 25 patient-months (range 6 - 110 patient-months). Overall patient and technique survival at 1, 2, 3, 4 and 5 years was 77%, 53%, 25%, 15%, and 10% respectively. Patient survival of diabetics vs non-diabetics at 1, 2, 3, 4, and 5 years was 68% vs 84%, 54% vs 53%, 14% vs 34%, 11% vs 19%, and 11% vs 13%, respectively. The mortality in non-diabetics (16/32) was less than that in diabetic (18/28) patients (p = not significant). The main cause of mortality in these patients was cardiac followed by sepsis. There were 58 episodes of peritonitis. The rate of peritonitis was 1 episode per 30.6 patient-months or 0.39 episodes per patient-year. Furthermore, the total number of episodes of peritonitis and number of episodes of peritonitis per patient were higher in the non-survival group (p < 0.05). The incidence of tuberculosis (TB), herpes zoster (HZ) and hernias was 15%, 10% and 5% respectively. CONCLUSION The study reports long-term outcomes of the PD patients, the majority of whom were elderly with a high burden of comorbidities. There was a high proportion of diabetics. The survival of diabetic vs non-diabetic and elderly vs non-elderly PD patients was similar in our study. The mortality in non-diabetics was less than that in diabetic patients. TB and HZ were common causes of morbidity. Peritonitis was associated with mortality in these patients.
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Affiliation(s)
- Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla (Himachal Pradesh), 171001 India
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Soni R, Horowitz B, Unruh M. Immunization in end-stage renal disease: opportunity to improve outcomes. Semin Dial 2013; 26:416-26. [PMID: 23751048 DOI: 10.1111/sdi.12101] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Infection is the second most common cause of death in patients with end-stage renal disease (ESRD), following cardiovascular causes. Immunization is a fairly simple, but underutilized, strategy for prevention of infectious morbidity and mortality in patients with kidney failure. It is imperative for nephrologists and primary care providers to have an understanding of immunization as an essential component of preventive healthcare measures in this high-risk population. Patients with ESRD represent a unique population due to their immunosuppressed state, dialysis-related exposures and suboptimal response to routine vaccines. While the Advisory Committee on Immunization Practices (ACIP) provides guidelines for vaccination of patients with renal disease against Hepatitis B, influenza and pneumococcal disease, the data on immunization against other commonly preventable infectious diseases are lacking. This article reviews the recent evidence on immunization in the ESRD population and synthesizes the related implications for maximizing prevention of infectious diseases in this high-risk population.
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Affiliation(s)
- Ritu Soni
- Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Kuo CC, Kuo HW, Lee IM, Lee CT, Yang CY. The risk of upper gastrointestinal bleeding in patients treated with hemodialysis: a population-based cohort study. BMC Nephrol 2013; 14:15. [PMID: 23324652 PMCID: PMC3558322 DOI: 10.1186/1471-2369-14-15] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 01/14/2013] [Indexed: 12/16/2022] Open
Abstract
Background There are no prior studies that have estimated the risk of upper gastrointestinal bleeding (UGIB) among the dialysis population relative to the general population. The aim of this study was to examine the risk of UGIB among end-stage renal disease (ESRD) patients during a 6-year period following their initiation of hemodialysis (HD) therapy in Taiwan- a country with the highest incidence of ESRD in the world, using general population as an external comparison group. Methods Data were obtained from the Taiwan National health Insurance Research Database. In total, 796 patients who were beginning HD between 1999 and 2003 were recruited as the study cohort and 3,184 patients matched for age and sex were included as comparison cohort. Multivariate Cox proportional hazard regression models were used to adjust for confounding and to compare the 6-year UGIB-free survival rate between these two cohorts. Results The incidence rate of UGIB (42.01 per 1000 person-year) was significantly higher in the HD cohort than in the control cohort (27.39 per 1000 person-years). After adjusting for potential confounders, the adjusted hazard ratios for UGIB during the 6-year follow-up periods for HD patients was 1.27 (95% CI=1.03-1.57) compared to patients in the comparison cohort. Conclusions We conclude that HD patients were at an increased risk for UGIB compared with the general population.
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Affiliation(s)
- Chien-Chun Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang-Gung Memorial Hospital and Chang-Gung University College of Medicine, Kaohsiung, Taiwan
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Wu MY, Hsu YH, Su CL, Lin YF, Lin HW. Risk of Herpes Zoster in CKD: A Matched-Cohort Study Based on Administrative Data. Am J Kidney Dis 2012; 60:548-52. [DOI: 10.1053/j.ajkd.2012.03.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 03/19/2012] [Indexed: 11/11/2022]
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Wang YP, Liu CJ, Hu YW, Chen TJ, Lin YT, Fung CP. Risk of cancer among patients with herpes zoster infection: a population-based study. CMAJ 2012; 184:E804-9. [PMID: 22988158 DOI: 10.1503/cmaj.120518] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Whether the risk of cancer is increased among patients with herpes zoster is unclear. We investigated the risk of cancer among patients with herpes zoster using a nationwide health registry in Taiwan. METHODS We identified 35 871 patients with newly diagnosed herpes zoster during 2000-2008 from the National Health Insurance Research Database in Taiwan. We analyzed the standardized incidence ratios for various types of cancer. RESULTS Among patients with herpes zoster, 895 cases of cancer were reported. Patients with herpes zoster were not at increased risk of cancer (standardized incidence ratio 0.99, 95% confidence interval 0.93-1.06). Among the subgroups stratified by sex, age and years of follow-up, there was also no increased risk of overall cancer. INTERPRETATION Herpes zoster is not associated with increased risk of cancer in the general population. These findings do not support extensive investigations for occult cancer or enhanced surveillance for cancer in patients with herpes zoster.
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Affiliation(s)
- Yu-Ping Wang
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taiwan
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Lin SY, Liu JH, Lin CL, Tsai IJ, Chen PC, Chung CJ, Liu YL, Wang IK, Lin HH, Huang CC. A comparison of herpes zoster incidence across the spectrum of chronic kidney disease, dialysis and transplantation. Am J Nephrol 2012; 36:27-33. [PMID: 22699521 DOI: 10.1159/000339004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 04/17/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effect of different renal replacement therapies on the risk of developing herpes zoster in renal failure patients is unknown. We aimed to investigate the incidence of herpes zoster attack among renal failure patients who were receiving different dialysis modalities, renal transplantation (RT), or not receiving any of the above mentioned therapies yet. METHODS A retrospective cohort study of the national health insurance register database was conducted. This observational cohort study involved 79,581 study controls, 15,802 chronic kidney disease patients, 3,694 hemodialysis (HD) patients, 317 peritoneal dialysis (PD) patients, and 159 RT patients. RESULTS The RT group had the worst risk of herpes zoster (hazard ratio, HR, 8.46; 95% CI 5.85-12.2), followed by PD (HR 3.61; 95% CI 2.49-4.83) and HD (HR 1.35; 95% CI 1.18-1.55), compared with the comparison group (p < 0.0001). The RT group had also the highest risk of developing herpes zoster with complications among all groups (adjusted HR 15.3). The HRs of the PD group were higher than the HRs of the HD group in terms of herpes zoster or its complications (p < 0.0001 and p = 0.0002, respectively). CONCLUSIONS This study suggests that different treatment modalities are associated with different risks of herpes zoster attacks in renal failure patients. PD patients had higher risks than the HD group in terms of herpes zoster or its complications.
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Affiliation(s)
- Shih-Yi Lin
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan, ROC
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