High-Dose Flu Shot Best For Reducing Dialysis Patient Hospitalizations

A new study suggests that a high-dose influenza vaccine is associated with lower risk for hospitalizations in kidney failure patients who are on dialysis.

This study reported kidney patients receiving high-dose vs. standard-dose influenza vaccine in 2016-17 were associated with lower rates of hospitalization in dialysis patients, although this association was not seen in 2015-16.

*Chronic Kidney Disease Clinical Trial, Click Here*

But, there were no differences in rates of death between patients receiving the high-dose vs. standard-dose influenza vaccine during either influenza season.

This study was led by Dana Miskulin, MD, Tufts Medical Center, who compared hospitalizations and deaths during the 2015-16 and 2016-17 influenza seasons by vaccine-type standard trivalent, standard quadrivalent, and high-dose trivalent influenza vaccine.

“We found that the administration of the high-dose influenza vaccine was associated with 8 percent fewer first hospitalizations than the standard dose vaccine in 2016-17,” said Dr. Miskulin, in a press release.  

Additionally, Dr. Miskulin noted that the 2016-17 season results are consistent with lower hospitalizations with high-dose as compared with standard dose, seen in the elderly general population. 

High-dose influenza vaccines contain 400 percent more antigen than the standard dose flu shots. 

“In 2015-16 there was no difference by vaccine type although statistical power was limited, with only 8 percent of patients receiving high-dose vaccines that year, compared with 61 percent in 2016-17," said Dr. Miskulin.  

Adverse events were not collected in this study, but large clinical trials in the general population suggest that the high-dose vaccine is not associated with more adverse effects.

These flu shots were administered to more than 9,000 patients at a national dialysis organization. These study findings appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).   

"While these results should not be considered definitive, because vaccine type was not randomized, they suggest that there may be a reduction in influenza-related morbidity in dialysis patients with use of the high-dose vs. standard dose vaccine," said Dr. Miskulin.

Studies of other strategies to increase influenza vaccine effectiveness in dialysis patients and other immunocompromised populations, including the use of adjuvants and booster doses, could also be beneficial, according to an accompanying editorial by Megan Lindley, MPH and David Kim, MD, with the Centers for Disease Control and Prevention. 

"Even in the absence of increased vaccine effectiveness, improvements in influenza vaccination coverage among medically vulnerable populations such as dialysis patients could increase protection against influenza," they wrote.  

"In groups where the burden of influenza disease and its complications are disproportionately felt, small improvements in vaccine effectiveness and vaccination coverage may have large impacts."

The study co-authors include Daniel Weiner, MD, Hocine Tighiouart, MS, Eduardo Lacson Jr., MD, Klemens Meyer, MD, Taimur Dad, MD, and Harold Manley, PharmD. The authors reported no financial disclosures.