Kidney Week

Abstract: FR-PO780

Vaccinations for Patients with ESRD: Crossroads Between Nephrology and Primary Care

Session Information

• Dialysis: Inflammation and Infection
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Phen, Samuel, University of Florida, Gainesville, Florida, United States

Samuel Phen,

• Sattari, Maryam, University of Florida, Gainesville, Florida, United States

Maryam Sattari,

• Bozorgmehri, Shahab, University of Florida, Gainesville, Florida, United States

Shahab Bozorgmehri,

• Ozrazgat-baslanti, Tezcan, University of Florida, Gainesville, Florida, United States

Tezcan Ozrazgat-baslanti,

• Kazory, Amir, University of Florida, Gainesville, Florida, United States

Amir Kazory,

Background

A subset of patients with end-stage renal disease (ESRD) who receive maintenance hemodialysis consider their nephrologist as their primary care provider (PCP). Preventive measures such as vaccinations markedly reduce mortality among these patients, yet their vaccination rates fall far below recommended. We aimed to (1) determine whether there is a difference in rates of compliance with recommended vaccinations between ESRD patients with PCPs (PCP group) and those without PCPs (No PCP group), and (2) identify differences in the characteristics between the PCP and No PCP groups.

Methods

We performed a cross-sectional survey of adult patients with ESRD in two outpatient dialysis centers affiliated with the University of Florida. A survey instrument was used to conduct one-to-one interviews. We used the Advisory Committee on Immunization Practices (ACIP) guidelines to determine eligibility for various vaccinations. We used X² or t-test to compare various characteristics.

Results

The mean age of the 132 study participants was 57.8 ±14.7 years. Sixty-six (50%) were male, 81 (61.3%) were African American, and 118 (89.4%) reported having a PCP. The PCP group had significantly higher rates of influenza vaccination (89.8% vs. 71.4%, p=0.046), pneumonia (75% vs. 42.9%, p=0.012), and tetanus (Tdap) (96.4 vs. 78.6%, p=0.006). The rates of vaccination for human papillomavirus (HPV), hepatitis B, and shingles were also higher among the PCP group but did not reach statistical significance. The PCP group was older than the no PCP group (mean age 58.9 vs. 47.9 years, p=0.008) with higher education level; none of the patients without PCP had higher education while 54.2% of those with PCP had undergraduate or graduate education; p<0.001). Men were more likely not to have a PCP (p=0.024), but no difference was observed among races.

Conclusion

This study suggests that among ESRD patients receiving hemodialysis, having a PCP is associated with higher rates of recommended vaccinations and that female gender, advanced age, and higher education level are associated with higher likelihood of having a PCP. These findings could have important implications for optimizing the preventive care of these patients. Future studies are needed to explore whether increasing the number of patients with a PCP will portend salutary impact on their care.