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Abstract: FR-PO802

Poor Immune Response to Influenza Vaccine Is Associated with Increased Mortality in Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Eiselt, Jaromir, Internal Dept. 1, Charles University, Plzen, Czechia
  • Rajdl, Daniel, Dept. of Biochemistry, Plzen, Czechia
Background

Immune response reflects an individual's immune status. Hemodialysis (HD) and renal transplantation (TX) are associated with the state of immune dysfunction. The aim of our study was to assess natural levels of pneumococcal IgG (pne-IgG, patients unvaccinated against pneumococcus) and hemagglutination-inhibition antibodies (HIA, post influenza vaccine) in HD and TX patients. We tried to determine the factors influencing the immune status and the relationship of the immune response to mortality.

Methods

A total of 99 HD and 64 TX patients who have never received a pneumococcal vaccine were vaccinated against influenza in seasons 2015/16 and 2016/17. Their pne-IgG, pre- and post-vaccine HIA titre, iron status, C-reactive protein (CRP), albumin and 25-OH vitamin D were measured at baseline and after one year. Total follow-up was 30 months. To identify variables associated with mortality, univariate Cox regression analyses were performed with mortality as a dependent variable, and age, gender and the above mentioned markers as predictors. Markers with p<0.1 (post-vaccine rise in HIA, CRP, albumin, age) were subsequently included into a multivariate Cox regression model.

Results

Pneumococcal IgG levels and percentage of seroprotective HIA were comparable in HD and TX groups and between the two consecutive years (Table 1). Mortality was higher in the HD, in which 30 patients died, while only one death was recorded in TX. According to the multivariate Cox regression model (adjusted R2 0.246, p<0.0001), the predictors of death were low postvaccination HIA titre (p=0.019), and high CRP (p=0.003).

Conclusion

The immune response to the influenza vaccine and the natural production of pne-IgG are comparable in HD and TX patients. Besides dependence on HD, significant independent predictors of mortality in HD population are low antibody response to influenza vaccine and high CRP.

 HD 2015/16HD 2016/17TX 2015/16TX 2016/17
Pneunococcal IgG (mg/L)72 (43-125)62 (35-108)54 (34-88)66 (32-104)
A H1N1 SPpost (%)93899180
A H3N2 SPpost (%)82888377
B SPpost (%)91688773

Data are medians (interquartile ranges), unless stated otherwise; Mann-Whitney and χ2 test; A H1N1, A H3N2, B are influenza virus strains, SPpost is post-vaccine seroprotection rate; differences among groups were not statistically significant.

Funding

  • Government Support - Non-U.S.