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Abstract: SA-PO989

Pneumococcal Vaccination Status and Mortality Risk in a National Dialysis Cohort

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Rhee, Connie, University of California, Irvine, California, United States
  • You, Amy Seung, University of California, Irvine, California, United States
  • Moradi, Hamid, University of California, Irvine, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Jittirat, Arksarapuk, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
  • Park, Christina, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Nakata, Tracy, University of California, Irvine, California, United States
  • Nakata, Michael B., University of California, Irvine, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Nguyen, Danh V., University of California, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, University of California, Irvine, California, United States
Background

Infection-related deaths are the second most common cause of mortality in end-stage renal disease (ESRD) patients, with pulmonary sources as the second dominant contributor following bacteremia/sepsis. While clinical practice guidelines recommend that ESRD patients undergo pneumococcal vaccination, large population-based studies suggest that non-vaccination is common, particularly in the setting of patient decline or contraindication. We thus sought to examine the relationship between pneumococcal vaccination status and mortality risk in a national dialysis cohort.

Methods

Among 976 ESRD patients from the national Biospecimen Registry Grant Program (BioReG) receiving dialysis treatment over the period of 1/2008-12/2014, we examined the relationship between pneumococcal vaccination status and all-cause mortality risk using unadjusted and multivariable Cox models adjusted for socio-demographic characteristics (e.g., age, sex, race, and ethnicity).

Results

In the overall cohort, mean ± SD age was 59 ± 14 years; 47% were female; 39% were Black; and 18% were of Hispanic ethnicity. During the follow-up period, 89.5% vs. 10.5% of received vs. did not receive pneumococcal vaccination. In unadjusted analyses, non-vaccination status was associated with a two-fold higher death risk: HR (95% CI) 2.02 (1.41-2.91), p<0.001. Following adjustment for socio-demographic characteristics, associations between non-vaccination status and higher mortality risk persisted: adjusted HR (95% CI) 1.53 (1.05-2.22), p=0.03.

Conclusion

In a national dialysis cohort, non-receipt of pneumococcal vaccination was associated with higher mortality risk. Further studies are needed to identify management strategies and develop clinical tools that augment vaccination rates in the ESRD population.

Funding

  • NIDDK Support