BACKGROUND: The Advisory Committee on Immunization Practices recommends annual influenza vaccination for dialysis patients, but does not issue a preference for high-dose vs. standard vaccine. The high-dose vaccine is licensed for people ≥65 years regardless of comorbidity status. The standard vaccine has been shown to have limited effectiveness in dialysis patients, and little is known about use of high-dose vaccine in the dialysis population.
OBJECTIVES: To describe temporal trends in national use and to identify patient characteristics associated with high-dose vaccine receipt.
METHODS: We created four yearly cohorts (2010-2013) of dialysis patients in the United States Renal Data System to examine vaccine administration from August to December of each influenza season. Patients were required to have Medicare as a primary payer and ≥3 months of continuous in-center hemodialysis prior to August 1 of the given year. To assess predictors of high-dose vs. standard vaccine receipt, we restricted to vaccinated patients ≥65 years with ≥9 months of continuous in-center hemodialysis prior to vaccination. We used multivariable logistic regression to identify patient characteristics independently associated with receipt of high-dose vs. standard vaccine.
RESULTS: We identified 421,482 eligible patients. Vaccination rates for any type of influenza vaccine increased from 68.3% in 2010 to 72.0% in 2013. From 2010 to 2013, the proportion of vaccinated patients who received high-dose vaccine increased from 0.5% to 1.8% overall, and increased from 0.9% to 3.5% among patients ≥65 years. Of vaccinated patients ≥65 years, high-dose vaccine receipt was more likely if patients were older (≥72 years), white, had <4 years of dialysis, and had screening tests such as lipid tests or diabetes eye exams. Vaccinated patients ≥65 years were less likely to receive high-dose vaccine if they were hospitalized for ≥7 days, had anemia, or used mobility aids (wheelchair, walker, cane, or modified bathroom equipment).
CONCLUSIONS: Evidence suggests very low, but increasing use of high-dose vaccine in the dialysis population. Although patients receiving high-dose vaccine were more likely to be older, they appeared to be healthier. Patients receiving standard vaccine exhibited more signs of frailty.
