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Influenza in dialysis patients

an opportunity to decrease mortality?

Miskulin, Dana C.

Current Opinion in Nephrology and Hypertension: November 2019 - Volume 28 - Issue 6 - p 607–614
doi: 10.1097/MNH.0000000000000550
DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker
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Purpose of review Influenza is a major cause of morbidity in dialysis patients.

Recent findings A recent meta-analysis finds reduced influenza infections, hospitalizations and deaths with use of high dose as compared with standard-dose vaccine in the elderly. There remain no randomized clinical trials of vaccine efficacy in dialysis patients. One observational study finds reduced all-cause hospitalization with high-dose as compared with standard-dose vaccine but another study finds no difference in influenza related events. A simulation study, in which the timing of vaccination and antibody waning rates are varied, finds vaccine efficacy among populations prone to premature waning, to be greater if the vaccine is administered later, as long as the opportunity to vaccinate does not decline. In a phase 3 trial involving low-risk patients with uncomplicated influenza, baloxavir (which is of a novel class of antiinfluenza treatment), was associated with a faster decline in virus titers and no difference in resolution of symptoms as compared with oseltamivir.

Summary By extension of high-quality evidence in the elderly, we recommend using the high dose vaccine in all dialysis patients. Vaccine efficacy may be enhanced in dialysis patients if vaccination is delayed until late October to mid-November. It is premature to use baloxavir over oseltamivir or the combination to treat influenza in dialysis patients though trials are forthcoming.

Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA

Correspondence to Dana C. Miskulin, MD, Division of Nephrology, Tufts Medical Center, 800 Washington St. Box 391, Boston, MA 02111, USA. Tel: +1 617 636 9936; fax: +1 617 636 8329; e-mail: dmiskulin@tuftsmedicalcenter.org

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