The association of pneumococcal vaccination with hospitalization and mortality in hemodialysis patients

David T. Gilbertson, Haifeng Guo, Thomas J. Arneson, Allan J. Collins

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51 Scopus citations


Background: Few studies have examined the effectiveness of pneumococcal vaccination (alone or with influenza vaccination) in improving hemodialysis patient outcomes. We aimed to describe vaccination rates between 2003-2005 and to study the effects on outcomes. Methods: For 118 533 prevalent patients who initiated hemodialysis ≥90 days before 1 November 2003, had Medicare Part A and Part B and were aged ≥18 years, and alive through 31 October 2005, Cox proportional hazards models were used to assess pneumococcal vaccination effects on subsequent hospitalization and mortality, adjusting for demographics and comorbidity. Results: The 21% of patients who received vaccinations were older; a higher proportion were white, with diabetes as cause of end-stage renal disease and more comorbidity. Pneumococcal vaccination was associated with a statistically significant decreased mortality hazard [hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.90-0.98], cardiac death (HR 0.91, 95% CI 0.85-0.97) and hospitalization for bacteremia/viremia/septicemia (HR 0.95, 95% CI 0.91-1.00). The mortality hazard was 0.73 (95% CI 0.68-0.78) for patients who received pneumococcal and influenza vaccinations. Conclusions: The small but significant association between pneumococcal vaccination and lower mortality risk was seen despite factors associated with poor outcomes in patients most likely to be vaccinated. Pneumococcal and influenza vaccines may have beneficial synergistic effects. Hemodialysis patients may benefit from revaccination more frequently than the recommended 5-year intervals.

Original languageEnglish (US)
Pages (from-to)2934-2939
Number of pages6
JournalNephrology Dialysis Transplantation
Issue number9
StatePublished - Sep 2011

Bibliographical note

Funding Information:
Acknowledgements. This study was supported by a research contract from Fresenius Medical Care. The contract provides for Minneapolis Medical Research Foundation investigators to have final determination of manuscript content. The data used for this study were independently acquired from the Centers for Medicare & Medicaid Services under data use agreements with the Minneapolis Medical Research Foundation; acquisition complied with all Privacy Act requirements for confidentiality of the beneficiary-specific information. Standard fees for access to the data were paid to the Centers for Medicare & Medicaid Services. The authors thank Chronic Disease Research Group colleagues Shane Nygaard, BA, for manuscript preparation, Nan Booth, MSW, MPH, ELS, for manuscript editing and Stephan Dunning, MBA, MGIS, for detailed project management.


  • End-stage renal disease
  • Hemodialysis
  • Hospitalization
  • Mortality
  • Pneumococcal vaccination


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