Knowledge, Attitudes and Practices of Flu Vaccination in Hemodialysis Patients

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Abstract

Background: Hemodialysis (HD) patients have an increased risk of morbidity and mortality due to infections. Despite the positive effect of vaccinations, the implementation of this method of prophylaxis is low. Objectives: This study aimed to explore the knowledge, attitudes and practices of flu vaccination among HD patients of two different dialysis centers. Methods: A total of 193 patients (mean age 63.6 years), who voluntarily agreed to participate in an anonymous survey related to influenza vaccination, were enrolled in this cross-sectional study. Results: A total of 45% of patients declared that they took regular, annual flu vaccination. In this group, 87.4% believed that vaccinations were effective. This opinion strongly correlated with the frequency of regular vaccinations (r = 0.56, p < 0.01). Multivariate logistic regression revealed that this opinion is an independent predictor of regular vaccinations with adjusted OR 9.86 (95% CI 4.36, 22.33). Groups of patients who had been irregularly or never vaccinated reject vaccinations for the following reasons: fear of adverse events—29.2%, conviction that vaccination was ineffective—26.4%, and lack of information about vaccination—22.6%. Conclusion: Knowledge among HD patients about the benefits of vaccinations is poor. Therefore, educational activities are required. Active vaccination promotion and education of patients rejecting this method of prevention play a key role in improving standards of care for HD patients.

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Aspects of immune dysfunction in end-stage renal disease.

Sawako Kato, Michal Chmielewski, Hirokazu Honda … (2008)

End-stage renal disease (ESRD) is associated with significantly increased morbidity and mortality resulting from cardiovascular disease (CVD) and infections, accounting for 50% and 20%, respectively, of the total mortality in ESRD patients. It is possible that these two complications are linked to alterations in the immune system in ESRD, as uremia is associated with a state of immune dysfunction characterized by immunodepression that contributes to the high prevalence of infections among these patients, as well as by immunoactivation resulting in inflammation that may contribute to CVD. This review describes disorders of the innate and adaptive immune systems in ESRD, underlining the specific role of ESRD-associated disturbances of Toll-like receptors. Finally, based on the emerging links between the alterations of immune system, CVD, and infections in ESRD patients, it emphasizes the potential role of the immune dysfunction in ESRD as an underlying cause for the high mortality in this patient population and the need for more studies in this area.

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Mortality caused by sepsis in patients with end-stage renal disease compared with the general population.

M. Sarnak, B Jaber (2000)

In the United States, infection is second to cardiovascular disease as the leading cause of death in patients with end-stage renal disease (ESRD), and septicemia accounts for more than 75% of this category. This increased susceptibility to infections is partly due to uremia, old age, and comorbid conditions. Although it is intuitive to believe that mortality caused by sepsis may be higher in patients with ESRD compared with the general population (GP), no such data are currently available. We compared annual mortality rates caused by sepsis in patients with ESRD (U.S. Health Care Financing Administration 2746 death notification form) with those in the GP (death certificate). Data were abstracted from the U.S. Renal Data System (1994 through 1996 Special Data request) and the National Center for Health Statistics. Data were stratified by age, gender, race, and diabetes mellitus (DM). Sensitivity analyses were performed to account for potential limitations of the data sources. Overall, the annual percentage mortality secondary to sepsis was approximately 100- to 300-fold higher in dialysis patients and 20-fold higher in renal transplant recipients (RTRs) compared with the GP. Mortality caused by sepsis was higher among diabetic patients across all populations. After stratification for age, differences between groups decreased but retained their magnitude. These findings remained robust despite a wide range of sensitivity analyses. Indeed, mortality secondary to sepsis remained approximately 50-fold higher in dialysis patients compared with the GP, using multiple cause-of-death analyses; was approximately 50-fold higher in diabetic patients with ESRD compared with diabetic patients in the GP, when accounting for underreporting of DM on death certificates in the GP; and was approximately 30-fold higher in RTRs compared with the GP, when accounting for the incomplete ascertainment of cause of death among RTRs. Furthermore, despite assignment of primary cause-of-death to major organ infections in the GP, annual mortality secondary to sepsis remained 30- to 45-fold higher in the dialysis population. Patients with ESRD treated by dialysis have higher annual mortality rates caused by sepsis compared with the GP, even after stratification for age, race, and DM. Consequently, this patient population should be considered at high-risk for the development of lethal sepsis.

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Inflammation and infections as risk factors for ischemic stroke.

Armin J Grau, Perttu Lindsberg (2003)

Inflammatory processes have fundamental roles in stroke in both the etiology of ischemic cerebrovascular disease and the pathophysiology of cerebral ischemia. We summarize clinical data on infection and inflammation as risk or trigger factors for human stroke and investigate current evidence for the hypothesis of a functional interrelation between traditional risk factors, genetic predisposition, and infection/inflammation in stroke pathogenesis. Several traditional vascular risk factors are associated with proinflammatory alterations, including leukocyte activation, and predispose cerebral vasculature to thrombogenesis on inflammatory stimulation. Furthermore, accumulation of inflammatory cells, mainly monocytes/macrophages, within the vascular wall starts early during atherogenesis. During later disease stages, their activation can lead to plaque rupture and thrombus formation, increasing stroke risk. Inflammatory markers (eg, leukocytes, fibrinogen, C-reactive protein) are independent predictors of ischemic stroke. Chronic infections (eg, infection with Chlamydia pneumoniae or Helicobacter pylori) were found to increase the risk of stroke; however, study results are at variance, residual confounding is not excluded, and causality is not established at present. In case-control studies, acute infection within the preceding week was a trigger factor for ischemic stroke. Acute and exacerbating chronic infection may act by activating coagulation and chronic infections and may contribute to atherogenesis. Genetic predisposition of the inflammatory host response may be an important codeterminant for atherogenesis and stroke risk. Inflammation contributes to stroke risk via various interrelated mechanisms. Infectious diseases, traditional risk factors, and genetic susceptibility may cooperate in stimulating inflammatory pathways. Final proof of a causal role of infectious/inflammatory mechanisms in stroke pathogenesis is still lacking and will require interventional studies.

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Author and article information

Contributors

Ralph A. Tripp: Role: Academic Editor

Journal

Journal ID (nlm-ta): Vaccines (Basel)

Journal ID (iso-abbrev): Vaccines (Basel)

Journal ID (publisher-id): vaccines

Title: Vaccines

Publisher: MDPI

ISSN (Electronic): 2076-393X

Publication date (Electronic): 22 January 2021

Publication date Collection: February 2021

Volume: 9

Issue: 2

Electronic Location Identifier: 77

Affiliations

[1 ]Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland; adagawrys@ 123456gmail.com (A.G.); melirus@ 123456wp.pl (D.Z.); hanna.augustyniak-bartosik@ 123456umed.wroc.pl (H.A.-B.); magdalena.kuriata-kordek@ 123456umed.wroc.pl (M.K.-K.); magdalena.krajewska@ 123456umed.wroc.pl (M.K.)

[2 ]Department of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wrocław, Poland; leszek.szenborn@ 123456umed.wroc.pl

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[* ]Correspondence: tomasz.golebiowski@ 123456umed.wroc.pl

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Tomasz Gołębiowski https://orcid.org/0000-0001-5477-2020

Hanna Augustyniak-Bartosik https://orcid.org/0000-0003-3969-396X

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Publisher ID: vaccines-09-00077

DOI: 10.3390/vaccines9020077

PMC ID: 7912544

PubMed ID: 33498996

SO-VID: e444d4bc-f705-4f3a-8591-d50f59309e05

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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Knowledge, Attitudes and Practices of Flu Vaccination in Hemodialysis Patients

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Abstract

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Malaria vaccine development

Most cited references 40

Aspects of immune dysfunction in end-stage renal disease.

Mortality caused by sepsis in patients with end-stage renal disease compared with the general population.

Inflammation and infections as risk factors for ischemic stroke.

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