Difficult influenza season for patients with IRT

Influenza-like illness has contributed significantly to the mortality of people with end-stage renal disease, a 14-year badysis of US data.

According to David Gilbertson, PhD of the Hennepin Institute of Health Research and the University of Minnesota, David Gilbertson, Ph.D., during the influenza season – from October to March – has recorded an average of more than 1,000 deaths per year. , indicating the flu-like illness (ILI) as the probable reason.

Reporting in the Journal of the American Society of Nephrology, the group calculated that an absolute 1% increase in influenza-like illness between January and March – the period of the year when the flu syndrome resembled a peak – was related to a value of 2.0% (95% CI 0.2% to 3.9%). ) increased relative morality during this season for patients with IRT compared to July to September.

From October to December, which consistently had the second highest rate of illness in the year, an absolute 1% increase in flu – like illness was linked to a 1.5% increase (IC 95 % 0.6% -2.4%) of the relative mortality of these diseases. the patients.

"In general, during influenza / flu-like seasons when influenza and pseudogriote reached an early peak, more deaths occurred early, and when the peak of the illness was late, the number of deaths was also higher. late, "said Gilbertson in a statement. "Similarly, the years when influenza and ILI were particularly severe were generally years when deaths were also higher than expected."

"While influenza-like illness may not be the direct cause of death in patients with end-stage renal disease, it may also contribute to other causes of death. flu syndrome may present a state of acute inflammation, making them vulnerable to other infections or to cardiovascular events "warned.

Using data from the CDC on influenza-related mortality coupled with Medicare ESRD data for the period 2000-2013, the researchers calculated mortality patterns broken down by season. Influenza-related mortality includes deaths from diseases defined as fever over 37.8 ° C (100 ° F) accompanied by a cough and / or sore throat. Although influenza is an influenza-like illness, the Gilbertson group noted that several viruses can contribute to influenza, including rhinovirus, adenovirus, respiratory syncytial virus, parainfluenza virus, and human metapneumovirus.

During this period, the annual number of deaths among patients with conbad heart disease increased from approximately 390,000 in 2000 to nearly 680,000 in 2014, although the researchers noted that this was mainly attributable to Increase of the population as a whole. The years with the highest rates of influenza-related deaths included 2003-2004 and 2009-2010, while the least-fatal flu season was 2011-2012.

Patients with SRI are a particularly at-risk population, the group explained, not only because of the high rate of comorbidities putting them at greater risk, but also because of the combination of a decrease in immunological function and frequent visits to maintenance hemodialysis centers, which can place them near contagious people.

To address these concerns, Gilbertson suggested that strategies could include "increased disinfection efforts in dialysis units in the winter, and to ensure that all patients with kidney failure receive influenza vaccine every year ".

Despite the benefit of a flu shot, the researchers warned nephrologists and other clinicians to "expect at most a modest benefit from any influenza vaccination program in the dialysis population" because "the vaccine seems to be significantly less effective in this population. "

"[I]Single-dose vaccines may decrease before the end of the influenza season, suggesting that dialysis patients receive high-dose or adjuvanted influenza vaccines, "they also recommended.

2019-01-24T17: 00: 00-0500