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Seasonal influenza-like illness associated with increased mortality in patients with ESRD
There may be a relationship between seasonal fluctuations of influenza-like illness and seasonal variation in mortality among patients with ESRD, with influenza-like illness potentially contributing to more than 1,000 of these patients’ deaths per year, according to a study published in the Journal of the American Society of Nephrology.
“Generally speaking, during influenza/[influenza-like illness] ILI seasons when influenza and ILI peaked early, more deaths occurred early, and when the illness peak was later, the peak in deaths was also later,” David T. Gilbertson, PhD, co-director of the Chronic Disease Research Group at Hennepin Healthcare Research Institute and associate professor of medicine at the University of Minnesota, told Healio Nephrology. “Similarly, years when influenza and ILI were particularly bad were generally years when the number of deaths was also higher than expected. While ILI may well not be the direct cause of death in ESRD patients, it may contribute to other causes of death; for example, patients with ILI may experience a state of acute inflammation, making them vulnerable to other infections or cardiovascular events.”
To examine the association between the seasonality of influenza activity and the seasonal patterns of mortality in patients with ESRD, researchers used data from both the U.S. Outpatient Influenza-like Illness Surveillance Network, through which the CDC monitors influenza and influenza-like illness activity, and from CMS, through which researchers obtained the total number of deaths among patients with ESRD from 2000 through 2013. The number of deaths was considered by quarter, from the fourth quarter in 2000 through the fourth quarter in 2012, with quarters four and one corresponding to each influenza season.
After researchers accounted for the overall increasing trend in deaths due to the growing prevalent ESRD population, they calculated quarterly relative mortality compared with average third-quarter (summer) death counts.
Researchers found that an estimated 1% increase in quarterly influenza-like illness was associated with a 1.5% increase in relative mortality for quarter four and also with a 2% increase in relative mortality for quarter one.
Furthermore, researchers concluded that an average of 1,100 annuals deaths in patients with ESRD may be attributable to influenza-like illness.
“The findings of our study support the importance of close monitoring, prevention, and treatment to reduce the deaths associated with influenza and influenza-like illness,” Gilbertson said. “Further research is needed to find ways to improve influenza vaccination rates in ESRD patients, and to find optimal vaccination strategies in these patients. For example, should all ESRD patients receive high-dose, or adjuvenated vaccines? Or, since there is some evidence of waning immunity following vaccination in patients with ESRD, does repeat vaccination during the flu season offer any benefit?” – by Melissa J. Webb
Disclosures: Gilbertson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.