Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
Clinical Epidemiology and Biostatistics Unit, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
PLoS One. 2023 Feb 9;18(2):e0281160. doi: 10.1371/journal.pone.0281160. eCollection 2023.
Due to the nature of the disease, end-stage renal disease (ESRD) patients suffer from dysfunction of the adaptive immune system, which leads to a poorer response to vaccination. Accordingly, it is crucial to evaluate the efficacy and safety of management strategies, including vaccinations, which could potentially reduce the risk of respiratory diseases, such as pneumonia, influenza, or COVID-19, and its associated outcomes. We searched PubMed, CENTRAL, ScienceDirect, Scopus, ProQuest, and Google Scholar databases using designated MeSH keywords. The risk of bias was assessed using ROBINS-I. The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Relative risk (RR) and 95% confidence interval (CI) were calculated. Heterogeneity was investigated using forest plots and I2 statistics. This systematic review included a total of 48 studies, with 13 studies of influenza (H1N1 and H3N2) vaccination and 35 studies of COVID-19 vaccination. H1N1 vaccination in ESRD patients undergoing hemodialysis induced lower seroconversion rates (RR 0.62, 95% CI: 0.56-0.68, p <0.00001) and lower seroprotection rates (RR 0.76, 95% CI: 0.70-0.83, p <0.00001) compared to controls. H3N2 vaccination in ESRD patients undergoing hemodialysis yielded lower seroconversion rates (RR 0.76, 95% CI: 0.68-0.85, p <0.00001) and lower seroprotection rates (RR 0.84, 95% CI: 0.77-0.90, p <0.00001) compared to controls. Twenty-nine studies demonstrate significantly lower antibody levels in ESRD patients undergoing hemodialysis compared to the controls following COVID-19 vaccination. This review presents evidence of lower seroconversion and seroprotection rates after vaccination against viral respiratory diseases in patients with ESRD undergoing hemodialysis. Since hemodialysis patients are more susceptible to infection and severe disease progression, a weakened yet substantial serological response can be considered adequate to recommend vaccination against respiratory diseases in this population. Vaccination dose, schedule, or strategy adjustments should be considered in stable ESRD patients on maintenance hemodialysis. Trial registration: Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255983, identifier: CRD42021255983.
由于疾病的性质，终末期肾病（ESRD）患者的适应性免疫系统功能障碍，导致对疫苗的反应较差。因此，评估管理策略（包括疫苗接种）的疗效和安全性至关重要，这些策略可能降低呼吸道疾病（如肺炎、流感或 COVID-19）及其相关结局的风险。我们使用指定的 MeSH 关键词在 PubMed、CENTRAL、ScienceDirect、Scopus、ProQuest 和 Google Scholar 数据库中进行了搜索。使用 ROBINS-I 评估偏倚风险。使用 GRADE（推荐分级、评估、发展与评价）方法评估证据质量。计算相对风险（RR）和 95%置信区间（CI）。使用森林图和 I2 统计量调查异质性。本系统评价共纳入 48 项研究，其中 13 项研究流感（H1N1 和 H3N2）疫苗接种，35 项研究 COVID-19 疫苗接种。与对照组相比，接受血液透析的 ESRD 患者接种 H1N1 疫苗后血清转化率（RR 0.62，95%CI：0.56-0.68，p<0.00001）和血清保护率（RR 0.76，95%CI：0.70-0.83，p<0.00001）较低。接受血液透析的 ESRD 患者接种 H3N2 疫苗后血清转化率（RR 0.76，95%CI：0.68-0.85，p<0.00001）和血清保护率（RR 0.84，95%CI：0.77-0.90，p<0.00001）较低。29 项研究表明，与对照组相比，接受血液透析的 ESRD 患者接种 COVID-19 疫苗后抗体水平显著较低。本综述提供了证据，表明接受血液透析的 ESRD 患者接种病毒性呼吸道疾病疫苗后血清转化率和血清保护率较低。由于血液透析患者更容易感染和病情严重进展，因此对于这一人群，推荐接种呼吸道疾病疫苗时，较弱但相当的血清学反应可以被认为是足够的。应考虑调整稳定的接受维持性血液透析的 ESRD 患者的疫苗剂量、方案或策略。试验注册：系统评价注册：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255983，标识符：CRD42021255983。
