{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:56:38Z","timestamp":1792814198096,"version":"4.5.0"},"reference-count":60,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","funder":[{"name":"National Institute of Allergy and Infectious Diseases","award":["R21AI178408"],"award-info":[{"award-number":["R21AI178408"]}],"id":[{"id":"https:\/\/ror.org\/043z4tv69","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>In patients with kidney failure, enhanced influenza vaccine formulations may provide modestly increased protection versus standard-dose vaccines.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>This cohort study compared the risk of influenza-like illness, influenza, influenza-related hospitalization, severe influenza, and all-cause mortality by vaccine formulation.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Findings support new Centers for Disease Control and Prevention guidelines recommending enhanced influenza vaccine formulations in adults \u226565 years, regardless of kidney failure.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Influenza vaccination is recommended to prevent influenza in patients with kidney failure. It remains unclear whether newer, enhanced vaccine formulations are more effective than standard-dose, egg-based, inactivated influenza vaccine (standard-dose vaccine) in patients undergoing maintenance hemodialysis. We sought to compare the effectiveness of five influenza vaccine formulations among patients undergoing hemodialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using the United States Renal Data System database, we performed an active comparator cohort study among adults \u226565 years with kidney failure undergoing hemodialysis (2011\/2012\u20132019\/2020 influenza seasons) who received a standard-dose, high-dose, cell culture\u2013based, adjuvanted, or recombinant influenza vaccine within a given season. We compared the risk of influenza-like illness, influenza, influenza-related hospitalization, severe influenza, and all-cause mortality during the influenza season by vaccine formulation. Season-specific risk differences and relative vaccine effectiveness (rVE) were estimated using propensity score\u2013weighted Kaplan\u2013Meier functions, accounting for the competing risk of death (for nonmortality outcomes). We combined the season-specific estimates\n                      <jats:italic toggle=\"yes\">via<\/jats:italic>\n                      a random effects meta-analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      578,232 influenza patient-seasons included standard-dose vaccine (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =372,907), high-dose vaccine (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =192,880), cell culture\u2013based vaccine (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =8177), adjuvanted vaccine (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =3308), or recombinant vaccine (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =960). Season-specific and meta-analytic estimates were consistent with a modest protective effect of high-dose vaccine versus standard-dose vaccine for influenza (meta-analytic rVE 5.1%; 95% confidence interval [CI], \u22120.7% to 10.5%), influenza-related hospitalization (meta-analytic rVE 5.5%; CI, \u22121.8% to 12.3%), and severe influenza (meta-analytic rVE 13.7%; CI, \u22129.7% to 32.1%), but not influenza-like illness or mortality. Patterns were similar for cell culture\u2013based vaccine versus standard-dose vaccine (\n                      <jats:italic toggle=\"yes\">e.g<\/jats:italic>\n                      ., meta-analytic rVE for influenza, 18.3%; CI, 2.2% to 31.7%). Estimates for adjuvanted or recombinant versus standard-dose vaccines were imprecise. Quantitative bias analyses did not indicate residual confounding, although some estimates were imprecise.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among older adults undergoing hemodialysis, high-dose vaccine and cell culture\u2013based vaccine provided modestly increased protection versus standard-dose vaccine.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1681\/asn.0000001099","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:04:19Z","timestamp":1776096259000},"page":"1979-1991","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Effectiveness of Different Influenza Vaccine Formulations among Patients Undergoing Maintenance Hemodialysis"],"prefix":"10.1681","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8137-0323","authenticated-orcid":false,"given":"John W.","family":"Davis","sequence":"first","affiliation":[{"name":"Department of Medicine, Washington University in St. Louis\/Barnes-Jewish Hospital, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0994-5820","authenticated-orcid":false,"given":"J. Bradley","family":"Layton","sequence":"additional","affiliation":[{"name":"RTI Health Solutions, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6000-0908","authenticated-orcid":false,"given":"John M.","family":"Sahrmann","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4116-512X","authenticated-orcid":false,"given":"Katelin B.","family":"Nickel","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8000-1385","authenticated-orcid":false,"given":"Vikas R.","family":"Dharnidharka","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1726-4435","authenticated-orcid":false,"given":"David J.","family":"Weber","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Butler","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"issue":"2","key":"B1-20261023","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1681\/ASN.2018060581","article-title":"Excess deaths attributable to influenza-like illness in the ESRD population","volume":"30","author":"Gilbertson","year":"2019","journal-title":"J Am Soc Nephrol."},{"issue":"7","key":"B2-20261023","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1097\/01.ASN.0000074237.78764.D1","article-title":"Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO study","volume":"14","author":"Allon","year":"2003","journal-title":"J Am Soc Nephrol."},{"issue":"3","key":"B3-20261023","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1681\/ASN.2006040406","article-title":"Infection-related hospitalization rates in pediatric versus adult patients with end-stage renal 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