SUN-060 PNEUMOCOCCAL VACCINATION COVERAGE AT THE INITIATION OF CHRONIC DIALYSIS, AND ITS ASSOCIATION WITH MORTALITY DURING THE FIRST YEAR

Abstract

Limited data are available on the impact of pneumococcal immunization in hemodialysis patients. The purpose of this study was to estimated vaccination coverage among incident patients who initiated chronic dialysis in France in 2015 and its association with mortality according to patient characteristics and vaccination schedule. Data were extracted from two national data-bases, merged using a deterministic linkage method: Renal Epidemiology and Information Network (REIN) registry, which includes all dialysed and transplanted patients in France, and the French National Health Insurance Information System (SNIIRAM) which includes individual data on health expenditure reimbursement, including vaccines. Data on health status at dialysis initiation, dialysis modalities, and all pneumococcal vaccine prescribed from 2 years before to 1 year after dialysis starting were collected. Univariate and multivariate Cox proportional hazard models were used to assess one-year all-cause mortality. Among the 8,294 incident patients included, 1,849 (22.3%) patients received at least one pneumococcal vaccine: 542 (6.5%) during the two years before dialysis start, and 1,307 (15.8%) after dialysis start, in 2015 or 2016. Among them, 35.1% received 23 valent-pneumococcal polysaccharide vaccine (PPSV23) alone, 50.7% 13 valent-pneumococcal conjugated vaccine (PCV13), followed by PPSV23, and 14.1% only PCV13. Vaccinated patients were younger, more likely to have a glomerulonephritis and less likely to start a dialysis in emergency start. Adjusted on age, sex, bio-clinical data and context of dialysis start (planned vs emergency), patients who received PCV13 and PPSV23 or only PCV13 were less likely to die (respectively, HR=0.37; 95%CI: 0.28-0.51, and HR=0.35; 95%CI: 0.19-0.65). Pneumococcal immunization with PCV13 and PPSV23, or only PCV13 but not with PPSV23, is associated with decreased one year-mortality in patients who start dialysis. Patients who initiate hemodialysis should receive pneumococcal immunization, preferably with PCV13 followed by PPSV23.