Vaccination gaps in incident hemodialysis patients: An opportunity for preventive nephrology, a prospective, cross-sectional study

Abstract

BACKGROUND

Patients initiating hemodialysis face heightened infection risks due to immunodeficiency and frequent healthcare exposure. Vaccinations against hepatitis B virus (HBV), Streptococcus pneumoniae, and influenza are recommended but often underutilized, particularly in resource-constrained settings.

AIM

To evaluate the baseline vaccination status and associated factors of patients starting hemodialysis in a tertiary nephrology center in North India, with the goal of identifying any overlooked opportunities for preventive care.

METHODS

A prospective cross-sectional study was conducted at the Institute of Liver and Biliary Sciences, New Delhi, from June 2023 to December 2024. Adult patients (≥ 18 years) initiating hemodialysis were evaluated for vaccination status (HBV, pneumococcal, influenza), comorbidities, prior nephrology consultation, transplant evaluation, and nutritional status. Statistical comparisons were made using χ² and t-tests, with P < 0.05 considered significant.

RESULTS

Among 132 patients (mean age 52.6 years; 72.7% male), 63 (47.7%) completed HBV vaccination, 37 (28.0%) received pneumococcal and influenza vaccines, and 73 (55.3%) were unvaccinated. Prior nephrology consultation significantly predicted vaccine uptake for HBV (72.1% vs 21.9%, P < 0.001), pneumococcal (47.1% vs 7.8%, P < 0.001), and influenza (47.1% vs 7.8%, P < 0.001). Protective anti-HBs titers were observed in 66.7% of vaccinated individuals. Vaccinated patients had higher rates of arteriovenous fistula creation and transplant evaluation.

CONCLUSION

Vaccination coverage at dialysis initiation remains suboptimal. Early nephrology referral and structured chronic kidney disease (CKD) care pathways are critical to improving vaccine uptake. Integrating adult immunization into routine CKD management may reduce infection-related morbidity and improve outcomes.

Keywords: Chronic kidney disease; Hemodialysis; Adult vaccination; Preventive nephrology

Core Tip: This study highlights critical gaps in adult immunization among patients with chronic kidney disease initiating hemodialysis, with suboptimal coverage for hepatitis B virus, pneumococcal, and influenza vaccines. Notably, a high prevalence of tuberculosis (TB) (16.7%) was observed, underscoring the dual infectious burden in this population. Prior nephrology consultation and pre-transplant evaluation were strongly associated with higher vaccine uptake. Integrating structured vaccination and TB screening into pre-dialysis care pathways offers a unique opportunity for preventive nephrology in resource-limited settings.