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Association between influenza vaccination and the reduced risk of acute kidney injury among older people: A nested case-control study

  • Chia-Hsiang Shih
    Affiliations
    Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan

    School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Department of Emergency Medicine, Asia university hospital, Taichung, Taiwan
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  • Author Footnotes
    1 These authors contributed equally to the paper.
    Yi-Jung Lee
    Footnotes
    1 These authors contributed equally to the paper.
    Affiliations
    Division of Neurology, Department of Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
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  • Pei-Wen Chao
    Affiliations
    College of Medicine, Taipei Medical University, Taipei, Taiwan

    Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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  • Shu-Chen Kuo
    Affiliations
    National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan
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  • Shuo-Ming Ou
    Affiliations
    Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Author Footnotes
    2 These authors were co-corresponding authors.
    Hung-Meng Huang
    Correspondence
    Correspondence to: H.-M. Huang, Department of Nephrology, Taipei City Hospital, Heping Fuyou Branch, Taipei 112, Taiwan.
    Footnotes
    2 These authors were co-corresponding authors.
    Affiliations
    Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan

    Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
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  • Author Footnotes
    2 These authors were co-corresponding authors.
    Yung-Tai Chen
    Correspondence
    Correspondence to: Y.-T. Chen, Department of Otolaryngology, Taipei City Hospital, Taipei 112, Taiwan.
    Footnotes
    2 These authors were co-corresponding authors.
    Affiliations
    Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Division of Nephrology, Department of Medicine, Taipei City Hospital, Heping, Fuyou Branch, Taipei, Taiwan
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  • Author Footnotes
    1 These authors contributed equally to the paper.
    2 These authors were co-corresponding authors.

      Highlights

      • AKI following influenza infection is not uncommon in the older population.
      • Vaccination rate remains below the recommended goal worldwide, especially in Asia.
      • The risk of AKI was 37% lower among older people who received influenza vaccine.
      • The results remained consistent in different subgroups.

      Abstract

      Objective

      The objective of this study is to determine whether vaccination against influenza is associated with a reduced risk of acute kidney injury (AKI) in a nationwide cohort of adults aged ≥65 years.

      Methods

      We investigated a total of 13,270 patients aged ≥65 years who were hospitalized for AKI between 2000 and 2013 from Taiwan's National Health Insurance Research Database. Each AKI case was matched with one control subject according to duration of follow-up, age, sex, monthly income, urbanization level, and baseline comorbidities. Odds ratios (ORs) for AKI associated with exposure to the influenza vaccine in the previous year were calculated in a nested case-control analysis.

      Results

      Influenza vaccination in the previous year was associated with a lower risk of AKI (adjusted OR 0.67, 95% confidence interval [CI] 0.63–0.72). Compared with a reference group of unvaccinated individuals with no influenza infection, vaccination with no influenza infection was associated with a lower risk of AKI (adjusted OR 0.68, 95% CI 0.64–0.73). Lack of vaccination and presence of influenza infection was associated with a higher risk of AKI (adjusted OR 1.78, 95% CI 1.57–2.01), whereas the risk of AKI was insignificant in vaccinated patients who developed influenza (adjusted OR 1.01, 95% CI 0.69–1.18).

      Conclusions

      The risk of AKI was 37% lower among older people who received vaccination against influenza in a real-world setting. Further work is required to clarify causality.

      Keywords

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