tetano
Editor, Senior Moderator
Hypertens Res
. 2026 May 11.
doi: 10.1038/s41440-026-02674-w. Online ahead of print.
Influenza vaccination after advanced acute kidney injury: effects on mortality, cardiovascular events, and pneumonia-a target trial emulation
Hung-Wei Liao[SUP] 1 [/SUP], Chung-Yi Cheng[SUP] 1 2 3 [/SUP], Chung-An Wang[SUP] 4 [/SUP], Jui-Yi Chen[SUP] 5 6 [/SUP], Tao-Min Huang[SUP] 7 [/SUP], Vin-Cent Wu[SUP] 8 9 10 [/SUP]
Affiliations
Patients in the post-advanced acute kidney injury (post-advanced AKI) period are vulnerable to cardiovascular complications, infection, and mortality. Whether seasonal influenza vaccination mitigates these risks after advanced AKI remains unknown. To address this gap, we emulated a target trial using the global TriNetX electronic health record network. The hypothetical trial compared influenza vaccination versus no vaccination among adults in the post-advanced AKI period following dialysis-requiring AKI or decline in eGFR to <15 ml/min/1.73 m². After propensity score matching, vaccinated and unvaccinated cohorts were followed for one year. Primary outcomes were all-cause mortality, major adverse cardiovascular events (MACE), and pneumonia. Secondary outcomes included, major adverse kidney events (MAKE), re-dialysis, and heart failure. Among 981,700 patients with post-advanced AKI, only 1.3% (n = 12,659) received influenza vaccination. Our analysis revealed that vaccination was associated with lower risks of all-cause mortality (aHR 0.73), MACE (aHR 0.54), pneumonia (aHR 0.51), MAKE (aHR 0.70), re-dialysis (aHR 0.57; all p < 0.001), and heart failure (aHR 0.62) after a mean follow-up of 11.7 months. Furthermore, a dose-response relationship was observed with repeated annual vaccination, and interrupted time-series analysis showed a 15.4-case monthly reduction in pneumonia per 1000 patients after vaccination. In this target trial emulation, influenza vaccination during the post-advanced AKI period was associated with substantially lower one-year risks of mortality, cardiovascular events, and pneumonia. These findings support integrating influenza vaccination into routine post-advanced AKI care to reduce clinical complications.
Keywords: Digital hypertension; Influenza vaccination; Major adverse cardiovascular events (MACE); Mortality; Post-advanced acute kidney injury.
. 2026 May 11.
doi: 10.1038/s41440-026-02674-w. Online ahead of print.
Influenza vaccination after advanced acute kidney injury: effects on mortality, cardiovascular events, and pneumonia-a target trial emulation
Hung-Wei Liao[SUP] 1 [/SUP], Chung-Yi Cheng[SUP] 1 2 3 [/SUP], Chung-An Wang[SUP] 4 [/SUP], Jui-Yi Chen[SUP] 5 6 [/SUP], Tao-Min Huang[SUP] 7 [/SUP], Vin-Cent Wu[SUP] 8 9 10 [/SUP]
Affiliations
- PMID: 42115687
- DOI: 10.1038/s41440-026-02674-w
Patients in the post-advanced acute kidney injury (post-advanced AKI) period are vulnerable to cardiovascular complications, infection, and mortality. Whether seasonal influenza vaccination mitigates these risks after advanced AKI remains unknown. To address this gap, we emulated a target trial using the global TriNetX electronic health record network. The hypothetical trial compared influenza vaccination versus no vaccination among adults in the post-advanced AKI period following dialysis-requiring AKI or decline in eGFR to <15 ml/min/1.73 m². After propensity score matching, vaccinated and unvaccinated cohorts were followed for one year. Primary outcomes were all-cause mortality, major adverse cardiovascular events (MACE), and pneumonia. Secondary outcomes included, major adverse kidney events (MAKE), re-dialysis, and heart failure. Among 981,700 patients with post-advanced AKI, only 1.3% (n = 12,659) received influenza vaccination. Our analysis revealed that vaccination was associated with lower risks of all-cause mortality (aHR 0.73), MACE (aHR 0.54), pneumonia (aHR 0.51), MAKE (aHR 0.70), re-dialysis (aHR 0.57; all p < 0.001), and heart failure (aHR 0.62) after a mean follow-up of 11.7 months. Furthermore, a dose-response relationship was observed with repeated annual vaccination, and interrupted time-series analysis showed a 15.4-case monthly reduction in pneumonia per 1000 patients after vaccination. In this target trial emulation, influenza vaccination during the post-advanced AKI period was associated with substantially lower one-year risks of mortality, cardiovascular events, and pneumonia. These findings support integrating influenza vaccination into routine post-advanced AKI care to reduce clinical complications.
Keywords: Digital hypertension; Influenza vaccination; Major adverse cardiovascular events (MACE); Mortality; Post-advanced acute kidney injury.