[/B] Prophylaxis of Influenza
For the prophylaxis of influenza, dose adjustment is recommended for patients with creatinine
clearance between 10 and 30 mL/min receiving TAMIFLU. In these patients it is recommended that
the dose be reduced to 75 mg of TAMIFLU every other day or 30 mg TAMIFLU Oral Suspension
every day. No recommended dosing regimens are available for patients undergoing routine hemodialysis and continuous peritoneal dialysis treatment with end-stage renal disease.
Can dialyzors now take Tamiflu?
The suggestion I didn’t see was that people on dialysis should get the Pneumococcal Polysaccharide Vaccine to protect against the most deadly side effect of the flu. Here is a link to the CDC recommendation for the Pneumococcal Polysaccharide Vaccine (link to PDF file).
Yes, dialyzors can take Tamiflu–that’s what it said in the article. If you can take it safely for preventive reasons, you can take it if you get the flu, too. Your doctor would need to give some thought as to the dose. It might be a bit lower than normal.
The pneumonia vaccine is also recommended for people on dialysis.
But that’s just it, the insert says “No recommended dosing regimens are available for patients undergoing routine hemodialysis and continuous peritoneal dialysis treatment with end-stage renal disease” (shouldn’t that be “or peritoneal?”). Would your Doc have to prescribe Tamiflu off label? I’d want to know what the risks are if a dialyzor takes Tamiflu. Especially to consider taking it as a prophylactic.
“No recommended dosing regimens” just means that at the time that the company applied for FDA approval of the drug studies had not yet been done specifically on this population. Since then, studies have been done proving that Tamiflu is safe and effective for dialyzors–if, possibly, at somewhat lower doses. Getting FDA approval is a lengthy process that typically costs millions of dollars. No drug company is going to go back for an amended approval for a population of less than half a million.
I’m not sure why it would matter if the prescription was “off label;” since there are studies to support use of the drug for this group of people. Once a drug is approved by the FDA, a doctor can prescribe it for anything he or she wants to–but drug companies are not allowed to promote off-label use.
Incidentally, if it makes you feel better, a nephrologist did review this article before we uploaded it.
[QUOTE=bobeleanor;11674] What have people on dialysis taken before?
And are other health factors taken into account?[/QUOTE]
In most cases, antiviral drugs have not been widely used for the flu. Amantadine (the drug that isn’t recommended this year) is one of the older flu drugs, so I suppose some people may have taken that in the past–but it doesn’t work against this year’s strain. The flu mutates–it changes a bit from one year to the next, so if you had the flu last year you may still have some immunity to this year’s strain, unless it is very different.
How many people on dialysis get the flu?
I’m not sure anyone knows that exact number, but here’s what the CDC says
(http://www.cdc.gov/flu/keyfacts.htm):
• Each year, 5-20% of the US population gets the flu
• More than 200,000 people are hospitalized with flu complications
• About 36,000 people die from the flu
There are about 350,000 people on dialysis, so 5% = 17,500 and 20% = 70,000. Since there are 300 million Americans, 200,000 hospitalized = .0006667% of the population. So, for dialyzors, it might be from about a dozen to about 4 dozen people expected to be hospitalized. But the complication rate is 3-4 times higher for people with kidney failure. This means the rate is probably more like 50-200 people in the hospital. That sounds low, so there may be other factors involved.
And are other health factors taken into account?
I have no idea what you mean, Bobeleanor, you’ll have to tell me.
I misunderstood the recommendations for Tamiflu, thanks for clearing them up Dori.
Bob I would guess that fewer dialyzors get the flu then average, especially when there is a good match between the vaccine and whatever flu strain is going around because I think dialyzors as a group are more likely then the general population to get vaccinated . I think I heard that this year’s vaccine is an average to good match and at least here in Seattle I think we get between 80 and 90% of dialyzors vaccinated.
Hi
other health , heart, breathing. Isn’t they a # of people who have other problems in dialysis that can play a role?
And Bill and Dori: Are you saying that people on dialysis should get a flu shot? I never had gotten one before, but then this is my first yr. on dialysis. I did not get last yr.
Thanks
bobeleanor
It’s been nearly 8 years since I had a flu shot…since then have not gotten sick at all. Before,… those flu shots made me feeling quite bad all year long. I was not feeling well, not even through summer. Same thing for some of my family members who got those shots. After stopping from getting those shots we felt alot alot better.
Perhaps some people are very vulnerable to the flu than others…
YES. Every person on dialysis should get a flu shot every year. I don’t know how often the pneumonia vaccine is needed, because I didn’t research that. Bill, do you know?
Gus, here is a CDC page about flu shot side effects: http://www.cdc.gov/nip/vaccine/side-effects.htm. At most, it might cause a bit of redness at the injection site. (One year a bad batch of flu vaccine caused a temporary kind of paralysis called Guillain Barre’–but that was 30 years ago!)
It’s not possible for a flu shot to cause the kinds of long-term problems you’re talking about–likely those were due to something else. If you catch the flu, you do have partial immunity to the flu strains for the next year, or even the next few years, until it changes too much. So, it’s great that you’ve been lucky enough not to catch the flu, and hopefully that will keep up. But since it’s been so long, and this year’s vaccine is supposed to be pretty close to the real flu, you might think about whether you want to change your mind.
I do not get flu shots anymore. When I was a kid I had no problem with them. After I started dialysis I got flu shots for a couple of years. I stopped them after noticing that my arm would go numb for several hours after the shot and that I would get deathly ill for about three days with some lingering symptoms. I was in my clinic today and they asked if I wanted a flu shor. I decline as I do every year. I usualy get about two ful like colds a year. Living in Berkeley california it is no surprise to get a flu of some kind. My personal opinion is that I am probably better off getting exposed to some flus. Sort of a build up the defenses technique. Sure that may sound crazy, but it’s worked ok for me. I really just rather deal with how sick the shot makes me. If I get sick tha natural way then that is what Ganesha has in store for me.
LSB
[quote=Leafsunbear;11695]I do not get flu shots anymore. When I was a kid I had no problem with them. After I started dialysis I got flu shots for a couple of years. I stopped them after noticing that my arm would go numb for several hours after the shot and that I would get deathly ill for about three days with some lingering symptoms. I was in my clinic today and they asked if I wanted a flu shor. I decline as I do every year. I usualy get about two ful like colds a year. Living in Berkeley california it is no surprise to get a flu of some kind. My personal opinion is that I am probably better off getting exposed to some flus. Sort of a build up the defenses technique. Sure that may sound crazy, but it’s worked ok for me. I really just rather deal with how sick the shot makes me. If I get sick tha natural way then that is what Ganesha has in store for me.
LSB[/quote]
I’d have to agree with you to some degree. Some people do well without the shot than getting the shot. That was the case for me and some family members. I’ve read in the past that its not recommended to give the shots to young people unless their immune system is weak.
I don’t think that all and every dialysis patient have weak immune systems but it can be checked upon your Doctor’s consultation. It really depends on your current health status, but I also kinda wonder between patients who are in-center and those of us who are at home now.
Don’t you think that in-center patients are at higher risk and don’t you think that because they’re only doing 3x a week their immune system may be maybe a little off?
As for phneumonia, I did get a shot years ago. Supposedly, they said its a shot that should be given every seven years. Somehow, seems that the shot is quite effective for longer than seven years!
I thought Ganesha was the remover of obstacles. I have one in my car (to help find parking spaces) and one on my desk (to keep projects moving forward).
Actually, there IS some support for this idea, Gus. There was one paper that I didn’t cite in the topic of the month article, because it would have started to get too complicated. It found that while folks who used 3x/week in-center HD had compromised immune systems, folks on PD were pretty much normal. I don’t know that anyone has yet studied the immune systems of people who do short daily or nocturnal, but if keeping the blood cleaner more of the time helps the immune system, then it would make sense.
Also, folks who are in-center might be exposed to more people, if you figure that when you dialyze at home, you can choose to stay out of crowds (or at least places where you have to be 3 feet away from others).
[quote=Dori Schatell;11705]Actually, there IS some support for this idea, Gus. There was one paper that I didn’t cite in the topic of the month article, because it would have started to get too complicated. It found that while folks who used 3x/week in-center HD had compromised immune systems, folks on PD were pretty much normal. I don’t know that anyone has yet studied the immune systems of people who do short daily or nocturnal, but if keeping the blood cleaner more of the time helps the immune system, then it would make sense.
Also, folks who are in-center might be exposed to more people, if you figure that when you dialyze at home, you can choose to stay out of crowds (or at least places where you have to be 3 feet away from others).[/quote]
I really believe in this and health professionals in-center said the same thing. The only thing needed to clarify this is a research study proving that this is the case.
He carries an Axe to cut the ties that bind you, He also carries a lasso to tie you down with new ties.
He is both the remover and placer of obstacles. He can remove hurdles and he can place them too.
In all he has been very good to me in my life. He has brought me joy of levels I can not explain and he has brought me pain in levels that could span life times. He has truly blessed me in this life. He has shown me infinite blessings. All while danceing and teaching.
LSB
[QUOTE=Leafsunbear;11721]He carries an Axe to cut the ties that bind you, He also carries a lasso to tie you down with new ties.
He is both the remover and placer of obstacles. He can remove hurdles and he can place them too.
In all he has been very good to me in my life. He has brought me joy of levels I can not explain and he has brought me pain in levels that could span life times. He has truly blessed me in this life. He has shown me infinite blessings. All while danceing and teaching.
LSB[/QUOTE]
That’s fascinating, LSB. I’ll have to learn more (and look at my little desk statuette more closely).
