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. 2021 Mar 3;6(5):1254-1264.
doi: 10.1016/j.ekir.2021.02.024. eCollection 2021 May.

Systematic Review and Meta-analysis of Herpes Zoster Vaccine in Patients With CKD

Mohamad A Hamad  1   2 , Hilda Allam  1 , Ashna Sulaiman  2 , Karumathil Murali  3   4 , Hicham I Cheikh Hassan  3   4
Affiliations

Systematic Review and Meta-analysis of Herpes Zoster Vaccine in Patients With CKD

Mohamad A Hamad et al. Kidney Int Rep. .

Abstract

Introduction: Chronic kidney disease (CKD) is a risk factor for herpes zoster (HZ) infection. Few studies have examined HZ vaccine (HZV) in this population. We conducted a systematic review and meta-analysis investigating the efficacy and safety of HZV in patients with renal disease (CKD, dialysis, and transplant).

Methods: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases (up to May 2020) were searched for randomized controlled trials and nonrandomized controlled studies evaluating HZV in patients with CKD for effectiveness and adverse event risks. Studies without a control group (placebo or no vaccine) were excluded. Extraction of prespecified data and risk of bias assessments using the Newcastle-Ottawa scale for cohort studies and the Cochrane Risk of Bias Tool for randomized controlled trials were done by 3 authors. Random-effects meta-analysis was used to generate pooled treatment effects and 95% confidence intervals.

Results: Included were 404,561 individuals from 8 studies (3 randomized controlled trials and 5 nonrandomized). All 8 studies examined HZ as an outcome, with 3 reporting adverse events. Risk of HZ was lower in patients who received HZV compared with controls (hazard ratio, 0.55; 95% confidence interval, 0.37-0.82; P < 0.01); however, heterogeneity was high (I 2 = 88%, P < 0.01). There was no significant difference in adverse events associated with HZV (hazard ratio, 1.03; 95% confidence interval, 0.54-1.28; P = 0.8).

Conclusions: HZV compared with control significantly lowers the risk of HZ without an increase in adverse events in CKD patients. However, significant heterogeneity was present. HZV should be actively considered in CKD patients because the prevalence of HZ is higher in this population.

Keywords: chronic kidney disease; dialysis; herpes zoster; herpes zoster vaccine; meta-analysis; transplant.

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Figures

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Graphical abstract
Figure 1
Figure 1
Flowchart of study selection in the meta-analysis. CENTRAL, Cochrane Central Register of Controlled Trials.
Figure 2
Figure 2
Risk of bias for the randomized controlled trials included in the meta-analysis. (a) Risk of bias summary. (b) Risk of bias graph. Symbols: +, low risk of bias; ?, some concerns; –, high risk of bias.
Figure 3
Figure 3
Forest plot of the relationship between (a) herpes zoster vaccine (HZV) and herpes zoster (HZ) in patients with chronic kidney disease and (b) risk of adverse events after HZV in patients with chronic kidney disease. The squares represent the risk ratio and lines the 95% confidence intervals (CIs) for individual studies. The area of each square is proportional to study weight. The diamond and width represent the pooled risk ratios and 95% CIs, respectively. M-H, Mantel- Haenszel.
Figure 4
Figure 4
Subgroup analysis of the risk of herpes zoster by chronic kidney disease, dialysis, or transplant population. The squares represent the risk ratio and the lines the 95% confidence intervals (CIs) for individual studies. The area of each square is proportional to study weight. The diamond and width represents the pooled risk ratios and 95% CIs, respectively. HZV, herpes zoster vaccine; M-H, Mantel- Haenszel.
Figure 5
Figure 5
Sensitivity analysis with given named study omitted. Study by Miller (2018) was not included due to lack of events. CI, confidence interval.
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