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Influenza vaccination after advanced acute kidney injury: effects on mortality, cardiovascular events, and pneumonia—a target trial emulation

Hypertension Research (2026) Cite this article

Abstract

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.

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Acknowledgements

Acknowledgments to the Board of Directors of the Affiliated Hospital of Chi-Mei Hospital for granting approval for the use of data.

Funding

This research was funded by Taiwan National Science Council (grants NSC 101-2314-B-002-132-MY3, NSC100-2314-B-002-119, NSC 101-2314-B-002-085-MY3, MOST 104-2314-B-002 -125 -MY3) and National Taiwan University Hospital (NTUH 100-N1776, 101-M1953, 102-S2097).

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, WanFang Hospital, Taipei Medical University, Taipei, Taiwan

    Hung-Wei Liao & Chung-Yi Cheng

  2. Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Chung-Yi Cheng

  3. Taipei Medical University-Research Center of Urology and Kidney (RCUK), School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Chung-Yi Cheng

  4. Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Chung-An Wang

  5. Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan

    Jui-Yi Chen

  6. Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

    Jui-Yi Chen

  7. Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Tao-Min Huang & Vin-Cent Wu

  8. Primary Aldosteronism Center, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Vin-Cent Wu

  9. NSARF (National Taiwan University Hospital Study Group of ARF), TAIPAI, (Taiwan Primary Aldosteronism Investigators), and CAKS (Taiwan Consortium for Acute Kidney Injury and Renal Diseases), Taipei, Taiwan

    Vin-Cent Wu

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  1. Hung-Wei Liao
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Correspondence to Vin-Cent Wu.

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Liao, HW., Cheng, CY., Wang, CA. et al. Influenza vaccination after advanced acute kidney injury: effects on mortality, cardiovascular events, and pneumonia—a target trial emulation. Hypertens Res (2026). https://doi.org/10.1038/s41440-026-02674-w

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