Vaccination Challenges and Outcomes in Patients Undergoing Hemodialysis: Experience From a Pharmacist-Led Program in Singapore

Background Patients receiving maintenance hemodialysis experience a high burden of infectious morbidity, and vaccination is a key preventive strategy in this population. Despite international guideline recommendations, vaccination uptake and immune response in this population remain suboptimal. Aims The study aimed to evaluate hepatitis B virus (HBV) vaccination completion and seroprotection, pneumococcal vaccination coverage, and pneumonia-related hospitalizations among incident hemodialysis patients managed under a pharmacist-led vaccination program. Design This retrospective cohort study was conducted between 2019 and 2022 at a tertiary hospital dialysis program in Singapore, where vaccination delivery was integrated into routine hemodialysis care by clinical pharmacists. Methods All consecutive incident adult hemodialysis patients managed between January 2019 and December 2022 under a pharmacist-led vaccination model were included. They were evaluated for vaccination uptake, immune response to HBV vaccination, and pneumonia-related hospitalizations within the first year of dialysis initiation. Data were extracted from the hospital’s electronic medical record (EMR) system. As this was a service evaluation of the entire eligible population during the study period, no formal sample size calculation was performed. Statistical analysis Categorical variables were analyzed using chi-square testing, with statistical significance defined as a two-sided p-value < 0.05. Results are reported with corresponding chi-square statistics and p-values where applicable. Results Among HBV-susceptible patients, just over one-third completed the recommended three-dose vaccination schedule, and approximately half of those achieved seroprotection. Pneumococcal vaccination coverage within the first year of hemodialysis initiation was below 50%. Pneumonia-related hospitalizations were lower among vaccinated patients (2.2%) compared with unvaccinated patients (7.5%) and were statistically significant (p = 0.032). Conclusions A pharmacist-led vaccination program was associated with moderate vaccine uptake and reduced pneumonia-related hospitalizations; however, substantial gaps in vaccination completion and immune response persisted. Multicomponent, system-level strategies may be required to enhance vaccine uptake and effectiveness in hemodialysis populations.