Patients on Dialysis Face High Herpes Zoster Burden
TOPLINEA French cohort study reported a herpes zoster incidence of nearly 10 per 1000 person-years in adults who started dialysis, with older patients at higher risk. About 1 in 5 of those affected required...
TOPLINE A French cohort study reported a herpes zoster incidence of nearly 10 per 1000 person-years in adults who started dialysis, with older patients at higher risk. About 1 in 5 of those affected required nerve pain medication, and nearly 1 in 4 were hospitalised within a week of receiving antiviral therapy.
METHODOLOGY Researchers performed a retrospective cohort study using French registry data to estimate the incidence, risk predictors, complications, and healthcare costs of herpes zoster in patients undergoing dialysis. They analysed 144,893 adults (mean age, 68.4 years; 64.5% men) who started haemodialysis (89.6%) or peritoneal dialysis (10.4%) from 2009 to 2023, excluding those younger than 18 years or those with a prior preemptive kidney transplant.
Herpes zoster cases were identified on the basis of a prescription for a short course (≥ 1 week but < 3 months) of oral antiviral drugs ( valacyclovir , acyclovir , or famciclovir ) and/or a hospital admission for herpes zoster. Longer or repeated antiviral prescriptions, as well as those associated with chemotherapy, were excluded.
The primary outcome was the incidence of herpes zoster; secondary outcomes included risk factors, complications such as postherpetic neuralgia (defined as a prescription for neuropathic painkillers within 90 days of antiviral therapy), hospitalisation, and healthcare costs. TAKEAWAY Overall, 4007 patients were identified as having herpes zoster, resulting in an incidence rate of 9.65 cases per 1000 person-years.
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Older patients were more likely to develop herpes zoster, with the strongest association seen in those aged 85 years or older vs those younger than 40 years (adjusted incidence rate ratio [aIRR], 1.36; P < .001). Women also had a higher incidence rate than men (aIRR, 1.16; P < .001), although this association lost significance in the competing risk analysis.
Among patients with herpes zoster, 19.8% received nerve pain drugs (mainly pregabalin ), and 23.1% were hospitalised in the week following antiviral therapy. Neuropathic pain management costs were estimated at approximately €43,300 per month, and total hospitalisation costs amounted to €3.4 million, of which €1.0 million was attributed specifically to herpes zoster itself or complications of its treatment.
IN PRACTICE "[The study] findings demonstrate that herpes zoster in this high-risk population is associated with a markedly higher clinical and economic burden than that reported in general populations, supporting the potential value of preventive strategies such as vaccination to reduce morbidity, healthcare utilization, and costs," the authors wrote.
SOURCE This study was led by Mabel Aoun, Fondation AUB Santé, Brittany, France. It was published online on September 29, 2026, in Clinical Kidney Journal . LIMITATIONS The study may have overestimated incidence if antiviral drugs were prescribed for other conditions or underestimated it among patients who were not treated due to late presentation.
Postherpetic neuralgia could be underestimated or overestimated because it was inferred only from prescriptions. In addition, the study did not account for immunosuppressive therapy. DISCLOSURES The study received financial support from the French Renal Epidemiology and Information Network registry.
The authors reported having no relevant conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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