French Registry Study Quantifies Herpes Zoster Incidence, Morbidity, and Costs in Patients on Dialysis

Adults starting dialysis in France developed herpes zoster at a rate of 9.65 per 1,000 person-years (95% CI, 9.40-9.95), according to the ZONA-REIN national study published online ahead of print in Clinical Kidney Journal. The investigators noted that incidence in the general population is 3 to 5 cases per 1,000 person-years.

The retrospective cohort study used the French Renal Epidemiology and Information Network (REIN) registry, linked to the French National Health Data System, to assess herpes zoster incidence, risk factors, complications, and costs among adults who initiated hemodialysis or peritoneal dialysis from 2009 through 2023. The study period preceded the commercial availability of the recombinant herpes zoster vaccine in France. Herpes zoster was defined by a 7-day to <3-month course of acyclovir, valacyclovir, or famciclovir and/or hospitalization with a herpes zoster diagnosis.

Among 144,893 patients included, 4,007 had herpes zoster, occurring a mean of 2.3 years after dialysis initiation. Incidence was 9.57 and 10.80 per 1,000 person-years among patients initiating hemodialysis and peritoneal dialysis, respectively. In Poisson regression, female sex (incidence rate ratio [IRR], 1.16) and older age were associated with higher incidence; the age association became significant at 75 years and was strongest at 85 years or older (IRR, 1.36). Diabetes was associated with lower incidence (IRR, 0.84). In competing-risk analyses accounting for death, however, age was the only significant predictor.

After antiviral therapy, 792 patients (19.8%) received neuropathic pain medications, which the investigators used to define postherpetic neuralgia; pregabalin was the most common. In addition, 927 patients (23.1%) were hospitalized within 1 week of antiviral dispensing. Of those admissions, 15.6% were labeled as herpes zoster, and 12.9% involved neurological complications, including medication-induced toxic encephalopathy. Neuropathic pain treatment cost €43,293 per month, and total hospitalization costs reached €3.4 million, including €1.0 million for zoster-related admissions and treatment-related intoxications.

The authors noted that incidence may have been underestimated if late-presenting cases went untreated, or overestimated if antivirals were prescribed for other indications, and that immunosuppressive therapy was not captured. They stated that the findings provide evidence to inform vaccination policies for patients receiving dialysis.

Source: Aoun M, Laruelle E, Dolley-Hitze T, Gauchon-Rousseau C, Edet S, Couchoud C. Incidence, risk factors, morbidity and cost of herpes zoster in patients on dialysis: the ZONA-REIN national study. Clin Kidney J. Published online September 29, 2026. doi:10.1093/ckj/sfag342