Vaccines for people with kidney disease

Kidney disease can damage the immune system. Therefore, patients with chronic kidney disease (CKD) are at higher risk of infection. The degree to which the body’s immunity is weakened is usually proportional to the degree of renal function decline.

Understanding Infections

It’s important to realize that even a moderate decline in kidney function can be associated with a significantly increased risk of serious life-threatening infections. These include infections from any pathogen such as bacteria, viruses, fungi, etc. Research has uncovered data on an association between kidney disease and serious infections such as pneumonia and herpes zoster (shingles).

Infections are also the leading cause of death in people with kidney disease. As noted above, the risk of infection in patients with kidney disease worsens as kidney disease progresses, making infection a leading cause of death, especially in kidney failure patients receiving dialysis.

While not all infections are preventable, vaccinating patients to prevent infection should be a priority. In fact, it should be part of the daily care of people with chronic kidney disease. This could lead to a much lower risk of future death and hospitalization.

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Adult Immunizations

The importance of preventive vaccination is easy to understand once you realize that CKD is indeed a de facto immunocompromised state. Therefore, vaccination should be an integral part of a comprehensive care plan for patients with CKD.

Specific vaccines are recommended based on the stage of CKD. In fact, both the CDC Advisory Committee on Immunization Practices (ACIP) and the international organization Kidney Disease: Improving Global Outcomes (KDIGO) now have specific guidelines on immunization of adults with kidney disease.

The following is a brief overview of the serious infections currently recommended for vaccination in adults with CKD.

Influenza (flu)

The flu shot, a common respiratory illness that hits every winter, may be one of the most important public health measures of our time.

There are two types of vaccines available to prevent the flu:

  1. This inactivated Influenza vaccine with a “killing” virus (injected intramuscularly)
  2. This live Attenuated flu vaccine (nasal spray)

The former is the “flu shot” you might get used to.

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ACIP recommends influenza immunization with inactivated vaccine only in patients with CKD. Ideally, all patients with CKD, regardless of stage, should receive annual seasonal influenza vaccines to prevent influenza (unless they have other contraindications).

“Nasal spray” influenza vaccine (live attenuated) is contraindicated in patients with chronic kidney disease or dialysis and should not be vaccinated.

pneumococcal infection

These infections can lead to serious and life-threatening diseases such as pneumonia and meningitis. The KDIGO CKD Task Force recommends the use of a “polyvalent” pneumococcal vaccine in patients with advanced kidney disease to prevent these infections. This vaccine should be given to patients with CKD in stages 4 and 5 (p107), and it is recommended that all adults with CKD be revaccinated within 5 years.

Hepatitis B

A serious liver disease, hepatitis B infection can also damage other organs, including the kidneys and blood vessels. Currently, hepatitis B vaccine is generally recommended for patients with stage 4 and 5 CKD.

The usual hepatitis B vaccination schedule consists of a series of injections at 0, 1 and 6 months.

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pertussis

Tetanus, diphtheria and pertussis vaccine (Tdap) is recommended for most adults and is safe for people with kidney disease. Typically, a vaccine is recommended every 10 years, followed by a Td booster.

VigorTip words

Given the profound impact of kidney disease on a person’s risk of developing life-threatening infections, influenza vaccine, pneumococcal infection, and hepatitis B vaccine should be part of the standard of care for patients with CKD.

Ask your nephrologist if you are up to date on immunizations. Vaccinations are backed by overwhelming evidence that they do save lives.