Vaccination issues in patients with chronic kidney disease

Abstract

Infections are an important cause of morbidity and mortality among patients at all stages of chronic kidney disease. Prevention through vaccination remains the best strategy to minimize the adverse consequences associated with these infectious diseases in this, and all, populations. Unfortunately, patients with chronic kidney disease demonstrate inadequacies of specific immune-cell function that are required for generating a protective vaccine response. Nevertheless, early vaccination of this high-risk population has demonstrated good clinical outcomes during progression to late-stage disease. We review the available evidence linking immune impairment in adult patients with late-stage chronic kidney disease to diminished vaccine responses. We highlight the importance of early vaccination in disease with high risk for development of CKD and novel vaccine approaches in development that may help to address improvement in protective boosting of immunity during late-stage disease.

Keywords::

• antibody
• chronic kidney disease
• end-stage renal disease
• immunity
• infection
• prevention
• T cell
• vaccination

Acknowledgement

The authors would like to thank Timothy Sellati, Trudeau Institute, NY, USA for editorial assistance.

Financial & competing interests disclosure

The authors were supported by internal funding at Albany Medical Center/College. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

Several healthcare-related implications in vaccination are understood from the current literature.

• Vaccination rates in both chronic kidney disease and end-stage renal disease patients are far below expectations of good clinical care of 100% of patients. These include vaccines for high-risk infections such as hepatitis B, influenza and pneumococcus. An implication of current data is that Nephrology specialists and primary care physicians of these patient populations should be more vigilant for updating vaccination status in this group.

• Prevention vaccination strategies for varicella zoster, MMR (if without primary series), pertussis and tetanus should be routinely considered in patients at high risk for chronic kidney disease or in the very early stages of the renal decline.

• Improved understanding of the potential needs for booster vaccinations to maintain seropositivity.

• In the era of electronic medical records, more formal tracking of vaccination status and subsequent healthcare monitoring of patient vaccination status should be routinely employed in high-risk populations both before overt development of disease and throughout the course of future treatment.