Vaccination For Chronic Kidney Disease (CKD)

Introduction

Patients with renal disease have a higher risk of illness and death. The No 2 cause of death after cardiovascular disease is infectious disease (ID).

Why is ID a significant problem?

People with CKD are unique in that:

1. They have additional exposures to infections via vascular access catheters and long term peritoneal dialysis catheters.
2. They have reduced immunity due to high blood urea as a result of renal failure.
3. Their antibody response is lower and decreases rapidly after immunization.

What can we do?

To vaccinate earlier is better!

Patients with renal failure, also known as CKD, have an increased risk of infection with a variety of bacteria and viruses particularly pneumococcus and hepatitis B.

Current vaccination schedule for all children

Hepatitis B Vaccine

This vaccine is recommended for:

All dialysis patients and CKD patients before they require dialysis.

Serologic testing, which is the testing of antibody levels against Hepatitis B, should be done 1-2 months after the last dose of vaccination.

Dialysis patients found to have anti-HBs (antibody) levels of less than 100 mIU/mL should receive another course of the vaccine.

Pneumococcal Vaccine
Patients with renal disease, especially nephritic syndrome, have an increased risk for pneumococcal infection which can cause severe infection in the lung, brain and blood stream.

Types of Pneumococcal Vaccine

PPV23

PCV 7

In children between the ages of 2-5 years, if they are at high risk for pneumococcal infection, two doses of PCV7 are administered 2 months apart, followed by one dose of PPV23 administered at least 2 months after the second dose of PCV7.

Children who have completed the PCV7 vaccination series before age 2 years should receive one dose of PPV23 at age 2 years (at least 2 months after the last dose of PCV7).

Measles, mumps and rubella vaccine (MMR vaccine)
Should be given to all children including those on dialysis between 12 and 15 months of age with a booster dose between 4-6 years of age.

Use of inactivated vaccine and toxoids in dialysis

Inactivated vaccines and toxoids are vaccines that do not contain live strains of the organism. All inactivated vaccine and toxoids are safe and effective when used in dialysis patients and should be administered to children and adults on chronic dialysis using standard recommended schedules.

Haemophilus influenza Type B conjugate vaccine (Hib)

Should be given to children beginning at 2 months to 5 years of age using same dosage and schedule used for healthy children and adults

Diphtheria and tetanus toxoids and pertussis vaccine

All children with CKD should receive diphtheria and tetanus toxoids and pertusis vaccine as recommended for healthy children

Summary

Infectious disease is the no. 2 cause of serious illness and death in patients with CKD.
To vaccinate earlier is better!
Patients with CKD are at increased risk of developing pneumococcal and hepatitis B infections.

References:

1. Immunizations in patients with end-stage renal disease- UpToDate
2. Compilation of International Guidelines for Immunization in CKD, 2008 Kidney Disease: Improving Global Outcomes (KDIGO)
3. A Kausz et al, The Value of Vaccination in Chronic Kidney Disease, Seminars in Dialysis Volume 17, Issue 1, pages 9–11, January 2004
4. A.Kausz, D.T. Gilbertson, Overview of Vaccination in Chronic Kidney Disease, Advances in Chronic Kidney Disease, Volume 13, Issue 3 , Pages 209-214, July 2006
5. Da Roza et al, Stage of chronic kidney disease predicts seroconversion after hepatitis B immunization: earlier is better, Am J Kidney Dis. 2003 Dec;42(6):1184-92.
6. N. Janus et al, Vaccination and chronic kidney disease, Nephrol. Dial. Transplant.(2008) 23 (3): 800-807. doi: 10.1093/ndt/gfm851

 

Last Reviewed	:	27 July 2016
Writer	:	Dr. Mirunalini Appadurai
Accreditor	:	Dr. Lee Ming Lee