Vaccines For Kidney Disease Patients

Kidney disease patients are high risk for infections

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Raed Mansour; Flickr.com; Creative Commons 2.0 License

KIDNEY DISEASE DOES COMPROMISE THE IMMUNE SYSTEM

Hence, patients with chronic kidney disease (CKD) are at a higher risk of infections. The extent to which the body's immunity gets weakened is usually directly proportional to the extent to which the kidney function has declined. The important point to realize is that even moderate decline in kidney function can be associated with a significantly higher risk of serious life threatening infections.

 These include infections from any agent: bacteria, virus, fungi, etc. Specific studies have already revealed data that points to the​ association of kidney disease with serious infections like pneumonia and herpes zoster.

INFECTIONS ARE A LEADING CAUSE OF DEATH IN KIDNEY DISEASE PATIENTS

As I mentioned above, the risk of infection in patients with kidney disease worsens with advancing stages of kidney disease making infections a major cause of death, especially in patients with kidney failure who are on dialysis.

While not every infection might be preventable, vaccinating patients against infections for which a vaccine exists should be a priority. In fact, it should be routine care of the chronic kidney disease patient. This could lead to a much lower risk of death and hospitalization in the future.  

ADULT IMMUNIZATIONS (VACCINES) IN PATIENTS WITH KIDNEY DISEASE

Once you realize that CKD really is a de facto immunocompromised state, it becomes easy to understand the importance of preventive vaccination.

Vaccinations should hence be an integral part of a comprehensive care plan for the CKD patient. Specific vaccines are recommended based on the stage of CKD, and in fact, both the Center for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP), and international bodies like Kidney Disease: Improving Global Outcomes (KDIGO) have now come up with specific guidelines regarding adult immunizations in patients with kidney disease.

Here is a brief overview of serious infections against which vaccination is currently recommended in adults with CKD:

INFLUENZA (FLU)

Vaccination against influenza, the common respiratory tract illness whose outbreaks occur every winter is perhaps one of the most important public health measures of our time. 

Two types of vaccines are available for immunization against influenza: the inactivated vaccine (intramuscular injection)- which has a "killed" virus, and the live attenuated vaccine (nasal spray). The former is the "flu shot" that you would probably be accustomed to. ACIP recommends only the inactivated vaccine shot for flu immunization in patients with CKD, and all CKD patients regardless of the stage should be ideally vaccinated against influenza every year with the seasonal flu shot (unless they have other contraindications). 

Again to reiterate, the "nasal spray" flu vaccine (live attenuated) is contraindicated in chronic kidney disease or dialysis patients, and should not be administered.

 

PNEUMOCOCCAL INFECTIONS 

These infections can cause severe and life threatening illnesses like pneumonia and meningitis. The ACIP recommends vaccination against these infections using the so-called "polyvalent" pneumococcal vaccine in patients with advanced kidney disease. Depending on your age, revaccination in 5 years may or may not be required. This vaccine should be offered to patients with CKD stages 4 and 5.

HEPATITIS B

A serious disease of the liver, Hepatitis B infection can also damage other organs, including the kidneys and blood vessels. Hence, at this time, vaccination against Hepatitis B is typically recommended for patients with CKD stages 4 and 5. The usual schedule is a shot at 0, 1, and 6 months.

WHOOPING COUGH

Vaccination against Tetanus, Diphtheria, and Pertussis (Tdap) is recommended for most adults and is safe for patients with kidney disease. Typically one vaccine, followed by a Td booster every ten years is recommended.

CONCLUSION

Given the profound effects that kidney disease has on your risk of developing life threatening infections, vaccinations against influenza, pneumococcal infections, and hepatitis B should be part of standard care of the CKD patient. Ask your nephrologist if you are up to date with these! Vaccinations are backed by an overwhelming body of evidence that they save lives; regardless of what the anti-vaccination movement and Jenny McCarthy tell you.  

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