Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic Kidney Disease

Patients with renal failure have an increased risk of infection with a variety of pathogens, particularly pneumococcus and hepatitis B. The efficacy of pneumococcal vaccination for some of these patients, including those on dialysis, may be considerably lower than for immunocompetent patients, their antibody levels may be lower, and they may require repeat vaccination or an increased dose of vaccine. Because secondary antibody responses are less affected than primary antibody responses, immunization strategies should be formulated early in the course of progressive renal disease. This approach is particularly important if transplantation and chronic immunosuppressive therapy are being considered. Nephrotic syndrome is the renal disease most clearly associated with an increased risk for pneumococcal infection.