Vaccination in Chronic Kidney Disease

      Infections after cardiovascular disease are the second most common cause of death in the chronic kidney disease population. Vaccination is an important component of maintaining health and wellness in patients with kidney disease. There is a changing epidemiologic landscape for several vaccine-preventable illnesses from childhood to adulthood and unfounded public perception of safety concerns. Several mechanisms have been proposed to cause inadequate vaccine protection in this high-risk group with chronic kidney disease. These have led to recent advances in new designs for vaccination strategies in kidney disease. In this article, we discuss the current evidence and recommendations for vaccination in those with kidney disease and needing renal replacement therapy (dialysis and transplant).

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        • Kausz A.
        • Pahari D.
        The value of vaccination in chronic kidney disease.
        Semin Dial. 2004; 17: 9-11
        • United States Renal Data System
        2017 USRDS annual data report: Epidemiology of kidney disease in the United States.
        National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD2017
        • Choudhury D.
        • Luna-Salazar C.
        Preventive health care in chronic kidney disease and end-stage renal disease.
        Nat Clin Pract Nephrol. 2008; 4: 194-206
        • Mathew R.
        • Mason D.
        • Kennedy J.S.
        Vaccination issues in patients with chronic kidney disease.
        Expert Rev Vaccin. 2014; 13: 285-298
        • Vandecasteele S.J.
        • Ombelet S.
        • Blumental S.
        • Peetermans W.E.
        The ABC of pneumococcal infections and vaccination in patients with chronic kidney disease.
        Clin Kidney J. 2015; 8: 318-324
        • Ventola C.L.
        Immunization in the United States: recommendations, barriers, and measures to improve compliance. Part 2: adult vaccinations.
        P T. 2016; 41: 492-506
        • Lee D.H.
        • Boyle S.M.
        • Malat G.
        • Sharma A.
        • Bias T.
        • Doyle A.M.
        Low rates of vaccination in listed kidney transplant candidates.
        Transpl Infect Dis. 2016; 18: 155-159
        • Annunziata K.
        • Rak A.
        • Del Buono H.
        • DiBonaventura M.
        • Krishnarajah G.
        Vaccination rates among the general adult population and high-risk groups in the United States.
        PLoS One. 2012; 7: e50553
        • Bitsori M.
        • Galanakis E.
        Vaccine-preventable infection morbidity of patients with chronic kidney disease and cocoon vaccination strategies.
        Expert Rev Vaccin. 2015; 14: 1385-1395
        • Kato S.
        • Chmielewski M.
        • Honda H.
        • et al.
        Aspects of immune dysfunction in end-stage renal disease.
        Clin J Am Soc Nephrol. 2008; 3: 1526-1533
        • Hesselink D.A.
        • Betjes M.G.
        • Verkade M.A.
        • Athanassopoulos P.
        • Baan C.C.
        • Weimar W.
        The effects of chronic kidney disease and renal replacement therapy on circulating dendritic cells.
        Nephrol Dial Transplant. 2005; 20: 1868-1873
        • Litjens N.H.
        • Huisman M.
        • van den Dorpel M.
        • Betjes M.G.
        Impaired immune responses and antigen-specific memory CD4+ T cells in hemodialysis patients.
        J Am Soc Nephrol. 2008; 19: 1483-1490
        • Danziger-Isakov L.
        • Kumar D.
        Vaccination in solid organ transplantation.
        Am J Transplant. 2013; 13: 311-317
        • DaRoza G.
        • Loewen A.
        • Djurdjev O.
        • et al.
        Stage of chronic kidney disease predicts seroconversion after hepatitis B immunization: earlier is better.
        Am J kidney Dis. 2003; 42: 1184-1192
        • Wheelock A.
        • Parand A.
        • Rigole B.
        • et al.
        Socio-psychological factors driving adult vaccination: a qualitative study.
        PLoS One. 2014; 9: e113503
        • Rubin L.G.
        • Levin M.J.
        • Ljungman P.
        • et al.
        2013 IDSA clinical practice guideline for vaccination of the immunocompromised host.
        Clin Infect Dis. 2014; 58: 309-318
        • Preboth M.
        PHS guidelines for management of occupational exposure to HBV, HCV and HIV: management of occupational blood exposures.
        Am Fam Physician. 2001; 64: 2012-2014
        • Mast E.E.
        • Margolis H.S.
        • Fiore A.E.
        • et al.
        A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents.
        MMWR Recommend Rep. 2005; 54: 1-31
        • Ribot S.
        • Rothstein M.
        • Goldblat M.
        • Grasso M.
        Duration of hepatitis B surface antigenemia (HBs Ag) in hemodialysis patients.
        Arch Intern Med. 1979; 139: 178-180
        • Edey M.
        • Barraclough K.
        • Johnson D.W.
        Review article: hepatitis B and dialysis.
        Nephrology (Carlton). 2010; 15: 137-145
        • Ghadiani M.H.
        • Besharati S.
        • Mousavinasab N.
        • Jalalzadeh M.
        Response rates to HB vaccine in CKD stages 3-4 and hemodialysis patients.
        J Res Med Sci. 2012; 17: 527-533
        • Lewis-Ximenez L.L.
        • Oliveira J.M.
        • Mercadante L.A.
        • et al.
        Serological and vaccination profile of hemodialysis patients during an outbreak of hepatitis B virus infection.
        Nephron. 2001; 87: 19-26
        • Kim D.K.
        • Riley L.E.
        • Hunter P.
        on behalf of the Advisory Committee on Immunization Practices. Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2018.
        Ann Intern Med. 2018; 168: 210-220
      1. A two-dose hepatitis B vaccine for adults (Heplisav-B).
        JAMA. 2018; 319: 822-823
        • Grzegorzewska A.E.
        Hepatitis B vaccination in chronic kidney disease patients: a call for novel vaccines.
        Expert Rev Vaccines. 2014; 13: 1317-1326
        • Wang I.K.
        • Lin C.L.
        • Lin P.C.
        • et al.
        Seasonal influenza vaccination is associated with reduced morbidity and mortality in peritoneal dialysis patients.
        Nephrol Dial Transplant. 2016; 31: 269-274
        • Wang I.K.
        • Lin C.L.
        • Lin P.C.
        • et al.
        Effectiveness of influenza vaccination in patients with end-stage renal disease receiving hemodialysis: a population-based study.
        PLoS One. 2013; 8: e58317
        • Gilbertson D.T.
        • Unruh M.
        • McBean A.M.
        • Kausz A.T.
        • Snyder J.J.
        • Collins A.J.
        Influenza vaccine delivery and effectiveness in end-stage renal disease.
        Kidney Int. 2003; 63: 738-743
        • Kausz A.T.
        • Gilbertson D.T.
        Overview of vaccination in chronic kidney disease.
        Adv Chronic Kidney Dis. 2006; 13: 209-214
        • Kumar D.
        • Blumberg E.A.
        • Danziger-Isakov L.
        • et al.
        Influenza vaccination in the organ transplant recipient: review and summary recommendations.
        Am J Transplant. 2011; 11: 2020-2030
        • Rodriguez M.A.
        • Gonzalez A.V.
        • Gavin M.A.
        • et al.
        Invasive pneumococcal disease: association between serotype, clinical presentation and lethality.
        Vaccine. 2011; 29: 5740-5746
        • Cho B.H.
        • Stoecker C.
        • Link-Gelles R.
        • Moore M.R.
        Cost-effectiveness of administering 13-valent pneumococcal conjugate vaccine in addition to 23-valent pneumococcal polysaccharide vaccine to adults with immunocompromising conditions.
        Vaccine. 2013; 31: 6011-6021
      2. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Morbidity Mortality Weekly Rep. 2012; 61: 816-819
        • Craig A.S.
        • Watson B.
        • Zink T.K.
        • Davis J.P.
        • Yu C.
        • Schaffner W.
        Hepatitis A outbreak activity in the United States: responding to a vaccine-preventable disease.
        Am J Med Sci. 2007; 334: 180-183
        • Baird N.L.
        • Yu X.
        • Cohrs R.J.
        • Gilden D.
        Varicella zoster virus (VZV)-human neuron interaction.
        Viruses. 2013; 5: 2106-2115
        • Hales C.M.
        • Harpaz R.
        • Ortega-Sanchez I.
        • Bialek S.R.
        Update on recommendations for use of herpes zoster vaccine.
        MMWR Morbidity Mortality Weekly Rep. 2014; 63: 729-731
        • McLean H.Q.
        • Fiebelkorn A.P.
        • Temte J.L.
        • Wallace G.S.
        Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Recomm Rep. 2013; 62: 1-34
        • Langan S.M.
        • Thomas S.L.
        • Smeeth L.
        • Margolis D.J.
        • Nitsch D.
        Zoster vaccination is associated with a reduction of zoster in elderly patients with chronic kidney disease.
        Nephrol Dial Transplant. 2016; 31: 2095-2098
        • Coffman R.L.
        • Sher A.
        • Seder R.A.
        Vaccine adjuvants: putting innate immunity to work.
        Immunity. 2010; 33: 492-503