Immunizations in Chronic Kidney Disease and Kidney Transplantation

Abstract

Purpose of Review Infection is a significant cause of morbidity and mortality in both patients with chronic kidney disease (CKD) and in recipients of a kidney transplant (KT). We review the current data in patients with CKD, on dialysis, and in KT recipients to provide further guidance for clinicians regarding vaccine optimization in this patient population. Recent Findings This patient population remains under-vaccinated and thus more vulnerable to vaccine-preventable illness. Despite diminished responses to immunization in this population, significant protection is generally achieved. Summary Vaccines are an important preventative tool and offer protection against infection. In the setting of suboptimal and waning immunity in this patient population, future studies are indicated to determine optimal vaccination regimens.

Vaccination in patients with kidney failure: lessons from COVID-19

“…Specifically, patients with kidney failure receive an HBV vaccination dose that is four times higher than the standard dose 164 . Moreover, immunogenicity (according to the antibody response) was significantly better in transplant recipients that received a high dose of influenza vaccination compared with the standard dose 165 . Of note, despite its higher mRNA concentration, which does not seem to have safety implications, the efficacy of the mRNA-1273 vaccine data was similar to that of the BNT162b2 vaccine in the general population 15 , 16 .…”

“…Additional adjuvants and intradermal application of vaccines might also improve vaccine immunogenicity 165 . For example, the addition of the MF59 adjuvant improved the rate of seroconversion in response to an influenza vaccine in patients receiving haemodialysis 166 .…”

Consenso colombiano sobre vacunación en pacientes con enfermedad renal crónica

“…Respecto a los esquemas de vacunación, se proponen entre tres y cuatro dosis de 40 µg/ml aplicadas en los meses 0, 1 y 6, o 0, 1, 2 y 6 desde el inicio del esquema de vacunación [13,[57][58][59][60][61][62]. Una dosis de refuerzo de la vacuna se ha sugerido en pacientes previamente inmunizados y sometidos a terapia de reemplazo renal o trasplante renal cuando se ha presentado serorreversión (caída de los anticuerpos contra el antígeno de superficie a un valor <10 mUI/ml) [56,60].…”

Vaccination of adult patients living with chronic kidney disease against SARS-CoV-2: a position statement by the South African Nephrology Society

“…Temporal kinetics in the dosing of immunosuppressants results in reduced vaccination success rates in the first 3-6 months after engraftment [27]; for similar reasons, vaccination is best deferred following periods of augmented immunosuppression for the treatment of rejection, particularly if the prescribed protocol includes high-dose MMF [28]. Improved seroconversion rates have been reported in recipients on stable immunosuppression therapy who received a third dose of the Pfizer-BNT162b2 vaccine administered 61 days after the standard second dose [29]; the CDC recommends administration of a third dose of mRNA vaccine at least 28 days after completion of the 2-dose regime [16] Vaccination has theoretically been associated with an increased risk of rejection [28]. Although rare, isolated cases of rejection following SARS-CoV-2 vaccination have been reported, and consideration should be given to monitoring graft function for signs of rejection after immunisation [30].…”