Practical Guide to Vaccination in All Stages of CKD, Including Patients Treated by Dialysis or Kidney Transplantation

Krueger, Karen; Ison, Michael G.; Ghossein, Cybele

doi:10.1053/j.ajkd.2019.06.014

Cited by 145 publications

(160 citation statements)

References 76 publications

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“…Post‐vaccination anti‐PPS levels can also be used to evaluate the functional status of antibacterial humoral immunity. However, in general, it is suggested to wait until the first 3‐6 months after kidney transplantation—the period of most intense immunosuppression—before attempting vaccination 26‐29 . However, this is precisely the time when most bacterial infections are concentrated.…”

Section: Discussionmentioning

confidence: 99%

Secondary antibody deficiency is associated with development of infection in kidney transplantation: Results of a multicenter study

Sarmiento

Jiménez

Natale

et al. 2020

Transplant Infectious Dis

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Background We performed a multicenter study to assess the association between secondary antibody deficiency (immunoglobulin G [IgG] hypogammaglobulinemia combined with low levels of specific antibodies) and development of infection in kidney transplantation. Methods We prospectively analyzed 250 adult kidney recipients at four centers. The assessment points were before transplantation and 7 and 30 days after transplantation. The immune parameters were as follows: IgG, IgA, and IgM and complement factors C3 and C4 tested by nephelometry; specific IgG antibodies to cytomegalovirus (CMV) and IgG and IgG2 antibodies to pneumococcal polysaccharide (anti‐PPS) determined using enzyme‐linked immunosorbent assay. The clinical follow‐up period lasted 6 months. The clinical outcomes were CMV disease and recurrent bacterial infections requiring antimicrobial therapy. Statistics: Multivariate logistic regression. Results At day 7, IgG hypogammaglobulinemia (IgG levels < 700 mg/dL) combined with low IgG anti‐CMV antibody titers (defined as levels < 10 000 units) was present in 12% of kidney recipients. IgG hypogammaglobulinemia combined with low IgG anti‐PPS antibody titers (defined as levels < 10 mg/dL) at 1 month after kidney transplantation were recorded in 16% of patients. At day 7 the combination of IgG hypogammaglobulinemia and low anti‐CMV titers was independently associated with the development of CMV disease (odds ratio [OR], 6.95; 95% confidence interval [CI], 1.17‐41.31; P = .033). At day 30 after transplantation, the combination of IgG < 700 mg/dL and IgG anti‐PPS < 10 mg/dL, was independently associated with recurrent bacterial infection (OR, 5.942; 95% CI, 1.943‐18.172; P = .002). Conclusion In a prospective multicenter study, early immunologic monitoring of secondary antibody deficiency proved useful for the identification of kidney recipients who developed severe infection.

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Section: Discussionmentioning

confidence: 99%

Secondary antibody deficiency is associated with development of infection in kidney transplantation: Results of a multicenter study

Sarmiento

Jiménez

Natale

et al. 2020

Transplant Infectious Dis

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“…Although immunodeficiency may impair the response to vaccines in patients with IMIDs affected by chronic kidney disease (CKD), including those receiving dialysis or previously transplanted ( 55), vaccination remains a crucial preventive measure due to its favorable safety profile and the high rate of several infections, including Sars-CoV2, in renal patients (56). Advanced CKD appears to be associated with an increased risk of severe infection, although causality remains unclear (57,58).…”

Section: Immune-mediated Glomerular Diseasesmentioning

confidence: 99%

How to Manage COVID-19 Vaccination in Immune-Mediated Inflammatory Diseases: An Expert Opinion by IMIDs Study Group

et al. 2021

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Since March 2020, the outbreak of Sars-CoV-2 pandemic has changed medical practice and daily routine around the world. Huge efforts from pharmacological industries have led to the development of COVID-19 vaccines. In particular two mRNA vaccines, namely the BNT162b2 (Pfizer-BioNTech) and the mRNA-1273 (Moderna), and a viral-vectored vaccine, i.e. ChAdOx1 nCoV-19 (AstraZeneca), have recently been approved in Europe. Clinical trials on these vaccines have been published on the general population showing a high efficacy with minor adverse events. However, specific data about the efficacy and safety of these vaccines in patients with immune-mediated inflammatory diseases (IMIDs) are still lacking. Moreover, the limited availability of these vaccines requires prioritizing some vulnerable categories of patients compared to others. In this position paper, we propose the point of view about the management of COVID-19 vaccination from Italian experts on IMIDs and the identification of high-risk groups according to the different diseases and their chronic therapy.

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“…HBV is endemic in the Asia‐Pacific region, while seasonal influenza, invasive pneumococcal disease and zoster reactivation contribute to substantial hospitalisations yearly worldwide, and are associated with increased mortality in CKD patients 4 . The transmission and severity of these infections can be effectively reduced by vaccinations 5‐8 . In general, patients with CKD demonstrate a lower seroconversion rate after vaccination, and a faster decay of protective antibodies after vaccination, due to impaired innate and adaptive immune responses 9 .…”

Section: Chronic Kidney Disease (Pre‐dialysis) Maintenance Dialysis Kmentioning

confidence: 99%

Vaccination in patients with chronic kidney disease—Review of current recommendations and recent advances

et al. 2020

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Hepatitis B virus (HBV), influenza, pneumococcus and herpes zoster are important infections which could result in significant morbidity and mortality in patients with chronic kidney disease (CKD). While seroconversion rates after vaccination are often lower in CKD patients compared with healthy adults due to impaired innate and adaptive immunity, vaccinations for HBV, influenza, pneumococcus and herpes zoster are generally effective in reducing the transmission and/or severity of these infections. Practical issues that have an impact on the efficacy of vaccination in the CKD population include the timing, dose, schedule of vaccination, the route of administration, and adjuncts applied at time of vaccination. This review discusses the vaccination regimens and the efficacy of HBV, influenza, pneumococcus and zoster vaccines in CKD patients, and highlights recent advances in enhancing vaccine seroconversion rates. K E Y W O R D S chronic kidney disease, hepatitis B, herpes zoster, influenza, invasive pneumococcal disease, vaccination Infection is a major cause of morbidity and mortality in patients with chronic kidney disease. Chronic infections such as that by hepatitis B virus (HBV) can lead to severe complications upon immunosuppression given for the treatment of glomerular diseases or for the prevention of kidney transplant rejection. 1-3 Therefore, for infections with effective vaccines, the prevention of infection by vaccination is of paramount importance in the CKD patient population. HBV is endemic in the Asia-Pacific region, while seasonal influenza, invasive pneumococcal disease and zoster reactivation contribute to substantial hospitalisations yearly worldwide, and are associated with increased mortality in CKD patients. 4 The transmission and severity of these infections can be effectively reduced by vaccinations. 5-8 In general, patients with CKD demonstrate a lower seroconversion rate after vaccination, and a faster decay of protective antibodies after vaccination, due to impaired innate and adaptive immune responses. 9 This review focuses on vaccination regimens for HBV, influenza, pneumococcal, and zoster infection, and recent advances in enhancing the seroconversion rate after vaccination. We searched in the PubMed database, using the following keywords: 'vaccine', 'kidney disease', 'haemodialysis', 'peritoneal dialysis', 'kidney transplant', 'hepatitis B', 'influenza', 'pneumococcal' and 'zoster', and summarized the results from relevant articles. Key recommendations of vaccination for other diseases are also summarised (Table 1). 1 | VACCINATION IMMUNOLOGY IN CKD PATIENTS Both innate and adaptive immunity are required for an effective response to immunisation. After inoculation, the epitopes of the vaccine antigens are recognized by receptors, which include toll-like receptors (TLR), macrophage scavenger receptors, and mannose-binding lectin, that are expressed on dendritic cells and macrophages. 9 The binding of these receptors activates dendritic cells and

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Practical Guide to Vaccination in All Stages of CKD, Including Patients Treated by Dialysis or Kidney Transplantation

Cited by 145 publications

References 76 publications

Secondary antibody deficiency is associated with development of infection in kidney transplantation: Results of a multicenter study

Secondary antibody deficiency is associated with development of infection in kidney transplantation: Results of a multicenter study

How to Manage COVID-19 Vaccination in Immune-Mediated Inflammatory Diseases: An Expert Opinion by IMIDs Study Group

Vaccination in patients with chronic kidney disease—Review of current recommendations and recent advances

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