Vaccines for Kidney Disease Patients

Kidney disease compromises 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.

Person getting a shot
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Understanding Infection

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, like bacteria, viruses, fungi, etc. And studies have already revealed data that points to the​ association of kidney disease with serious infections like pneumonia and herpes zoster (shingles).

Infections are a leading cause of death in kidney disease patients, too. As 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 part of the 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

Once you realize that CKD really is a de facto immunocompromised state, it becomes easy to understand the importance of preventive vaccinations. Vaccinations should, therefore, be an integral part of a comprehensive care plan for the CKD patient.

Specific vaccines are recommended based on the stage of CKD. In fact, both the CDC's Advisory Committee on Immunization Practices (ACIP) and the international organization 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:

  1. The inactivated influenza vaccine (intramuscular injection) which has a "killed" virus
  2. The live attenuated influenza 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 ideally be vaccinated against influenza every year with the seasonal flu shot (unless they have other contraindications).

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 KDIGO CKD Work Group recommends vaccination against these infections using the  "polyvalent" pneumococcal vaccine for patients with advanced kidney disease. This vaccine should be offered to patients with CKD at stages 4 and 5 (p107), and re-vaccination is recommended for all adults with CKD within 5 years.

Hepatitis B

A serious disease of the liver, Hepatitis B infection can also damage other organs, including the kidneys and blood vessels. At this time, vaccination against Hepatitis B is typically recommended for patients with CKD at stages 4 and 5.

The usual Hep B vaccination schedule involves a series of shots 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 10 years is recommended.

A Word From Verywell

Given the profound effects that kidney disease has on one's risk of developing life-threatening infections, vaccinations against influenza, pneumococcal infections, and hepatitis B should be part of standard care for the CKD patient.

Ask your nephrologist if you are up-to-date with your immunizations. Vaccinations are backed by an overwhelming body of evidence that they indeed save lives.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Syed-Ahmed M, Narayanan M. Immune dysfunction and risk of infection in chronic kidney diseaseAdvances in Chronic Kidney Disease. 2019;26(1):8-15. doi:10.1053/j.ackd.2019.01.004

  2. Thompson S, James M, Wiebe N, et al. Cause of death in patients with reduced kidney functionJASN. 2015;26(10):2504-2511. doi:10.1681/ASN.2014070714

  3. Krueger KM, Ison MG, Ghossein C. Practical guide to vaccination in all stages of CKD, including patients treated by dialysis or kidney transplantationAmerican Journal of Kidney Diseases. 2020;75(3):417-425. doi:10.1053/j.ajkd.2019.06.014

  4. Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013; 3(1):1-150.

  5. Advisory Committee on Immunization Practices (ACIP). Guidelines for vaccinating dialysis patients and patients with chronic kidney disease. Centers for Disease Control and Prevention. 2012.

  6. Centers for Disease Control and Prevention. Renal disease and adult vaccination.

By Veeraish Chauhan, MD
Veeraish Chauhan, MD, FACP, FASN, is a board-certified nephrologist who treats patients with kidney diseases and related conditions.