Why do we care about vaccinating patients with glomerular diseases?
Infections are among the leading causes of morbidity and mortality in chronic kidney disease patients (CKD). CKD causes immunosuppression, which is multifactorial, a combination of innate and adaptive immune system dysfunction, chronic inflammation, and endothelial cell dysfunction caused by uremia.
What are the current vaccination recommendations for CKD patients?
As summarized in a recently published guide to vaccination, CKD patients should receive routinely recommended vaccinations according to age group and other risk groups depending on their comorbidities. A particular emphasis is placed on three specific vaccines, the hepatitis B (HBV), influenza, and pneumococcal vaccine. However, the true benefit of routine vaccination in this population is not well defined, and more clinical data is needed to determine immunization efficiency. Live-attenuated vaccines are generally considered appropriate if inactivated vaccines are not available, but safety data are limited. However, patients who are receiving immunosuppressive treatment should avoid live-attenuated vaccines.
When should we vaccinate patients with CKD?
Patients with advanced CKD and patients receiving immunosuppressive treatment have a lower rate of seroconversion, lower antibody titers, and less sustained response after immunization than healthy controls. For instance, the HBV vaccine’s response is decreased in advanced kidney disease. This raises the importance of vaccinating CKD patients earlier in the course of the disease.