1. Chronic kidney disease patients are susceptible to infections due to immunosuppression and should receive appropriate vaccinations when diagnosed. 2. Vaccine response is often sub-optimal in hemodialysis patients, and some live vaccines cannot be given to transplant patients. 3. Planning vaccination is important, with hepatitis B vaccine recommended for hemodialysis patients except those HBsAg positive, using double the normal dose.

1. Dr V Krishna Kumar
Senior Resident
Dept of Nephrology

2.  Chronic Kidney Disease is considered a
state of immunosupression and hence
patients with CKD are susceptible to
infections.
 Hence it is imperative that the patients are
given appropriate vaccination as and when
they are diagnosed as CKD

3. When patients are on hemodialysis, the
response to number of commonly used
vaccines are sub-optimal.
Moreover, when patients are planned for
transplant/transplanted already, some live
vaccines cannot be given.
Hence planning of vaccines is very
important

4.  All patients on HD except those with
HBsAg positivity should receive HBV
vaccine.
The chances of successful vaccination is
higher with double the dose of normal
amount.
 A total of 40 mcg HBsAg subunit vaccine
should be given as intramuscular injection

5.  4 doses of HBV vaccine are given on 0,1,2
and 6 months.
 Gluteal injection is avoided as it has been
associated with failure to develop antibodies.
 The overall successful vaccination in HD
patients is around 50-60%.
 The booster doses are required if the
antibody titers fall below the protective levels

6.  Influenza A and B Vaccines - Annually
 Pneumococcal Vaccine
• Pneumovax 23 ( polyvalent vaccine) - given in children
> 5 years and repeated in adults > 65 years, repeat
every 5 years
• Prevanar - 3 doses in children<2 years
 Td/Tdap - 3 doses in childhood and 1 dose in adults;
repeat every 10 years

7. Ideally the live vaccines should be given
atleast 6 weeks prior to planned transplant
surgery.
MMR Vaccine – 2 doses, 1 month apart
Varicella- Children and non immune adults
ahould receive 2 doses 1 month apart
Zoster – In adults >60 years, 1 dose

8. These vaccines can be given on either
side of the transplant
Hib Vaccine – 3 doses, alteast 4 weeks
between doses
HAV – 2 doses, 6 months apart
HPV – 3 doses at 0,2 and 6 months in age
group 11 – 26 years