This summary is not meant to apply to chronic kidney disease patients who are recently post-transplant. These patients are considered more significantly immunosuppressed than those who have only chronic kidney disease, with or without dialysis. Determination of chronic kidney disease is important to the vaccine provider because incidence or severity of some vaccine-preventable diseases is higher in persons with altered immunocompetence ; therefore, certain vaccines (e.g., inactivated influenza vaccine and pneumococcal vaccines) are recommended specifically for persons with immune compromise. In addition, vaccines might be less effective during a period of altered immunocompetence. Inactivated vaccines administered during a period of altered immunocompetence might need to be repeated. Because secondary antibody responses are less affected by immune compromise than primary antibody responses, immunization strategies should be formulated early in the course of progressive renal disease to maximize likelihood of vaccine-induced immunity. This approach is particularly important if transplantation and chronic immunosuppressive therapy are being considered. Live vaccines might need to be deferred if severe immune compromise is present; persons with altered immunocompetence might be at increased risk for an adverse reaction after administration of live, attenuated vaccines because of uninhibited replication. However, the majority of persons with CKD (regardless of CKD stage) have sufficient immune function to safely receive all live vaccines for which an inactivated vaccine is not an alternative.

Stephen B. Thacker CDC Library collection