All the #vaccine talk this week has made me think about the rest of the the vaccines that are important in our patients with #KidneyDisease

Let's review them together
(Thread )

#Nephtwitter #MedEd #ESKD #CKD

#HepatitisB Vaccine in CKD:

No specific recs for CKD stage 1-3
Advanced CKD (stage 4 & 5) vaccinate if not already immune

Is the rate of seroconversion similar for all stages?

Yes! lower rate of seroconversion in more advanced CKD

If progressing to ESKD vaccinate before initiating HD
3 types in US:
2nd-gen Recombivax-HB (Merck) & Energix-B
3rd-gen with immune adjuvant, Heplisav-B (HepB-CpG Better immunogenicity

https://www.ajkd.org/action/showPdf?pii=S0272-6386%2819%2930891-1

Check titers 1-2 months after last dose
If HepBsAb titer is<10 IU/ml it is recommended to re-vaccinate with a full series.

Need for booster dose?
Check titers annually - If declines to <10 IU/M Give single dose

Influenza vaccine in #CKD

Rates of seroprotection lower in CKD pts compared to general population

Inactivated seasonal flu vaccine to all stages of CKD annually (adults)
High-dose for patients 65 years or older

Pneumococcal in #CKD

Recommended for:
All patients with CKD and ESKD
Pts with nephrotic syndrome, and the ones requiring immunosuppression
Other comorbidities such as T2DM

Dosing schedule
https://www.ajkd.org/action/showPdf?pii=S0272-6386%2819%2930891-1

Herpes Zoster vaccine in CKD

2 types in the US:
Adults > 50 years and older (Shingrix; nonlive recombinant glycoprotein E vaccine with adjuvant); requires 2 doses
or > 60 years (Zostavax [Merck]; a live zoster vaccine; single dose

A summary of all vaccines for CKD and transplant:

Great reference: https://www.ajkd.org/action/showPdf?pii=S0272-6386%2819%2930891-1