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For Patients With CKD, Don’t Wait—Vaccinate!
Q) What can I tell my kidney patients to increase acceptance of the influenza and pneumonia vaccines during cold and flu season?
The CDC recommends that everyone ages 6 months and older receive an annual flu vaccination, unless contraindicated.1 Additionally, administration of either the 13-valent pneumococcal conjugate vaccine (PCV13) or the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for all adults ages 65 and older and for younger adults (ages 19 to 64) with diabetes, chronic kidney disease (CKD), chronic heart disease, and/or solid organ transplant.1 Despite these recommendations, patients often decline vaccination. What they may not realize is that CKD increases their risk for infection.
In a cohort of more than 1 million Swedish patients, researchers found that any stage of CKD increased risk for community-acquired infection and that the risk for lower respiratory tract infection increased as glomerular filtration rate declined.2 Patients on hemodialysis have an increased risk for pneumonia and an incidence of pneumonia-related mortality that is up to 16 times higher than that of the general population.3 Pneumonia also increases the risk for cardiovascular events among all patients with CKD, regardless of stage.4
So, can vaccines reduce these risks in our kidney patients? McGrath and colleagues found that patients with end-stage renal disease (ESRD) who were vaccinated against the flu had lower mortality rates than those who were not vaccinated—even when the vaccine was poorly matched to the circulating virus strain.5 Additional research has demonstrated that for patients with any stage of CKD, including those on dialysis, the flu vaccine is safe and effective, and its protection may be durable over time.6
For pneumonia vaccines, antibody response in patients with CKD may be suboptimal; however, Medicare data have demonstrated that patients with ESRD who are vaccinated against pneumonia have lower rates of all-cause and cardiovascular mortality than unvaccinated patients do.5 Given their increased vulnerability to vaccine-preventable respiratory illnesses, it is imperative that our kidney patients receive both the flu and pneumonia vaccines.
Nicole DeFeo McCormick, DNP, MBA, NP-C, CCTC
Assistant Professor
School of Medicine at the University of Colorado
1. CDC. Recommended immunization schedule for adults aged 19 years or older, United States, 2017. www.cdc.gov/vaccines/schedules/hcp/index.html. Accessed November 22, 2017.
2. Xu H, Gasparini A, Ishigami J, et al. eGFR and the risk of community-acquired infections. Clin J Am Soc Nephrol. 2017; 12(9):1399-1408.
3. Sarnak MJ, Jaber BL. Pulmonary infectious mortality among patients with end-stage renal disease. Chest. 2001;120(6): 1883-1887.
4. Mathew R, Mason D, Kennedy JS. Vaccination issues in patients with chronic kidney disease. Expert Rev Vaccines. 2014;13(2):285-298.
5. McGrath LJ, Kshirsagar AV, Cole SR, et al. Evaluating influenza vaccine effectiveness among hemodialysis patients using a natural experiment. Arch Intern Med. 2012;172(7): 548-554.
6. Janus N, Vacher L, Karie S, et al. Vaccination and chronic kidney disease. Nephrol Dial Transplant. 2008;23(3):800-807.
Clinician Reviews in partnership with
Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation's Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month's responses were authored by Nicole DeFeo McCormick, DNP, MBA, NP-C, CCTC, who is an Assistant Professor in the School of Medicine at the University of Colorado, and LCDR Julie Taylor, PA-C, who is with the United States Public Health Service in Boston.
Clinician Reviews in partnership with
Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation's Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month's responses were authored by Nicole DeFeo McCormick, DNP, MBA, NP-C, CCTC, who is an Assistant Professor in the School of Medicine at the University of Colorado, and LCDR Julie Taylor, PA-C, who is with the United States Public Health Service in Boston.
Clinician Reviews in partnership with
Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation's Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month's responses were authored by Nicole DeFeo McCormick, DNP, MBA, NP-C, CCTC, who is an Assistant Professor in the School of Medicine at the University of Colorado, and LCDR Julie Taylor, PA-C, who is with the United States Public Health Service in Boston.
Q) What can I tell my kidney patients to increase acceptance of the influenza and pneumonia vaccines during cold and flu season?
The CDC recommends that everyone ages 6 months and older receive an annual flu vaccination, unless contraindicated.1 Additionally, administration of either the 13-valent pneumococcal conjugate vaccine (PCV13) or the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for all adults ages 65 and older and for younger adults (ages 19 to 64) with diabetes, chronic kidney disease (CKD), chronic heart disease, and/or solid organ transplant.1 Despite these recommendations, patients often decline vaccination. What they may not realize is that CKD increases their risk for infection.
In a cohort of more than 1 million Swedish patients, researchers found that any stage of CKD increased risk for community-acquired infection and that the risk for lower respiratory tract infection increased as glomerular filtration rate declined.2 Patients on hemodialysis have an increased risk for pneumonia and an incidence of pneumonia-related mortality that is up to 16 times higher than that of the general population.3 Pneumonia also increases the risk for cardiovascular events among all patients with CKD, regardless of stage.4
So, can vaccines reduce these risks in our kidney patients? McGrath and colleagues found that patients with end-stage renal disease (ESRD) who were vaccinated against the flu had lower mortality rates than those who were not vaccinated—even when the vaccine was poorly matched to the circulating virus strain.5 Additional research has demonstrated that for patients with any stage of CKD, including those on dialysis, the flu vaccine is safe and effective, and its protection may be durable over time.6
For pneumonia vaccines, antibody response in patients with CKD may be suboptimal; however, Medicare data have demonstrated that patients with ESRD who are vaccinated against pneumonia have lower rates of all-cause and cardiovascular mortality than unvaccinated patients do.5 Given their increased vulnerability to vaccine-preventable respiratory illnesses, it is imperative that our kidney patients receive both the flu and pneumonia vaccines.
Nicole DeFeo McCormick, DNP, MBA, NP-C, CCTC
Assistant Professor
School of Medicine at the University of Colorado
Q) What can I tell my kidney patients to increase acceptance of the influenza and pneumonia vaccines during cold and flu season?
The CDC recommends that everyone ages 6 months and older receive an annual flu vaccination, unless contraindicated.1 Additionally, administration of either the 13-valent pneumococcal conjugate vaccine (PCV13) or the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for all adults ages 65 and older and for younger adults (ages 19 to 64) with diabetes, chronic kidney disease (CKD), chronic heart disease, and/or solid organ transplant.1 Despite these recommendations, patients often decline vaccination. What they may not realize is that CKD increases their risk for infection.
In a cohort of more than 1 million Swedish patients, researchers found that any stage of CKD increased risk for community-acquired infection and that the risk for lower respiratory tract infection increased as glomerular filtration rate declined.2 Patients on hemodialysis have an increased risk for pneumonia and an incidence of pneumonia-related mortality that is up to 16 times higher than that of the general population.3 Pneumonia also increases the risk for cardiovascular events among all patients with CKD, regardless of stage.4
So, can vaccines reduce these risks in our kidney patients? McGrath and colleagues found that patients with end-stage renal disease (ESRD) who were vaccinated against the flu had lower mortality rates than those who were not vaccinated—even when the vaccine was poorly matched to the circulating virus strain.5 Additional research has demonstrated that for patients with any stage of CKD, including those on dialysis, the flu vaccine is safe and effective, and its protection may be durable over time.6
For pneumonia vaccines, antibody response in patients with CKD may be suboptimal; however, Medicare data have demonstrated that patients with ESRD who are vaccinated against pneumonia have lower rates of all-cause and cardiovascular mortality than unvaccinated patients do.5 Given their increased vulnerability to vaccine-preventable respiratory illnesses, it is imperative that our kidney patients receive both the flu and pneumonia vaccines.
Nicole DeFeo McCormick, DNP, MBA, NP-C, CCTC
Assistant Professor
School of Medicine at the University of Colorado
1. CDC. Recommended immunization schedule for adults aged 19 years or older, United States, 2017. www.cdc.gov/vaccines/schedules/hcp/index.html. Accessed November 22, 2017.
2. Xu H, Gasparini A, Ishigami J, et al. eGFR and the risk of community-acquired infections. Clin J Am Soc Nephrol. 2017; 12(9):1399-1408.
3. Sarnak MJ, Jaber BL. Pulmonary infectious mortality among patients with end-stage renal disease. Chest. 2001;120(6): 1883-1887.
4. Mathew R, Mason D, Kennedy JS. Vaccination issues in patients with chronic kidney disease. Expert Rev Vaccines. 2014;13(2):285-298.
5. McGrath LJ, Kshirsagar AV, Cole SR, et al. Evaluating influenza vaccine effectiveness among hemodialysis patients using a natural experiment. Arch Intern Med. 2012;172(7): 548-554.
6. Janus N, Vacher L, Karie S, et al. Vaccination and chronic kidney disease. Nephrol Dial Transplant. 2008;23(3):800-807.
1. CDC. Recommended immunization schedule for adults aged 19 years or older, United States, 2017. www.cdc.gov/vaccines/schedules/hcp/index.html. Accessed November 22, 2017.
2. Xu H, Gasparini A, Ishigami J, et al. eGFR and the risk of community-acquired infections. Clin J Am Soc Nephrol. 2017; 12(9):1399-1408.
3. Sarnak MJ, Jaber BL. Pulmonary infectious mortality among patients with end-stage renal disease. Chest. 2001;120(6): 1883-1887.
4. Mathew R, Mason D, Kennedy JS. Vaccination issues in patients with chronic kidney disease. Expert Rev Vaccines. 2014;13(2):285-298.
5. McGrath LJ, Kshirsagar AV, Cole SR, et al. Evaluating influenza vaccine effectiveness among hemodialysis patients using a natural experiment. Arch Intern Med. 2012;172(7): 548-554.
6. Janus N, Vacher L, Karie S, et al. Vaccination and chronic kidney disease. Nephrol Dial Transplant. 2008;23(3):800-807.
