Thread by @NWiegley, All the #vaccine talk this week has made me think about the [...]

Nasim Wiegley, MD

NWiegley

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

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#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

Yes! lower rate of seroconversion in more advanced CKDIf 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

Pneumococcal in #CKD Recommended for:All patients with CKD and ESKDPts with nephrotic syndrome, and the ones requiring immunosuppressionOther comorbidities such as T2DMDosing 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

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