Vaccines for Adults with Advanced Chronic Kidney Disease, Kidney Failure, or Kidney Transplant

Vaccines can help keep you from getting or becoming seriously ill with a disease. They protect you from many diseases, like the flu, diphtheria, tetanus, hepatitis B, COVID-19, shingles, and pneumonia. People who get some of these diseases can pass them to others, so vaccines can also help protect other people.

Some people have a higher risk of becoming seriously ill from these diseases, especially older adults, children, and people with chronic illnesses. Vaccines are important to help prevent serious diseases in people with chronic kidney disease, those on dialysis, and immunocompromised people, such as kidney transplant recipients.

Vaccines can help protect against certain diseases by imitating an infection. This type of imitation infection helps teach the immune system how to fight off future infections. Sometimes, after getting a vaccine, your body responds by causing minor symptoms, such as fever. These kinds of minor symptoms are normal and should be expected as your body builds immunity.

It usually takes a few weeks for your body to build up the full immune response, which means that a person can be infected with a disease and start having symptoms just before or just after getting vaccinated. It is also possible to get a disease even when vaccinated, but you are less likely to become seriously ill.

Some vaccines require more than one dose to be fully effective and give the most protection. These are the kinds of vaccines that need more doses:

• Multi-dose vaccines: Some vaccines require 2 or more doses to build more complete immunity. An example of a multi-dose vaccine is the shingles vaccine, which requires getting a second dose several months after the first dose.
• Boosters: Over time, some vaccines start to wear off and lose their effectiveness. At that point, a booster dose is needed to bring protection levels back up. For example, it is recommended that adults get a tetanus vaccine booster every 10 years.
• Yearly: Other types of vaccines are needed every year. This is usually because the virus strain that this kind of vaccine protects against is always changing. That is why the vaccine needs to be updated to match the virus strain(s) that is spreading the most. For example, the flu shot is a yearly vaccine.

Scientists take many approaches to develop vaccines. These approaches are based on information about the diseases that the vaccine will prevent, such as how germs infect cells, how the immune system responds to it, regions of the world where the germ is found, the strain of a virus or bacteria, and environmental conditions. According to the CDC, the main types of vaccines that are available in the United States include:

• Live, attenuated vaccines:
  • These contain a version of the living virus or bacteria that has been weakened so that it does not cause serious disease in people with healthy immune systems. Because live, attenuated vaccines are the closest thing to a natural infection, they are good teachers for the immune system.
  • People who have received a kidney transplant should not get any sort of live vaccine. These include:
    • Nasal flu vaccines (live attenuated influenza)
    • Chickenpox (varicella)
    • Measles, mumps, rubella (MMR)
    • Yellow fever
• Inactivated (non-live) vaccines:
  • These are made by stopping, or killing, the germ during the process of making the vaccine. Even though the germ in the vaccine is dead, the immune system still practices trying to kill it to make sure it is ready for the live germ in the future.
  • The inactivated polio vaccine is an example of this type of vaccine. Often, multiple doses are necessary to build up and/or maintain immunity.
• Toxoid vaccines:
  • These prevent diseases caused by bacteria that produce toxins (poisons) in the body. In the process of making these vaccines, the toxins are weakened so they cannot cause illness. Weakened toxins are called toxoids. When the immune system receives a vaccine containing a toxoid, it learns how to fight off the natural toxin.
  • An example of a toxoid vaccine is the tetanus vaccine, which contains tetanus toxoids.
• Subunit, recombinant, polysaccharide, and conjugate vaccines:
  • These include only parts of the virus or bacteria instead of the entire germ. These vaccines train the immune system to quickly identify specific parts of the germ.
  • The hepatitis B vaccine uses germs from the hepatitis B virus and is an example of a subunit vaccine.
• Messenger RNA (mRNA) vaccines:
  • These vaccines teach the body how to make a very small piece of the germ. After getting the vaccine, the body starts to make that piece of the germ, which then tells the immune system to quickly attack it.
  • Like other vaccines, this process helps prepare the immune system to quickly recognize and attack that germ in the future. Because the vaccine only has instructions for a small piece of the germ, it cannot cause the infection it is helping to prevent.
  • An example of this type of vaccine are some mRNA COVID-19 vaccines.

Overall, vaccines are a very helpful way to keep people healthy. Vaccines may not stop your body from catching a specific germ like the influenza or COVID-19 virus. Instead, vaccines help get your body ready in case the germ does get into your body and avoid getting severely ill. This means that even though you may get a vaccine, it is still possible to get the disease. The goal is to increase your chances of fighting off that infection quickly.

Usually, it takes time for the immune system to build protection after a vaccine. For vaccines that only require one dose, people usually have the most immunity in just a few weeks. For vaccines that require multiple doses, the first dose will only provide some immunity. The most immunity will happen a few weeks after you get the last dose in the series, so it is important to get all the doses in a vaccine series and to get those doses on schedule so you get the best protection from a vaccine.

How well a vaccine works depends on your immune system. People living with a weakened immune system are at highest risk for developing serious illness. However, the weakened immune system can also make some vaccines slightly less effective. That is why people who have a weakened immune systems may need higher doses or extra doses for some vaccines.

A person can have a weakened immune system due to several reasons, such as being over the age of 65, on dialysis for a long time, chemotherapy, and those who are on anti-rejection drugs, such as kidney or other solid organ transplant. Immunosuppression is not the same for everyone. In some people, their level of immunosuppression may be very high, while others may only have a slightly weakened immune system.

As with any medication, vaccines do come with a risk of side effects. Some people may feel minor discomfort, soreness, or mild rash on the skin where the vaccine was given. Other vaccine-related side effects can include low fever, headache or feeling tired. All these mild side effects are normal and should not cause alarm.

More serious side effects include allergic reactions (eg, hives, swelling of the face and throat, fast heartbeat, dizziness, or weakness), seizures, or an immune system reaction called Guillain-Barre Syndrome (tingling and weakness in the feet, legs, arms or face, shortness of breath, choking on saliva). These side effects are extremely rare. If you have any of these symptoms, call 911 or get to a hospital immediately. Having a serious reaction to one vaccine may increase the chance of it happening with another vaccine, though not always.

If you are worried about having a serious reaction to a vaccine, the National Vaccine Injury Compensation Program (VICP) was created to compensate people who may have been injured by certain vaccines. Not all vaccines are covered by this program. More information can be found on their website: https://www.hrsa.gov/vaccine-compensation.

Vaccines are the safest way to protect against certain diseases and prevent serious illnesses. Natural infections are more likely to cause severe and deadlier complications than the protection that vaccines provide. This is true even for diseases that many people consider mild, like chickenpox. It is impossible to know who may get seriously ill from a virus or bacterial infection. That is why vaccines are the best way to protect yourself and those close to you. 

If you have chronic kidney disease, are on dialysis, or have received a kidney transplant, it’s important to know which vaccines are best for you. Always ask your healthcare provider before getting a vaccine and tell the vaccine provider if you are on dialysis, have received a kidney or other organ transplant, or have had a serious reaction to a vaccine in the past.

The information below provides a starting point for the vaccines that are recommended for most adults with kidney-related conditions as of December 2023, according to recommendations from the CDC National Center for Immunization and Respiratory Diseases (NCIRD).

For more customized vaccine recommendations for your specific situation, visit the Adult Vaccine Assessment Tool from the CDC and be sure to discuss the results with your healthcare provider.

Reference to specific commercial products, manufacturers, companies, or trademarks does not constitute its endorsement or recommendation by the U.S. Government, Department of Health and Human Services, or Centers for Disease Control and Prevention.

Locating vaccines

Talk with your healthcare provider first to find out which vaccines are recommended for you. They can be given at the clinic where you regularly receive medical care, at your public health department, or your local pharmacy. Local health agencies and hospitals often conduct clinics during the year to provide vaccinations.

Cost of vaccines

The cost of these vaccines varies. They are usually covered by your insurance. Local health departments may provide them free of charge or at a lower cost. Remember, flu, pneumococcal, COVID-19, and hepatitis B vaccines are covered under by Medicare Part B (although a copay may apply). Shingles, RSV and Tdap vaccines are covered with no deductible or cost-sharing for people with Medicare Part D benefits.

Some states may require you to get a prescription from your healthcare provider to get a vaccine at the pharmacy or to get it covered by your insurance.

Shingles (herpes zoster) vaccine

If you received an organ transplant a few years ago, you may have been advised against getting the shingles vaccine. This is because the original shingles vaccine was only available as a live vaccine. An inactivated version of the vaccine is now available, which means people who have received an organ transplant are eligible to receive it. The weakened immune system caused by anti-rejection medicines after a transplant greatly increases your risk for developing shingles. This is the reason why people who have received an organ transplant should get the new inactivated shingles vaccine for this added protection.

• Which vaccines do I need to get to be up to date?
• Do I need any other vaccines based on my other health conditions or risk factors?
• How might this vaccine affect my kidney function?

• Vaccination and Dialysis: What you should know
• Centers for Disease Control and Prevention (CDC)
• Immunize.org
• Understanding How Vaccines Work
• NKF AtoZ: Flu & COVID-19
• Vaccine Administration Record for Adults
• Center for Disease Control and Prevention (CDC): vaccines.gov

This content is provided for informational use only and is not intended as medical advice or as a substitute for the medical advice of a healthcare professional.