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Vaccination in Hemodialysis Patients

The advent of renal replacement therapy has led to the emergence of a population of patients whose total medical care is relegated to the renal specialist. Nonnephrologists are frequently averse to assume the care of non-renal problems encountered in this population and the renal specialist is called upon to attend to a myraid of preventive and therapeutic needs. Their unique characteristics notwithstanding, patients on maintenance hemodialysis are subject to the common infectious diseases for which adult immunizations are now available. In fact, because of their altered immune status, they are more prone to suffer serious consequences and chronic sequelae of these infections. Influenza, pneumococcal, and hepatitis B vaccines have been shown to be efficacious and safe in the general population, but questions remain as to their efficacy in the renal patient. Successful immunization requires an optimally operative immune system. Depressed cellular and humoral immunity in uremic subjects may underlie the impairment in adequate response to immunization. A review of health care maintenance policies in dialysis centers during 1982 to 1983 found that 88% of units offered yearly influenza vaccines, 66% offered Pneumovax, and only 17% offered hepatitis B vaccine (1). Underutilization of adult immunization may leave renal patients exposed to risks of serious morbidity and possible mortality. In this essay we will review the efficacy of the three common vaccines and their usefulness in the renal patient.