Study: Recommendations From Health Care Professionals Improve Immunization Rates Among Patients With CKD

Both influenza and pneumococcus vaccination rates in patients with chronic kidney disease (CKD) are below established targets, wrote authors of research published in BMC Nephrology. It is crucial that health care professionals make efforts to improve vaccination rates within this vulnerable population, and the authors noted that specific policies that consider factors leading to vaccine hesitancy should be addressed in the decision-making process.¹

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Following cardiovascular diseases, infections are a predominant cause of hospitalization and mortality in patients with CKD. Because patients with CKD are often in immunosuppressive states, they are more vulnerable to infections that can result from the interplay of innate and adaptive immune system impairment, chronic inflammation, oxidative stress, and other complications. For certain diseases, vaccination is the main strategy to reduce the risk of infection. The authors acknowledged that although there are some concerns regarding reduced seroconversion and vaccine effectiveness in CKD, it is still crucial that patients with CKD—particularly those undergoing kidney transplantation or dialysis—receive their annual influenza vaccine and are appropriately vaccinated with pneumococcal vaccines according to the recommended schedule.^1,2

Although immunization rates have risen over the years, not all at-risk populations are receiving their vaccinations. In the current paper, the investigators aimed to determine the vaccination rates and the factors that contribute to vaccination acceptance, which are critical for improving rates while mitigating risks associated with infections.^1,2

This cross-sectional study enrolled 307 patients who were diagnosed with CKD for at least 1 year. The average age of the patients was 57 ± 16 years, with a predominance of males (56.7%). Additionally, most of the patients were not on dialysis (40.4%), whereas 37.1% were on dialysis. The remaining 22.5% had received a kidney transplantation. Demographic data, clinical conditions, and social factors (eg, nutritional status, frailty, and health literacy) were also evaluated and considered. The vaccination rates for influenza and pneumococcus, along with the associated variables, were analyzed.¹

All patients completed a questionnaire on vaccination status for influenza, pneumococcus, and COVID-19. In addition, patients were provided with health care providers’ recommendations for each vaccine in person by the attending physicians in the study. Immunization status was verified using the national vaccination database. Following the questionnaire, participants were informed about influenza and pneumococcal vaccines and were advised to receive the vaccination.¹

The authors observed the percentages of individuals who were unvaccinated for influenza, pneumococcus, and COVID-19 were 61.9%, 60.9%, and 5.9%, respectively, while only 11 patients (3.9%) received an annual influenza vaccine. Health care professionals recommended influenza and pneumococcal vaccination to 60.3% and 37.1% of patients, of whom 71% visited a health care professional 5 or more times a year.¹

Notably, the frequency of regular or infrequent influenza vaccination was significantly associated with the recommendations of health care providers (HR, 14.348; 95% CI, 6.842–30.086; p < 0.001), increased risk of malnutrition (HR, 2.722; [95% CI 1.467–5.050]; p:0.002), and previous pneumococcal vaccination (HR, 2.100 [95% CI 1.180–3.737]; p:0.012). Conversely, frailty was linked to reduced vaccination rates (HR, 0.198 [95% CI, 0.083–0.472]; p < 0.001). The recommendations of health care professionals (HR, 17.804; 95% CI, 9.353–33.892; p < 0.001) and advanced age (HR, 1.024; 95% CI, 1.001–1.046; p:0.040) were determined as factors associated with pneumococcal vaccination, according to the multivariable models.¹

“Health care providers play a crucial role in improving vaccination rates and standard patient care needs to highlight and discuss the importance of vaccination with CKD patients. Developing health policies that consider the factors influencing vaccine hesitancy and incorporate nephrologists in the decision-making process is essential,” the study authors concluded.¹

REFERENCES

1. Kumru G, Akdemir İ, Demir CK, et al. Indicators of vaccination status in patients with chronic kidney disease: the importance of recommendations from healthcare providers. BMC Nephrol. 2025;26,309. doi:10.1186/s12882-025-04238-5

2. National Kidney Foundation. Updated October 28, 2024. Accessed July 8, 2025. https://www.kidney.org/kidney-topics/vaccines-adults-advanced-chronic-kidney-disease-kidney-failure-or-kidney-transplant