Can a patient with one kidney and Chronic Kidney Disease (CKD) stage 4 receive the flu shot and Prevnar (Pneumococcal conjugate vaccine) at the same time?

Simultaneous Administration of Influenza and Pneumococcal Vaccines in CKD Stage 4

Yes, a patient with one kidney and CKD stage 4 can and should receive both the influenza vaccine and Prevnar (pneumococcal conjugate vaccine) at the same time, as there are no contraindications to simultaneous administration and both vaccines are strongly recommended for this population.

Guideline-Based Recommendations for CKD Stage 4

Influenza Vaccination

• All adults with CKD should receive annual influenza vaccination regardless of CKD stage, as this is a Grade 1B recommendation from KDIGO guidelines 1.
• The presence of only one kidney does not alter this recommendation, as the indication is based on eGFR and CKD status 1.

Pneumococcal Vaccination

• All adults with eGFR <30 mL/min/1.73 m² (CKD stages G4-G5) should receive pneumococcal vaccination unless contraindicated, per KDIGO Grade 1B recommendation 1.
• Your patient with CKD stage 4 falls directly into this category and has a clear indication for pneumococcal vaccination 1.
• Revaccination should be offered within 5 years for patients with CKD who have received prior pneumococcal vaccination 1.

Safety of Simultaneous Administration

Evidence Supporting Co-Administration

• Influenza and pneumococcal vaccines can be safely administered simultaneously if both are indicated, according to guidance from the American Academy of Pediatrics 2.
• Both vaccines are inactivated (not live) vaccines, which eliminates concerns about vaccine interference 3, 2.
• There are no specific contraindications to simultaneous administration in the CKD population 1.

Safety Profile in CKD Patients

• Vaccination against H1N1 influenza in hemodialysis patients demonstrated that adverse reactions were actually less frequent in CKD patients (33.6%) compared to non-CKD controls (52.4%), with all side effects being mild and of short duration 4.
• The most common side effect in both groups was mild local pain at the injection site, with no serious adverse reactions 4.

Practical Implementation

Timing Considerations

• There is no need to separate the administration of these two vaccines - they can be given during the same visit 2.
• If given simultaneously, administer in different anatomical sites (e.g., one in each arm) 2.
• Influenza vaccination should begin in September and continue throughout the influenza season, with optimal timing from October through mid-November 3.

Important Clinical Considerations

• Only use inactivated influenza vaccine (injection) - never use live attenuated influenza vaccine (nasal spray) in patients with CKD, as they may have some degree of immunosuppression 3.
• The patient's fever status and overall clinical condition should be assessed before vaccination, though antibiotic use alone is not a contraindication 2.
• Vaccination should not be delayed if the patient is clinically stable, even if on antibiotics for a concurrent infection 2.

Expected Immune Response in CKD Stage 4

Immunogenicity Concerns

• Patients with severe CKD (stages 4-5) demonstrate reduced antibody responses to both influenza and pneumococcal vaccines compared to healthy controls, with responses of less intensity and shorter duration 5.
• For pneumococcal vaccination specifically, PCV13 significantly increases serotype-specific IgG, IgA, and some IgM antibodies in CKD patients, though the response may be inferior if the patient received prior PPV23 vaccination more than one year ago 6.
• Despite reduced immunogenicity, vaccination remains strongly recommended as it provides meaningful protection even with suboptimal antibody responses 5.

Common Pitfalls to Avoid

• Do not delay vaccination waiting to separate the two vaccines - simultaneous administration is safe and improves compliance 2.
• Do not use live vaccines (such as intranasal influenza vaccine) in CKD patients due to potential immunosuppression 3.
• Do not assume that having one kidney changes vaccination recommendations - the indication is based on eGFR, not kidney number 1.
• Do not forget that pneumococcal vaccination protection declines over time, requiring revaccination within 5 years 1.