Adult Vaccination Schedule for Chronic Renal Failure
Adults with chronic renal failure require a comprehensive vaccination schedule that includes high-dose hepatitis B vaccine (40 μg), pneumococcal vaccines (both PCV13 and PPSV23), annual influenza vaccine, and other routine immunizations, with specific timing and dosing modifications due to their immunocompromised state. 1
Hepatitis B Vaccination (Critical Priority)
For adults with end-stage renal disease or on hemodialysis, use high-dose formulations:
- Recombivax HB 40 μg at 0,1, and 6 months 1, 2
- OR Engerix-B 40 μg (administered as 2 × 20 μg injections) at 0,1,2, and 6 months 1, 2
- Annual anti-HBs testing is mandatory - give booster doses when antibody levels fall below 10 mIU/mL 1, 3, 4
- Standard adult doses (10-20 μg) are insufficient for this population and should not be used 1, 2
Starting from [DATE], the schedule would be:
- Day 0 (today): First dose 40 μg
- 1 month later: Second dose 40 μg
- 2 months from start (Engerix-B only): Third dose 40 μg
- 6 months from start: Final dose 40 μg
- 7-8 months from start: Check anti-HBs levels 1, 4
Pneumococcal Vaccination (Essential)
Patients with chronic renal failure require both pneumococcal vaccines in sequence: 1
- PCV13 (Prevnar 13): Give first, one dose 1, 5
- PPSV23 (Pneumovax 23): Give at least 8 weeks after PCV13 1, 5
- Revaccination with PPSV23: One-time revaccination after 5 years for chronic renal failure 1, 5
- At age ≥65 years: Give another dose of PPSV23 if at least 5 years have passed since the previous PPSV23 (only one dose recommended at age ≥65) 1
Starting from [DATE]:
- Day 0: PCV13 (can be given same day as hepatitis B dose 1, different injection site)
- 8 weeks later: PPSV23
- 5 years later: PPSV23 revaccination
- At age 65+ (if applicable): Final PPSV23 if ≥5 years since last dose
Influenza Vaccination (Annual Requirement)
Annual inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) is required: 1, 5
- Use inactivated or recombinant formulations only - live attenuated influenza vaccine (LAIV) is contraindicated in end-stage renal disease 1
- Give one dose annually, ideally in early fall before influenza season 1
- Chronic renal disease is a medical indication for influenza vaccination due to increased risk of complications 1
Tetanus, Diphtheria, Pertussis (Tdap/Td)
- Tdap: One dose if not previously received as an adult 1, 5
- Td booster: Every 10 years thereafter 1, 5
Hepatitis A Vaccination
Not routinely indicated for chronic renal failure alone, but consider if: 1
- Patient has chronic liver disease in addition to renal disease 1, 5
- Two-dose series at 0 and 6-12 months (Havrix) or 0 and 6-18 months (Vaqta) 1
Varicella Vaccination
- Two-dose series (0 and 4-8 weeks) if no evidence of immunity 1
- Check immunity status before administering 1
Zoster Vaccination (Age ≥50 Years)
- Recombinant zoster vaccine (Shingrix): Two-dose series, second dose 2-6 months after first 1
- Recommended for adults ≥50 years, even if previously vaccinated with live zoster vaccine 1
Measles, Mumps, Rubella (MMR)
- If no evidence of immunity: One or two doses depending on risk factors 1
- Not contraindicated in chronic renal failure unless severely immunocompromised 1
Critical Pitfalls to Avoid
- Never use standard-dose hepatitis B vaccine (10-20 μg) in hemodialysis patients - this results in inadequate immune response 1, 2
- Never skip annual anti-HBs testing in dialysis patients - protection wanes more rapidly than in healthy individuals 1, 3
- Never give PPSV23 before PCV13 - the sequence matters for optimal immune response 1
- Never use live attenuated influenza vaccine (LAIV) in patients with end-stage renal disease - use only inactivated or recombinant formulations 1
- Never delay pneumococcal revaccination beyond 5 years - chronic renal failure patients lose protection faster 1, 5
- Never give PCV13 and PPSV23 during the same visit - maintain at least 8 weeks between them 1