P73
CAN WE MAXIMISE THE BENEFITS OF PNEUMOCOCCAL VACCINATION [PV]
IN PATIENTS WITH CHRONIC KIDNEY DISEASE [CKD]?
Naik, R, Vaux, E, Barker, L, Mohteshamzadeh, M, Tuckett, J
Royal Berkshire Hospital NHS Trust
Patients with CKD have a 10 times higher incidence of invasive Pneumococcal disease
compared to healthy individuals over the age of 65years, and this is associated with a significant
mortality (9.8%) [Kyaw et al., 2003] The Department of Health (DOH) recommends
vaccination against streptococcus pneumoniae every 5 years in patients with CKD and renal
transplants. This offers immunity although it may not be 100%. Anti-pneumococcal antibody
levels fall more rapidly in patients with CKD and a more frequent booster dose of vaccine has
been suggested [Kausz and Pahari, 2004]. We investigated uptake of Pneumococcal vaccine in
our patients following the death from Pneumococcal meningitis of a 55-year-old on
haemodialysis (HD) who had not received PV. We also surveyed the advice given about PV in
other renal units in the United Kingdom.
We gave a letter to all patients on HD asking them to check with their General Practitioner (GP)
when they last received Pneumococcal vaccine. All GP practices who did not reply were
telephoned as were the GP practices of all our patients on Peritoneal Dialysis (PD) and those
with a kidney transplant. Clinical Directors of 48 other Renal Units were asked their policy
regarding PV through an email sent by the chair of the Clinical Services Committee of the
Renal Association.
412 [77%] of renal replacement patients in our unit had been vaccinated [See Table 1]. Only
298 [55%] had been vaccinated within the last 5 years.
Table 1
PV in patients on renal replacement therapy
History of PV
History of PV in past 5 years
Haemodialysis (n = 218)
166 (76%)
118 (54%)
Peritoneal dialysis (n = 85)
71 (84%)
58 (68%)
Renal transplant (n = 234)
175 (75%)
122 (52%)
Total (n = 537)
412 (77%)
298 (55%)
We received responses from 11 out of 48 Lead Consultants of other Renal Units. The policy
regarding PV was diverse. 4/11 departments had no specific policy. 2/ 11 advised the patient to
seek vaccination from the GP while 4/11 departments specifically asked GPs to vaccinate their
CKD patients. 1/11 departments routinely administers Pneumococcal vaccine in its work-up to
dialysis treatment. Our unit policy has been to give low clearance clinic and late presenting
dialysis patients an information pack and record card to take to their GPs requesting influenza,
Pneumococcal and Hepatitis B vaccination. We do not routinely follow this up with patients or
GPs nor have we ensured 5 year repeat of PV.
The DOH’s recommendations with regard to PV in patients with CKD are currently not being
satisfactorily met in our patients. Surprisingly, only 16% of dialysis patients in an American
review had PV [USRDS 2006 Annual Data Report]. The DOH guidelines with regard to the
interval between repeat PV may need revision but there is a paucity of data on which to base
any recommendations. Infectious disease is the second most common cause of death in CKD
patients yet vaccination which is a readily available intervention that could improve mortality
outcomes is underutilised. PV in CKD patients is not a Quality Outcomes Framework target for
GPs at present and this could be expanded to attempt an increased coverage by general practice.
Pneumococcal vaccination may not be 100% effective. However it is inexpensive and crucially
may prevent deaths from invasive pneumococcal disease in CKD patients.