[Vaccination scheme in advanced chronic kidney disease]

1. VACCINATION AGAINST HEPATITIS B a) All patients with chronic advanced renal disease and negative serology for HBsAg and antiHBs are to be vaccinated against hepatitis B (Evidence level: B). b) For classic vaccines (Engerix B and HBVAxpro) the adult vaccine dose is 40 mcg (20 mcg in the paediatric population). There are two dose regimens based on the medicinal product used: 0, 1 and 6 months with HBVAxpro and 0, 1, 2 and 6 months with Engerix B. With the new vaccine Fendrix, the dose is 20 mcg and the schedule 0, 1, 2 and 6 months (Evidence level: C). c) The antiHBs titre is to be measured 1-2 months after administration of the last dose. In patients whose antibody titres are below 10 mIU/mL, a booster may be administered, checking the response or administering a second full vaccination (Evidence level: B). d) In responders, antibody levels are to be tested at least once a year. If the antiHBs titre is below 10 mIU/mL, a booster is to be administered (Evidence level: C). 2. VACCINATION AGAINST INFLUENZA a) All patients with chronic advanced renal disease are to be vaccinated every year against influenza (Evidence level: B). b) The vaccination dose and regimen are the same as recommended for the general population (Evidence level: C) 3. VACCINATION AGAINST PNEUMOCOCCUS a) Vaccination against pneumococcus is recommended in patients with chronic renal disease associated with nephrotic syndrome or who may be future candidates for renal transplant (Evidence level: B). b) There is no evidence of the clinical value of the pneumococcal vaccine in adult patients with chronic renal failure, not transplanted. However, some regions are recommending routine vaccination in the population aged >or= 60 years, the age of a high percentage of our patients. c) To maintain immunisation, revaccination is required every 3- 5 years. 4. OTHER VACCINES a) Vaccination against hepatitis A is recommended in patients with renal failure associated with chronic liver disease or who are candidates for renal transplant (Evidence level: C). b) The recommendations for vaccination against tetanus and diphtheria are the same as for the general population (Evidence level: C). c) Chickenpox vaccine is indicated in children with chronic renal disease, particularly if they are candidates for transplant (Evidence level: B). Although there is no evidence of the value of this vaccine in adults, it is advisable to perform it in those who may be candidates for renal transplant with no protecting antibodies. d) There is no evidence of the clinical value of the vaccine against Staphylococcus aureus.