Immune function and immunizations in dialyzed children

Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are associated with significant alterations in immune function. On the one hand, CKD is associated with a state of chronic inflammation, which in turn has been associated with increased muscle catabolism, vascular calcification, insulin resistance, and malnutrition [1]. However, patients with CKD and ESRD also have immunodeficiency, as manifested by an increased risk for infection and sepsis and impaired response to vaccinations [1] Infection is a leading reported cause of death in children with ESRD [2, 3]. Peritoneal dialysis (PD) continues to be plagued with the infectious complication of peritonitis, and hemodialysis (HD) is complicated by the development of catheter-related bacteremia. Excluding transplantation, infection is reported to be the most common –reason for dialysis modality termination in children [2]. The treatment and the prevention of infections are therefore important elements in the care of pediatric dialysis patients, both for reduction of mortality and morbidity, and in the setting of PD, for preservation of the peritoneal membrane function. This chapter will provide a brief review of currently available information regarding the immune dysfunction associated with CKD and ESRD. In addition, because delivery of routine childhood and supplemental vaccinations remains a cornerstone of infection prevention, data regarding response to immunizations in children with CKD and alterations to the routine immunization schedule for healthy children required for children with CKD will be presented.