Kausz Annamaria, Pahari Dilip
Department of Medicine, Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
Semin Dial. 2004 Jan-Feb;17(1):9-11. doi: 10.1111/j.1525-139x.2004.17104.x.
There has been much attention directed toward the high mortality of patients with end-stage renal disease (ESRD), with much of the focus on cardiovascular disease. However, infectious disease is the second most common cause of death in late-stage chronic kidney disease (CKD) patients. Although CKD patients are immunocompromised, some vaccines such as influenza, retain their efficacy and reduce infection rates with a standard immunization schedule. Other vaccines, such as hepatitis B and pneumococcal vaccines, require more frequent and/or higher doses to produce and maintain protective antibody levels. Attention has recently been given to the efficacy of influenza vaccination in ESRD patients in reducing morbidity and mortality. Centers with vaccination protocols have demonstrated reduced infection rates and resultant decreased morbidity and mortality. It could be extrapolated from this that widespread vaccination would reduce the total cost of ESRD patient care, and potentially improve patient well-being. However, vaccination appears to be underutilized in CKD patients, and it is a readily available intervention to improve outcomes.
晚期肾病（ESRD）患者的高死亡率已备受关注，其中大部分焦点集中在心血管疾病上。然而，传染病是晚期慢性肾病（CKD）患者第二常见的死亡原因。尽管CKD患者免疫功能低下，但一些疫苗，如流感疫苗，按照标准免疫程序接种仍能保持其效力并降低感染率。其他疫苗，如乙肝疫苗和肺炎球菌疫苗，则需要更频繁和/或更高剂量才能产生并维持保护性抗体水平。最近，人们关注到流感疫苗接种对ESRD患者降低发病率和死亡率的功效。有疫苗接种方案的中心已证明感染率降低，进而发病率和死亡率也随之下降。由此可以推断，广泛接种疫苗将降低ESRD患者的总体护理成本，并有可能改善患者的健康状况。然而，疫苗接种在CKD患者中似乎未得到充分利用，而这是一种可轻易获得的改善预后的干预措施。
