Camargo Leonardo Figueiredo, Lother Alessandra Martins, Mazzali Marilda, Stucchi Raquel S B
Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Renal Transplant Unit, Clinics Hospital, University of Campinas, Campinas, SP, Brazil.
Transpl Infect Dis. 2018 Jun;20(3):e12831. doi: 10.1111/tid.12831. Epub 2018 Feb 12.
The number of patients with chronic kidney disease is increasing worldwide, as well as the number of patients in kidney transplant waiting lists. In order to prevent infections related to immunosuppressive therapy, immunization guidelines for CKD patients before transplantation have been proposed. The aim of the present study was to evaluate adherence to immunization in a cohort of CKD patients in transplant waiting list and their renal replacement therapy clinics.
CKD patients older than 18 years old, receiving renal replacement therapy longer than 12 months and included in kidney transplant waiting list at University of Campinas (Unicamp) were enrolled.
From February 2014 to December 2015, 105 patients fulfilled the inclusion criteria. Complete hepatitis B vaccination was observed in 73% and influenza vaccine in 67%. None of the other vaccine protocols reached 50% of coverage. Patients receiving immunization at primary health units presented higher coverage for diphtheria, tetanus (dT), measles, mumps, rubella (MMR), and hepatitis B vaccines, while patients immunized at renal replacement therapy clinics showed higher prevalence of pneumococcus (pneumo23).
The low rates of immunization could reflect the RRT's clinics knowledge about the vaccines guidelines and its application on daily care. We suggest an integration between transplant center and RRT clinics, through lectures, periodic checking of vaccination cards, and easy to follow guidelines in order to provide a better vaccine coverage and to obtain higher immunization rates.
全球慢性肾脏病患者数量以及肾移植等待名单上的患者数量都在增加。为预防与免疫抑制治疗相关的感染，已提出慢性肾脏病患者移植前的免疫接种指南。本研究的目的是评估肾移植等待名单上的慢性肾脏病患者队列及其肾脏替代治疗诊所的免疫接种依从性。
纳入坎皮纳斯大学（Unicamp）年龄大于18岁、接受肾脏替代治疗超过12个月且被列入肾移植等待名单的慢性肾脏病患者。
2014年2月至2015年12月，105例患者符合纳入标准。观察到73%的患者完成了乙肝疫苗接种，67%的患者完成了流感疫苗接种。其他疫苗接种方案的覆盖率均未达到50%。在初级卫生单位接受免疫接种的患者对白喉、破伤风（dT）、麻疹、腮腺炎、风疹（MMR）和乙肝疫苗的接种率较高，而在肾脏替代治疗诊所接种的患者肺炎球菌（pneumo23）疫苗接种率较高。
免疫接种率低可能反映了肾脏替代治疗诊所对疫苗指南及其在日常护理中的应用的了解情况。我们建议通过讲座、定期检查疫苗接种卡以及易于遵循的指南，在移植中心和肾脏替代治疗诊所之间进行整合，以提供更好的疫苗覆盖率并获得更高的免疫接种率。
