# Vaccination in Children with Chronic Kidney Disease: Current Status and Perspectives

## TL;DR

Children with chronic kidney disease are at higher infection risk and need better vaccination strategies to reduce illness and hospitalization.

## Contribution

This review identifies barriers to vaccination in children with CKD and proposes targeted interventions to improve coverage.

## Key findings

- Vaccination coverage in children with CKD remains suboptimal despite existing guidelines.
- Molecular studies have improved understanding of CKD children's immune vulnerability to infections.
- Strategies like family communication and vaccination teams show promise in improving vaccination rates.

## Abstract

Introduction: Children with chronic kidney disease (CKD) are susceptible to infections due to impaired immunity, immunosuppressive treatments, and dialysis, which lead to increased mortality, morbidity, and hospitalization rates. Immunization is an efficient preventive strategy, but despite the long-existing guidelines, vaccination rates of children with CKD remain suboptimal. Aim: This review aims to summarize the available data on vaccine-preventable infection morbidity and vaccination coverage in children with CKD, the reasons of vulnerability and suboptimal vaccination of this population and strategies that have been proposed for their overcoming. Results: Vaccination coverage studies for children with CKD are limited and outdated but, despite their variability, they confirm suboptimal vaccine coverage. The vulnerability of children with CKD to infectious dis-eases has been better understood with advanced molecular studies of their immune re-sponse. Several barriers, some of them unique to this population, hamper adherence with vaccination guidelines. Targeted interventions at different levels that have already been tried in adults with CKD, such as enhanced communication with families, cocooning strategies for the most vulnerable, education of specialists on vaccines, and organization of vaccination teams, seem promising in improving vaccination rates and infection prevention. Conclusions: The suboptimal protection from infections of children with CKD can be improved with prioritization of vaccination in their complicated care.