Vaccine efficacy in CKD patients not on dialysis: a systematic review and meta-analysis
Abstract
ABSTRACT Background Patients with chronic kidney disease (CKD) have increased infection risk, contributing to higher rates of hospitalization and mortality. While vaccines can prevent or reduce the severity, data primarily focus on dialysis-dependent patients. This meta-analysis aimed to evaluate vaccine efficacy in non-dialysis CKD patients (CKD-ND). Methods We systematically searched the MEDLINE, Embase, Scopus and OVID databases through April 2025 for randomized controlled and observational studies reporting the vaccine efficacy in stage 1–5 CKD-ND patients. Efficacy was assessed using laboratory markers (seroconversion, antibody titres) and clinical outcomes. The quality of the studies was assessed by ROBINS-I V2 and RoB2. A random effects model was used to estimate pooled effect size with 95% confidence interval. Results Twenty-eight studies involving >500 000 participants were included covering hepatitis B virus (HBV), COVID-19, influenza, herpes zoster, pneumococcus and human papillomavirus (HPV) vaccines. Most studies were graded fair quality. Ten studies on HBV vaccination revealed a pooled seroconversion rate of 80% that decreased to 60% at 12 months post-vaccination. For COVID-19, the pooled anti-spike immunoglobulin G titre was 228.39 BAU/ml, with a reduced risk of COVID-19 infection following a boosting dose. Two doses of the influenza vaccine yielded higher seroconversion rates than a single dose, but the antibody levels declined over time, indicating waning…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 500 participants or records.
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