Role

What Is the Role of Pneumococcal Vaccination in Renal Diseases?

Burden of Chronic Renal Diseases

CKDs are defined as abnormalities of kidney structure or function, present for >3 months, with implications for health and are categorised based on the cause, GFR category and albuminuria.¹ A population screening of 4712 subjects in New Delhi² suggested that there are approximately 7.85 million patients with CRF in India and etiologically diabetes accounted for 41% of all causes. Another prospective study in 48 centres distributed all over India suggested the prevalence of CRF to be 0.8% in India.³ Diabetic nephropathy was found to be the most common cause of CKD in a cross-sectional study using the Indian CKD registry and about 48% of cases were in Stage V at presentation.⁴

Infectious Complications in Chronic Renal Diseases

Regardless of the primary cause for the development of CKD, patient outcomes after the development of infections were 3 to 4 times worse as compared with the non-CKD population. Compared with the non-CKD population, the rates of pneumonia are 3 times greater in the CKD population and 5 times greater in the dialysis population.⁵ The annual percentage of mortality secondary to sepsis is approximately 100- to 300-fold higher in patients with dialysis.⁶ According to the Medicare claims in patients initiating dialysis in the US between 1996 and 2001, 1 in 5 patients was diagnosed with pneumonia in the 1-year period following the inception of dialysis therapy, and the cumulative survival probability was 0.51 at 1 year after the first occurrence of pneumonia.⁷ In a population-based retrospective cohort study from Taiwan, the incidence rate ratio of ESRD was 23% higher in individuals with pneumococcal pneumonia than in those without pneumococcal pneumonia (5.26 vs. 3.10 per 1000 person-years).⁸ The incidence rate of IPD in organ transplant population is 12.7 times more than the general population.⁹

CKD, chronic kidney disease; CRF, chronic renal failure; ESRD, end-stage renal disease; GFR, glomerular filtration rate; IPD, invasive pneumococcal disease.

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