Vaccine efficacy in CKD Patients not on Dialysis: A Systematic Review and Meta-analysis

Introduction Patients with chronic kidney disease (CKD) have increased infection risk, contributing to higher rate 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 titers) and clinical outcomes. Quality of studies was assessed by ROBINS-I V2 and RoB2. A random effect model was used to estimate pooled effect size with 95% confidence interval. Results Twenty-eight studies involving over 500,000 participants were included covering hepatitis V virus (HBV), COVID-19, Influenza, Zoster, Pneumococcus, and HPV vaccines. Most studies were graded fair quality. Ten studies on HBV vaccination revealed a pooled seroconversion rate of 80% and declined to 60% at 12 months post-vaccination. For COVID-19, the pooled antispike IgG titer was 228.39 BAU/mL, with a reduced risk of COVID-19 infection following 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 of immunity. The zoster vaccine showed a pooled adjusted hazard ratio was 0.74 for herpes zoster incidence compared with unvaccinated. Pneumococcal vaccine elicited a modest transient response and was associated with reduced S. pneumoniae hospitalization and community-acquired pneumonia risk. The HPV vaccine demonstrated 100% seroconversions, though with lower HPV neutralizing antibody levels. Conclusion Vaccination in CKD-ND patients is associated with a high rate of seroconversion and seroprotection across multiple vaccines. However, these surrogate markers may not fully reflect clinical effectiveness. Further studies are needed to evaluate the impact of vaccination on demonstrated clinical outcomes, particularly infection-related morbidities and mortalities.