The Covid-19 vaccines and kidney disease
We've been working with the professional kidney organisations and charities to ensure we all provide consistent, accurate information about the Covid-19 vaccines and work together to drive change for people affected by kidney disease.
Things change quickly, so we’ll try and keep the information as up-to-date as we can.
- Millions of people in the UK have received one of the Covid-19 vaccines. They are all suitable for adults with kidney disease.
- There are several types of vaccine. Find out more about them and how they work in the frequently asked questions below.
- You should have the vaccine when you are offered it, and any booster doses. People with advanced kidney disease are much more likely to develop severe illness and even pass away from Covid-19. The vaccine will offer some protection for you and your community.
- If you are over 18, or are over 16 and share a household with someone who is immunosuppressed, you should have had one or two doses of vaccines or been invited to have them.
How does the Covid vaccine help protect you?
Vaccines work by training your body to fight off viruses with which you come into contact.
Take a look at our download which explains how vaccines do this and in particular how they work against the virus which causes COVID-19. We also explain how to interpret antibody blood tests.
Continue to take care
Even if you have received the vaccine we recommend you:
- continue to social distance
- wash your hands regularly
- wear a face mask.
It will take a few weeks before your immunity builds up and we don’t yet know the level of protection is provides for everyone, or whether people who are vaccinated can still pass the virus on. Following this advice will reduce the risk to you and your friends and family.
About Covid-19 and the vaccines
As of June 2021, the Delta variant is now the dominant variant in the UK. It transmits more easily between people and there is some suggestion it increases the risk of people with Covid-19 needing to be in hospital (although people currently being admitted to hospital with Covid-19 have more mild symptoms than people hospitalised during previous waves).
There is no data to suggest that the Delta variant poses a more severe risk for kidney patients, but as with other variants, the risk of severe disease from the Delta variant of Covid-19 increases as the severity of a person’s kidney disease increases. The risk increases after stage 3 chronic kidney disease (CKD).
People should continue to be take precautions to reduce their risk, even after vaccination. We know that one dose of the vaccine is not quite as protective against the Delta variant, but two doses gives good protection for most people against serious illness from the Delta virus.
There are several different vaccines for Covid-19. If you live in the UK, you will be offered the Pfizer/BioNTech, the Oxford/AstraZeneca, or the Moderna vaccine.
The Pfizer/BioNTech vaccine contains a small section of the virus’s genetic code, called messenger RNA (mRNA). This carries the instructions – like a recipe - for making the spike protein of SARS-CoV-2 (the virus that causes Covid-19) infection, which the virus uses to enter cells.
When the mRNA is injected into the body, it enters cells in our immune system which follow its instructions to make the spike protein, just as it would if it was infected with the virus. Our immune system recognises the spike protein as foreign and creates antibodies and other immune cells against it, to fight the infection. Our immune systems also develop an immune memory – so it remembers how to fight it should it encounter the virus again.
The Oxford/AstraZeneca vaccine is called a viral vector vaccine – it uses part of another harmless virus to ‘carry’ a small section of the spike protein’s genetic code. When the vaccine enters cells in the body, they use this genetic code to produce the surface spike protein of SARS-CoV-2. As with the Pfizer/BioNTech vaccine, our immune systems then mount an attack and fight the virus.
The Moderna vaccine works in the same way as the Pfizer vaccine, but uses a different type of mRNA, called mRNA-1273.
We recommend you take the vaccine you are offered, when you are offered it.
You cannot usually choose which vaccine you have. Most people can have any of the COVID-19 vaccines, but some people are only offered certain vaccines.
For example, if you're pregnant or under 40 you'll usually only be offered appointments for the Pfizer/BioNTech or Moderna vaccines.
You should have the same vaccine for both doses, unless you had serious side effects (such as a serious allergic reaction) after your 1st dose.
Third dose primary Covid-19 vaccine
This third dose is for people who may not have had a sufficient immune response to the first two doses of a Covid-19 vaccination. This is likely to happen in people that are immunosuppressed or have other health conditions affecting their response to the vaccine. This dose is recommended to form part of a standard primary course and is not deemed to be an “additional” or a “booster” dose, but a necessary dose to help increase these people’s immunity closer to levels others would already have from their first two doses.
The booster vaccine is for people whose initial immune response to their first two doses is likely to have weakened over time. Boosters are given when immunity gradually wanes to provide further protection against the Covid-19 virus.
The Pfizer/BioNTech, Oxford/AstraZeneca and Moderna vaccines are not live vaccines. This means they don’t contain the active, or ‘live’ virus that causes Covid-19 itself.
The vaccines all work slightly differently. But they all deliver an instruction for the body to make the important spike protein from the Covid-19 virus. This allows the body to prepare the immune system so that it can recognise and fight the actual virus if it is encountered in the future.
Safety concerns answered
The safety and effectiveness of the approved vaccines were scrutinised by an independent body which followed all stages of a well-established process. A vaccine had to be produced quickly due to the seriousness of the Covid-19 pandemic.
The vaccine was available quickly and faster than usual because of a global effort - so many people worked together to prioritise their production and huge funds were made available from governments around the world. This means something that normally takes years has taken just months.
The kidney experts at the UK Kidney Association (who represent kidney doctors and nurses) have reviewed the evidence and agree that the vaccines are safe for people with kidney disease, on dialysis and who have kidney transplants.
Advice to individual people may vary because people with kidney disease often have other conditions too. What is right for one person may not be right for someone else. Your kidney doctors will know what is best for you so speak to them for more advice.
When deciding whether to have the vaccine it is also important to consider your risk of becoming more seriously ill with Covid-19. We know many people with kidney disease are at higher risk of being more seriously ill with Covid-19 and some may even die from it.
The scientists working on the vaccines and the companies that that make them are monitoring people who have had the vaccines and looking for any safety concerns.
After giving them to millions of people in many different countries, safety issues have been reported in some people who have serious allergies. Rare blood clots have also been reported in a very small number of people who have had the Oxford/AstraZeneca vaccine, which has led to younger people in the UK being advised to have an alternative.
Kidney experts strongly recommend having the vaccine to help reduce your risk of getting Covid-19.
All of the vaccines administered in the UK have passed stringent safety tests. They would not have been approved for use if they did not pass these tests.
The manufacturers monitor for long term effects and as yet no significant, or longer-term side effects have been reported among the millions of people who have received the vaccines. The vaccines have been approved by specialists in drug safety not only in the UK but across the world.
These specialists, also known as regulators, look at all the data from the companies that make the vaccines but are independent of them and make a decision about whether they can be safely given. They also monitor for any longer term effects of the vaccine after they have been approved. Our independent UK regulator is called the Medicines Health Research Agency or MHRA.
The Covid-19 vaccines have gone through the same strict processes and regulations as other vaccines, such as for measles, mumps, rubella and TB.
It is normal to have certain reactions after a vaccination. There may be redness, swelling or pain around the injection site. Tiredness, fever, headache and aching limbs are also not uncommon in the first three days after vaccination. These normal vaccine reactions are usually mild and get better after a few days.
Your kidney doctors or GP will advise you, but you should not avoid having a vaccine because of potential side effects. The risks of catching Covid-19 far outweigh any potential risk from the vaccines.
It is very rare for vaccines to have significant side effects.
There is no chip or tracker in the vaccine to keep watching where you go, your mobile phone does a much better job of that!
The Covid vaccine has no adverse effect on kidney function
Many thousands of people with solid organ transplants, of which many are kidney transplants, have received the Covid-19 vaccine. This has not shown any adverse effect on kidney function or complications, for example rejection. It remains that case that kidney patients are at increased risk of becoming very unwell or dying if they do contract Covid-19 and two doses of the vaccine provides an excellent layer of protection against that risk.
Who should have the vaccine?
Women who are trying to become pregnant do not need to avoid pregnancy after vaccination and a pregnancy test is not needed before vaccination. Getting pregnant at this point is a matter of personal choice. The Royal College of Obstetricians and Gynaecologists has excellent advice on this.
However, if you are pregnant and have serious kidney disease, vaccination should be considered as you would be at very high risk of complications from Covid-19. Please talk to your kidney team about whether you might benefit from the vaccine if you are pregnant.
Breastfeeding women can be offered the vaccine.
There is no evidence to suggest the vaccine affects fertility or that the vaccine is harmful to future pregnancies.
There is no scientific evidence to suggest the vaccine will work differently on people from ethnic minority backgrounds
The vaccine does not include pork or any material of foetal or animal origin.
Most children and young people with kidney disease are not at an increased risk of Covid-19 compared to others their age. Your kidney team will determine if your child is at an increased risk or not.
It is important to be up to date with immunisations including the annual inactive influenza when it is offered and to continue with the hands, face, space principles and avoid the crowds, and encourage others in your household to do the same.
Those aged 12+ are eligible for vaccination if they:
- have had a kidney transplant in the last six weeks
- are taking high-dose medicines to suppress the immune system
- are living with a person who has a reduced immune system
Those aged 16 years or older are eligible for vaccination if they:
- meet any of the above criteria.
- have chronic kidney disease (CKD) stages 3–5
- are on dialysis.
Vaccine efficacy in kidney patients
There are a few research studies happening now looking at this.
Data from the arm of OCTAVE, a UK study of vaccine responses in people with long term conditions, will be published soon. So far the researchers have looked at the blood test results in the laboratory, rather than the clinical data on how many kidney patients are getting severe disease.
A second study of vaccine response (funded by Kidney Research UK, National Kidney Foundation and other kidney patient charities – see here for more information) in people on haemodialysis is the first to look specifically at neutralising antibodies, which are likely to be a better guide to the level of protection as these antibodies coat the virus to prevent infection.
Kidney patients can ask their doctors about participating in trials.
Several laboratory studies are measuring the level of antibodies in the blood, following vaccination. People with kidney disease who do not receive immunosuppression have been shown to have a good antibody response, whilst those on immunosuppressant drugs have weaker responses. This is to be expected, because of how immunosuppressant medication works, but does not mean to say that the vaccine is not effective at protecting people.
People taking immunosuppressants also produce less antibodies following their flu jab, but each year the flu jab protects people from developing severe flu and going into hospital. Antibodies are only one facet of the immune system and don’t give the whole picture of the immune response.
While the lab findings tell us about antibody response, it will take a bit longer before we know how much being vaccinated reduces the risk of kidney patients developing severe Covid-19 and going into hospital. It will take time to collect enough data on this because fortunately there is a much lower number of kidney patients becoming infected with Covid-19 since the vaccine rollout. Reassuringly, we are seeing a significant reduction in the number of kidney patients who have received their vaccination getting very ill with Covid-19 and going into hospital with the disease. Routine testing of haemodialysis patients is picking up some infections, but these are often asymptomatic.
In terms of differences between vaccine brands, lab studies within the general population found the Pfizer vaccine led to a greater antibody response and the AstraZeneca produces more of T-cell response. Antibodies and T-cell responses are two different parts of the immune system and both play an important role in protecting against severe disease. Having good responses of either can protect you against severe Covid-19.
While they may work in slightly different ways, both the Pfizer and AstraZeneca vaccines have been found to be equally effective in preventing infection, severe disease and hospitalisations among the general population.
Reducing Covid-19 infections in the general population is good news for kidney patients, because it means they are less likely to be exposed to and catch Covid-19.
However, very sadly some people will still become severely ill or die from Covid-19, even after they have had both doses of vaccine. This is because although the vaccines are highly effective at preventing severe disease and death, they are not 100% effective at stopping it. So therefore there will be a very small number of people who get very ill or die with Covid-19.
If you have Covid-19 and continue to test positive for the virus for a number of weeks, it does not necessarily mean that person still has an active infection, as the test may be picking up fragments of dead virus. However, it’s likely that a dialysis patient who has had Covid-19 infection will take a good few weeks to feel better, although there is no reason why they won’t rehabilitate and they should try to do a little bit more each day and give themselves time to recover.
Yes. No vaccine is ever 100% effective. For example, the flu vaccine which is used every year is only about 70% effective. For people with kidney disease, Covid-19 can be very serious and therefore the benefit from the protection that the vaccine will give you would outweigh the potential risks.
There will always be people who react differently but protection from the virus is really important and the vaccines offer protection for yourself and others around you.
It may be that people with kidney disease and people taking immunosuppressants do not respond quite as well. However, it is expected that the vaccines will work well enough make it worthwhile having the vaccine, especially when the high risk to kidney patients from Covid-19 is considered. The new study we are funding will also help us to know this for sure.
None of the trials specifically included people with serious kidney disease. But they have included a wider population from diverse backgrounds that included healthy people and those with pre-existing conditions.
The risks kidney patients face from catching Covid-19 far outweigh the risks of potential side effects from the vaccine.
The good news is these studies are now starting to happen. We are funding a study to assess how effective Covid-19 vaccines are in kidney patients on haemodialysis and to identify if and when boosters are needed (as with flu vaccination, which is once a year). This is just the start – we hope more studies to happen in other groups of kidney patients too in the near future.
All of the vaccines being rolled out are suitable for people with kidney disease, whether you have had a transplant, are on dialysis or have another kidney condition.
Live vaccines are not safe for people with kidney transplants but the Covid-19 vaccines are not live vaccines. Transplant experts are happy that they are safe for people with transplants.
We recommend you take the vaccine you are offered, when you are offered it. We recommend both doses.
Scientists around the world are studying how effective the vaccines are in kidney patients. You may have seen some results emerging from studies in other countries, but many are small studies or only testing one fraction of our immune systems, so not giving the complete picture. Some only report results after the first dose of vaccine, and we need to know the full picture after the second dose. Some also report results over a short period of time since the vaccination course had started.
Two large UK studies will provide a more complete picture of immunity following vaccination and include more patients.
One study is led by researchers at Imperial College London and The Francis Crick Institute and we are co-funding this with the National Kidney Federation, several kidney patient associations and Kidney Wales. This study will assess how effective Covid-19 vaccines are in kidney patients on haemodialysis by studying the antibodies that are produced in detail – what kind and whether they prevent the virus infecting cells. It will reveal the effect the vaccines are having, and how long immunity lasts – and will influence how often boosters are needed, if at all. We expect the first results from this study in summer 2021.
This study complements another large study called OCTAVE which is studying how effective vaccines are in a broader range of immunocompromised patients. Funded by the Medical Research Council this study is in people with rheumatological diseases, blood cancers, liver disease and those who have had a kidney transplant. The wider results will be relevant to other kidney patients too, because many of them receive the same immunosuppressant drugs to treat their conditions. Results from OCTAVE are expected shortly.
With some other vaccines, some kidney patients don’t develop as strong an immune response, so it possible this may also happen with Covid-19 vaccines. This is why it is important to still be cautious and socially distance, and wear masks, for example. It is also why researchers are also testing additional ways of protecting kidney patients from Covid-19, in addition to the vaccine. One of these studies is the PROTECT-V study that is testing if a tapeworm drug called niclosamide given as a nasal spray can prevent Covid-19 infection in kidney patients. This study is now recruiting patients and we hope will be rolling out across the country – please speak to your kidney doctor to find out if you are able to take part.
Based on all the information we have reviewed, immunosuppressed patients can receive any of the vaccines offered to them; there is currently no evidence that any vaccine is better than the other for this group of patients.
Although they may not give as much protection as they might do in someone who has a fully functioning immune system, they are still likely to give a degree of protection so are helpful.
The stronger your immunosuppressant medication, the less likely you are to have an antibody response to any type of vaccine and this is reflected in the Covid-19 vaccine data we’ve seen. Specific studies have shown people taking certain combinations of immunosuppressant drugs, such as Belatacept and Mycophenolate mofetil (MMF), have lower antibody response than healthy people.
Despite this effect, no one should adjust their medication before talking to their doctor. This is extremely important for transplant recipients because reducing immunosuppressant medication puts their transplant at risk.
If you are about to start immunosuppression, for example if you have a planned living donation, you should have both doses of vaccine beforehand. This is because you will mount a better response to the vaccine before you start this medication. More information is here.
If you have previously contracted Covid-19 infection you should still go ahead and get both doses of vaccine, as you could get it again. You will have some immune response from the infection, but this will be strengthened by having both doses of the vaccine. You should wait 4 weeks from the date you first tested positive for Covid-19 before you book an appointment.
There are no plans currently to roll out antibody testing for kidney patients after vaccination. Doctors recommend that patients should not have an antibody test outside of a research study, either from the private sector or via your GP.
Firstly, it will be very hard to understand what the test results mean in terms of your protection. Different tests test for different antibodies, some just tell you whether you have had Covid-19 in the past, some will give a yes/no answer as to whether you have any antibodies, others will give you a level of the specific antibodies that the test measures. It would be difficult to interpret this information in terms of your level of protection.
Secondly, immunity isn’t straightforward and there are different aspects of the immune system, including antibodies and T-cells. We measure antibodies because they are fairly straightforward to measure, while T cells are more difficult to measure. But antibodies are not the full story and we don’t yet know what level of antibodies are protective against severe disease.
Therefore, an antibody test is not yet useful in terms of guiding your behaviour or explaining your level of protection. We are measuring antibodies in research studies because by comparing this laboratory data with numbers of people becoming ill, we hope to learn what level of antibody indicates a person is protected from severe illness. Then we might be able to start recommending people get antibody tests, but we’re not there yet.
Until we know what level of antibodies gives a good level of protection from severe disease, kidney patients should continue to take care where they can, by taking measures such as wearing masks, social distancing and washing hands.
We know this can be very frustrating to have to wait longer for evidence about the level of protection and guidance for behaviour, but the research community is working tirelessly to get these answers for patients and their families.
Vaccine responses wane over time, which is why we have annual flu jabs, so we expected booster doses of Covid-19 vaccines would be required. Prioritising people with reduced responses, such as transplant recipients, for third doses is likely to be sensible.
On 1st July, the JCVI announced interim advice on plans for a booster dose of vaccines starting in September, with immunosuppressed and clinically extremely vulnerable adults likely to be offered their dose first.
Our knowledge of how to treat Covid-19 has advanced hugely over the last year and we continue to research new ways to protect against and treat the virus.
One new treatment which is showing promising results, particularly for people who have not mounted a strong antibody response after vaccination, is based on treating people with severe Covid-19 with neutralising antibodies.
In terms of protecting against infection, the PROTECT-V trial will test a range of interventions which may prevent kidney patients from catching Covid-19. The first is a medicine currently used to treat tapeworm infection called niclosamide but delivered as a nasal spray.
The new research from the Francis Crick Institute suggests that people on haemodialysis have a better response to a mRNA vaccine (such as Pfizer) than an adenovirus vaccine (such as AstraZeneca). This has also been found in other studies involving kidney transplant patients and other kidney patients. Researchers are therefore recommending that, where possible, kidney patients receive a third dose using an mRNA vaccine, particularly if they have received two doses of AstraZeneca vaccine. However, this proposal has yet to be approved by the Joint Committee on Vaccination and Immunisation.
All of the studies so far show that all UK-approved vaccines including AstraZeneca offer good protection against becoming seriously ill and dying from Covid-19 However the evidence is beginning to show that the antibody levels are a bit higher after having the Pfizer vaccine than the AstraZeneca vaccine.
Our researchers are working hard to collect data on how kidney patients respond to the vaccines in order to be able to provide up-to-date advice on how best to protect them from Covid-19 infection.
The work from the Crick Institute didn’t involve transplant patients but there are other international published studies showing that transplant patients will benefit from having a third dose of vaccine, preferably an mRNA vaccine like Pfizer or Moderna. This is not yet standard treatment. As transplant patients may not get full protection from two doses of vaccine, it is important that as well as being vaccinated, they continue to stay cautious to avoid catching Covid-19, by social distancing, wearing masks indoors, meeting others outside or in well ventilated spaces, and doing their best to make sure that they don’t come into close contact with unvaccinated individuals.
The Kidney Charity Together Group are jointly calling on the Joint Committee on Vaccination and Immunisation (JCVI) to urgently prioritise the roll out of a third dose to kidney patients who are on haemodialysis, or who have had a transplant or who are taking immunosuppressants due to a particular kidney condition. We need clear information and guidance, an update to the interim advice issued in June and clarity on when and how these individuals can receive their third dose. We are calling on the JCVI to prioritise these groups, along with other groups of vulnerable people (e.g. blood cancer).
Coping with risk and uncertainty as restrictions are lifted
It is still really important that clinically vulnerable people who go out to work have Covid-secure workplaces. The “SafeAtWork” coalition of charities wrote to all employers to remind them of their duties to maintain safety measures at work particularly for people who may remain at higher risk from Covid-19. People with kidney disease may like to download the letter from Kidney Care UK’s website and share with their employers.
Doctors recommend people should ask for a risk assessment and for any issues arising from that process to be dealt with before they return to the workplace. If you have access to an Occupational Health team at work, you should ask them for support with risk assessments and appropriate adjustments. If employees face any difficulties they could approach their kidney doctors who may be able to write to employers.
Other avenues for support with returning to work include unions, ACAS and kidney patient charity support services and websites.
As well as the adjustments your employer may put in place, you should think through all the protective behaviours that you can adopt to reduce your risk, such as having two doses of vaccine, wearing a mask, keeping a safe distance from others, keeping indoor spaces well ventilated, frequent handwashing, and travelling at quieter times if that is possible.
Advice that clinically extremely vulnerable people should shield is no longer in place and people can resume social contact and activities, whilst following government guidance for their area. But it still important that people with kidney disease do so carefully and continue to take precautions, even after restrictions ease further from 19 July.
When you are thinking through the measures that you could adopt, you should consider your own individual risk from Covid-19, as this varies considerably between kidney patients. You are at reduced risk if you are younger, have less severe kidney disease, and fewer co-existing health conditions.
You may find it helpful to read this blog from Dr Tony Williams on assessing personal risk of Covid-19 and tools that can help with this. Infographics here illustrate which kidney patients are at greater risk from Covid-19. You can also discuss individual risk with your kidney care team.
If you feel you are in a higher risk category, the panel suggest that once restrictions ease, as far as is practical for you, you may wish to try to follow the measures we have all become used to. This means keeping two metres from people who are not part of your household, frequent handwashing, and wearing a mask. It is also very strongly recommended that immunocompromised people encourage their household members, aged 16 and over, to take up the offer of vaccination as this will provide an important layer of protection.
Where possible, people with kidney disease at high risk from Covid-19 should try to avoid high risk environments, such as areas with a high prevalence of Covid-19, indoor spaces with poor ventilation, or where people tend to be crowded together and social distancing is difficult. For example, having lunch in a pub garden would be better than eating indoors in a busy pub, or you might choose to go shopping when you know the supermarket will be quieter, if that is possible for you. Or you may choose not to visit a town where you know the infection rate is particularly high. See here for a postcode search tool.
In terms of meeting up with people, it is sensible to continue to keep a bit of distance and to keep indoor spaces well ventilated. If you are meeting adults who are not vaccinated, you might choose to meet outdoors.
Lateral flow tests can be a helpful tool, as they can help identify people who have Covid-19 but do not have symptoms. However, they are not as reliable as PCR tests (which you should only take if you have Covid-19 symptoms) so risk-reducing measures should still be followed even if a person you are meeting has had a negative lateral flow test.
Some kidney patients are feeling anxious about the easing of restrictions and rejoining society, whilst others may be looking forward to it. If you are apprehensive, give yourself permission to feel a bit anxious. Meeting friends and family and resuming activities is a very positive thing to do, but no-one should be expected to forget the very difficult time that they have been through over the last 16 months, so people should go at their own pace.
People feeling worried can choose to return to normality gradually and slowly, whilst maintaining the measures we know can minimise risk of infection. Planning trips out and social occasions in advance, to avoid high risk environments and follow risk reducing measures, can help people feel more prepared and comfortable with what they are doing.
If you have any other concerns, do address these with your doctors.