Making vaccinations work better for patients on dialysis

20 July 2022

Professor Alan Salama and his colleagues at University College London are building on their previous finding that the immune systems of dialysis patients don’t work as well as they should. We are thrilled to be able to support his work on making vaccinations work better for patients on dialysis.

Explaining the problem

Patients whose kidneys fail are put on dialysis while they wait for a suitable donor kidney to become available. Dialysis machines take over the job of the kidneys and clean the patient’s blood. Dialysis has saved countless lives, however, there are some drawbacks. Dialysis weakens the immune system leaving an already vulnerable group more susceptible to illnesses. This has been particularly highlighted during the coronavirus pandemic.

During the first waves of the pandemic, dialysis patients had a higher risk of hospitalisation and death from Covid-19 infection. Additionally, despite vaccination, some dialysis patients show little or no response in terms of building up immunity.

On the other hand, patients with an autoimmune disease (conditions where an overactive immune system attacks the body), see an improvement if they are placed on dialysis. The reason behind these situations is not fully understood.

Vaccine learning

Professor Alan Salama wants to help. They have previously found differences between dialysis patients, with some of them making more and some of them making fewer antibodies following vaccination. Alan wants to know why. By understanding the reasons behind this Alan and his team will be able to figure out how to manipulate the immune system to create more antibodies. This would mean that dialysis patients could be as effectively vaccinated as the general population. Not just against Covid-19 but other illnesses such as hepatitis and flu.

What this means for kidney patients

We all suffered during the lock downs, but dialysis patients suffered more than most. If they were unable to dialyse at home, then they still had to dialyse in hospital, knowing full well that as a group they had worse outcomes in terms of hospitalisation and even death. We collectively took a sigh of relief when the vaccines were rolled out, knowing that this would be a path back to normality. Again, this was not necessarily the case for dialysis patients.

Professor Alan Salama

When most people started to venture back out, many dialysis patients were still shielding. Alan’s work will enable dialysis patients to benefit from vaccinations just like everyone else. This is not just important for the coronavirus pandemic but will be essential for seasonal flu. Effective vaccinations will allow dialysis patients to participate fully in their communities without fear.

Alan said, “This grant will enable us to try an understand a critically important observation that we have known about but haven't truly understood, which is why dialysis patients don’t respond to vaccines as well as patients with normal kidney function and why certain autoimmune diseases become quieter in patients on dialysis.

"We will make use of the responses to the COVID vaccine to help identify good and bad responders, as well as patients with autoimmune diseases that have or have not relapsed on dialysis and explore differences in their immune systems.

"Ultimately, we hope to find a way to boost the poor vaccine responses in those that need it and understand what we could do to better switch off autoimmune diseases in those with better kidney function”.