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.
About the vaccine
- 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.
How does the Covid vaccine help protect you?
Vaccines work by training your body to fight off viruses with which you come into contact.
Find out 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.
Your questions answered
You may have questions about the Covid-19 vaccines and how they affect you.
Here are some of the most common questions with answers from kidney specialists.
About Covid-19 and the vaccines
As of December 2021, the Omicron variant is now the dominant variant in the UK. This variant spreads much faster than the previously dominant variant, Delta. We don’t yet have any data to show how the Omicron variant affects kidney patients but people should continue to take precautions to reduce their risk, even after vaccination.
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.
The JCVI advises that for adults aged 18 and older, either the Moderna or Pfizer-BioNTech COVID-19 vaccines be administered for the third dose, as a number of studies have reported an increased immune response in some immunosuppressed people after a third dose of an mRNA vaccine. For those aged 12 to 17, the Pfizer-BioNTech vaccine is preferred.
If you receive the Moderna vaccine, make sure it is the FULL DOSE (rather than the half dose that is given as a booster).
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.
The vaccine does not change or damage our DNA.
Individuals who are immunodeficient including those with:
- Blood cancers, including patients with acute and chronic leukaemias, lymphomas, myeloma, Waldenstrom’s macroglobulinaemia. (For other blood cancers or if you are recovered or recovering from your blood cancer, please check with your specialist.)
- HIV/AIDS if current CD4 count is <200 cells/µl for adults or children
- Primary or secondary immune deficiencies
Individuals on treatment that affects the immune system, at the time of or around the first or second vaccination including:
- Kidney and other organ transplant recipients on immunosuppressants (anti-rejection treatment)
- Patients on dialysis after a failed transplant but who are on immunosuppression or have been within the previous 6 months
- Cancer chemotherapy or radiotherapy in the last 6 months
- Stem cell transplant in the previous 24 months, or more than 24 months ago but had ongoing immunosuppression or graft versus host disease (GVHD)
- Prednisolone (oral steroids) 20mg or more a day for more than 10 days in the previous month or 10 mg day or more in the previous 3 months
- Methotrexate 20 mg or higher per week
- Azathioprine 3.0mg or greater per kg (of patient weight) per day
- 6-mercaptopurine 1.5mg or greater per kg (of patient weight) per day
- Mycophenolate 1g or greater per day in the previous 3 months
(If you are on combinations of these drugs, please check with your hospital specialist.)
Individuals who are immunodeficient including those with:
- Anti-TNF biologics: infliximab, adalimumab, etanercept, golimumab, certolizumab pegol
- Other biologics: tocilizumab, abatacept, ustekinumab, secukinumab, belimumab
- JAK inhibitors: baricitinib, tofacitinib, upadacitinib, filgotinib
- T cell modulators: tacrolimus, ciclosporin, abatacept
- B-cell targeted therapies including rituximab (in the 6 months before their second vaccine)
This list is by no means comprehensive and other immune therapies will also be included – please check with your specialist.
Have a look at the Kidney Charities Together document for a breakdown of the differences.
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.
As well as receiving all recommended vaccinations, there are several precautions you can take to keep yourselves and others safe:
- Wear a fluid resistant surgical face mask (FRSM) throughout the dialysis process from leaving the house until arriving back home. Masks may be removed to allow eating and drinking (only touching the outer side) but should be replaced immediately afterwards (and be sure to sanitise your hands before and after removing and replacing the mask). Anyone taking their mask off should maintain a 2-metre distance between them and all other people on the unit, including staff and other patients receiving dialysis.
- Be sure to wash your hands on entry and exit from haemodialysis units, before and after snacks and before and after touching your mask.
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.
Following extensive assessment of the risks and benefits of vaccinations for 5-11 year olds, including analysis of clinical trial results and real-world international data, the JCVI has updated its advice for this age group.
Children aged 5 to 11, who are in a clinical risk group or who are a household contact of someone (of any age) who is immunosuppressed, should be offered a primary course of vaccination.
Primary course vaccination for these children should be with two 10-microgram doses of the Pfizer-BioNTech COVID-19 vaccine (a third of the adult dose), with an interval of 8 weeks between the first and second doses.
Separately, in response to the threat from the Omicron variant, the JCVI has advised that booster vaccinations should be offered to:
- Persons aged 16 to 17 years
- Persons aged 12 to 15 who are in a clinical risk group or who are a household contact of someone (of any age) who is immunosuppressed
- Persons aged 12 to 15 years who are severely immunocompromised and who have had a third primary dose.
The booster vaccination for these age groups should be with 30 micrograms of the PfizerBioNTech COVID-19 vaccine, given no sooner than three months after completion of the primary course.
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.
We are delighted to be supporting a national study, MELODY, to investigate how well third doses of Covid-19 vaccine protect immunocompromised patients and identify those who may still be at risk. Using an antibody test that participants can carry out at home, researchers will measure whether patients have developed antibodies against the virus that causes Covid-19. The study will be investigating solid organ transplant recipients, people with blood cancer and people with rare autoimmune conditions receiving immunosuppression.
With news of the new omicron variant, this research is more vital than ever. Recognising which patients still remain at high risk after vaccination will highlight which patients must remain cautious and will also identify those who may be eligible for alternative protective treatments.
We are funding this study with the Medical Research Council in partnership with several other health charities including the Cystic Fibrosis Trust, Blood Cancer UK and Vasculitis UK.
We strongly encourage transplant recipients to take part, your participation will be invaluable. You can register here: www.melodystudy.org
- New results released on Thursday 16 December showed that amongst people who had been double vaccinated, those with chronic kidney disease, on dialysis or who had had a kidney transplant were at much higher risk of being hospitalised with Covid-19, or of dying from it than those in the general population. Find out more about these results.
- A research study that we funded alongside Kidney Research UK with other charities; The National Kidney Federation (NKF), Kidney Wales, the PKD Charity and several Kidney Patient Associations, shows kidney patients who receive in-hospital dialysis treatment for kidney disease produced a greater immune response when given the Pfizer-BioNTech Covid-19 vaccine, compared to the Oxford-AstraZeneca vaccine. Find out more.
- Preliminary results of the OCTAVE study suggest that kidney transplant patients show a stronger antibody response to the Pfizer/BioNTech vaccine than the Oxford/AstraZeneca vaccine. But overall, transplant patients showed a weaker antibody response to both vaccines than healthy individuals. The results also suggest that, if possible, patients should be vaccinated before they start immunosuppressive treatments. The study does not report on whether the vaccine prevented infection in patients, which is the most important measure of how well vaccines work. Find out more.
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.
Get information for kidney patients to explain the schedule of Covid vaccines they should be receiving, and how to get the ones they need.
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.
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.
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. The government have announced that vulnerable people will be given access to cutting-edge antiviral and antibody treatments after testing positive for Covid-19. Get the latest information on these treatment options.
We are also helping to fund the PROTECT-V trial; a clinical trial to find out if the drug niclosamide, given as a nasal spray, can prevent Covid-19 infection in vulnerable, high-risk kidney patients and reduce the number of people who become seriously ill or die from it. Two further treatments will also shortly be added to the trial.
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 and the JCVI 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.
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 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.