Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain
the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in
Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles
and JavaScript.
Chronic kidney disease is a major public health problem that is associated with excessive morbidity, mortality and healthcare costs. However, limited clinician awareness of chronic kidney disease is universally identified as a key barrier to care. A concerted effort is urgently needed to address the knowledge gaps of primary care providers.
Quality geriatric kidney care extends beyond traditional therapy to care that balances the impact of both disease and treatment around how individuals manage their daily routines. In this Comment, we discuss clinical and policy changes that could benefit older people with advanced kidney disease.
Vaccines against SARS-CoV-2 are key to ending the COVID-19 pandemic, but their success depends on global availability and acceptance, as well as measures to protect the most vulnerable.
Vaccination against SARS-CoV-2 seems to be safe in patients with immunity-mediated kidney disease, although their immunological responses to vaccination are impaired. Further strategies, including the administration of additional vaccine doses and passive immunization with long-acting monoclonal antibodies, might increase protection in this vulnerable patient group.
Patients receiving dialysis are at high risk of contracting SARS-CoV-2 and developing severe COVID-19. Established SARS-CoV-2 vaccination schemes might lack efficacy in these patients and a personalized approach is therefore necessary. Importantly, given the enhanced infection risks associated with dialysis, current vaccines do not replace non-pharmacological measures to prevent infection.
Kidney transplant recipients receive therapeutic immunosuppression that impairs their immune responses to the COVID-19 mRNA vaccine. For this reason, this vulnerable patient population is insufficiently protected by the standard two-dose COVID-19 vaccination programme and requires a specific follow-up to guide personalization of an intensified vaccination approach.