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World J Nephrol. Sep 25, 2026; 15(3): 119445
Published online Sep 25, 2026. doi: 10.5527/wjn.119445
Vaccination gaps and infection risk at dialysis initiation
Pranjal Kashiv, Manish Ramesh Balwani, Priyanka Tolani, Amit Pasari, Khushboo Saxena, Vivek B Kute
Pranjal Kashiv, Department of Nephrology, All India Institute of Medical Sciences, Nagpur 441108, Mahārāshtra, India
Manish Ramesh Balwani, Department of Nephrology, Saraswati Kidney Care Center, Nagpur 440015, Mahārāshtra, India
Priyanka Tolani, Department of Internal Medicine, Jawaharlal Nehru Medical College, Wardha 442001, Mahārāshtra, India
Amit Pasari, Department of Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha 442001, Maharashtra, India
Khushboo Saxena, Vivek B Kute, Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, Gujarāt, India
Author contributions: Kashiv P conceptualized the study, designed the methodology, collected data, performed analysis, and drafted the initial manuscript; Balwani MR, Tolani P, and Pasari A provided critical supervision, conceptual guidance, and major revisions of the manuscript; Saxena K assisted in data collection, literature review, and preparation of tables; Kute VB contributed to study design, interpretation of results, and final review of the manuscript for important intellectual content. All authors approved the final version and agree to be accountable for all aspects of the work.
AI contribution statement: AI tools including ChatGPT and Grammarly were used in a limited capacity for language refinement, grammatical correction, and improvement of readability of the manuscript text. No part of the scientific content of the manuscript (including the Abstract, Introduction, Materials and Methods, Results, Discussion, or Conclusions) was generated de novo by AI. All scientific concepts, clinical observations, data interpretations, and conclusions are the original work of the authors. AI tools were used only for linguistic polishing and grammatical correction. They did not contribute to data analysis, study design, translation, or substantive scientific writing. No AI tool participated in the design of the study or in the interpretation of its results. All scientific reasoning was performed entirely by the human authors. No images were used in this manuscript; therefore, no AI tools were involved in image generation or editing. The authors take full responsibility for the entire content of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Vivek B Kute, MD, FASN, FRCP, Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, Room No. 125, First Floor, Civil Hospital Campus, Ahmedabad 380016, Gujarat, India.
drvivekkute@rediffmail.com
Received: January 28, 2026
Revised: February 18, 2026
Accepted: April 13, 2026
Published online: September 25, 2026
Processing time: 197 Days and 22.5 Hours
In this editorial, we comment on the study by Puri et al published in the World Journal of Nephrology, which highlights a neglected gap in preventive care at dialysis initiation: Inadequate protection against vaccine-preventable and endemic infections in advanced chronic kidney disease. In an incident hemodialysis cohort from a tertiary centre in North India, the authors report major deficiencies in adult vaccination against hepatitis B virus, pneumococcus, and influenza at dialysis entry, with more than half of patients having received none of the recommended immunizations. Concurrently, a substantial burden of tuberculosis - predominantly extrapulmonary - was observed, underscoring a dual infectious vulnerability at the outset of renal replacement therapy in endemic, resource-constrained settings. Importantly, vaccination uptake aligned with markers of health-system engagement rather than patient characteristics or presumed biological limitations: Prior nephrology follow-up and structured pre-transplant evaluation were associated with higher vaccination rates and indicators of anticipatory care, including permanent vascular access. These findings suggest that impaired immunogenicity may not be the sole barrier to vaccination in advanced kidney disease and are consistent with an association between delayed referral, fragmented care pathways, and avoidable infectious risk. Although limited by its single-centre, cross-sectional design, this study supports viewing dialysis initiation as a sentinel checkpoint for infection prevention. We argue for integrating vaccination assessment, delivery, serologic monitoring, and tuberculosis screening into pre-dialysis and dialysis-start workflows to operationalize preventive nephrology in routine practice.
Core Tip: Dialysis initiation is a high-risk checkpoint where preventable infections cluster early, yet vaccination and screening are commonly missed. In an incident hemodialysis cohort from North India, major gaps in adult immunization against hepatitis B, pneumococcus, and influenza were evident at dialysis entry, alongside a substantial burden of tuberculosis, often extrapulmonary. Importantly, vaccine uptake tracked with health-system engagement - prior nephrology follow-up, transplant evaluation, and planned vascular access - rather than patient factors alone, reframing “poor vaccine response” as a systems-delivery problem. Embedding vaccination assessment, serologic monitoring, and tuberculosis screening into pre-dialysis and dialysis-start workflows can operationalize preventive nephrology and reduce avoidable morbidity.
