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COVID-19 vaccine and treatments for people with kidney disease

Vaccines are one of the most effective tools to protect your health and prevent disease. Vaccines work with your body’s natural defenses so your body will be ready to fight the virus if you are exposed (also called immunity).

While the effectiveness rates of COVID-19 vaccines are very good, we now know that people who are on immunosuppression medications for the treatment of advanced kidney disease and kidney transplant recipients, may not receive the same level of protection, also known as antibody immunity, from the COVID-19 vaccine as people who are not on immunosuppressive medication.

While more research is needed to learn more about the effectiveness in people with advanced CKD, those on dialysis, and transplant recipients -- these vaccines have been demonstrated to be safe in this population.

The National Kidney Foundation urges patients with advanced kidney disease, including transplant and dialysis patients and patients requiring immunosuppression for treatment of advanced kidney disease, to continue masking and practicing social distancing, after being fully vaccinated.

Many experts also think getting a COVID-19 vaccine may help keep you from getting seriously ill if you do get COVID-19. These vaccines cannot give you COVID-19.

Vaccine mandates

" At this time, 164 million Americans are fully vaccinated, including 80% of seniors and more than 60% of adults."

Just a few months ago, COVID-19 infections and hospitalizations were decreasing – but cases have been quickly going up due to the rapid spread of the Delta variant. The Delta variant has been a game-changer because it is much more likely to spread than other variants and it appears to cause more serious disease. The Delta variant has the potential to erase much of the hard work that people across the county have done to try to reduce the spread of severe disease from COVID-19.  

White House COVID-19 action plan

Recently, the White House released a COVID-19 action plan. This plan includes a Presidential Executive Order instructing the Occupational Safety and Health Administration (OSHA) to develop a rule that requires all public (including all federal agencies) and private employers with 100 or more employees to ensure that the people who are employed by them are fully vaccinated or require unvaccinated workers to produce a negative test result at least weekly. Employers that do not follow the mandate may face significant fines.

These vaccine mandates also apply to federal contractors and all other companies and agencies that receive reimbursements from Medicare or Medicaid, such as nursing homes, long-term care facilities, hospitals, clinics, doctors’ offices, and dialysis centers.

What is the COVID-19 vaccine mandate?

OSHA is instituting an emergency temporary standard, known as ETS, which is a special type of rulemaking authority that is allowed when the agency believes there is enough credible information to  determine working people are in danger due to a particular hazard and that an emergency standard is needed to protect them.

People who must be vaccinated against COVID-19  

  • All federal workers and contractors, with very few exceptions.

  • Employers with 100 or more workers or test unvaccinated workers every week.

  • Healthcare workers in hospitals, clinics, dialysis centers, transplant centers, doctors’ offices, and any other in-patient and out-patient facilities that accept Medicare and Medicaid payments.

  • Employees of Head Start early childhood education and all other federal education programs.

  • All members of the military and armed services.

Did you know? Over 80 million people in the US work for a private-sector business with 100 or more employees.

The ETS goes into effect as soon as it is published in the federal register and essentially operates as an interim final rule with authority to go around the usual rulemaking processes. Unless an ETS is legally overturned, these rules will remain in effect until they are replaced by a permanent ruling. The COVID-19 vaccine mandate ETS is expected to officially go into effect within the next month or so.

It’s important to keep in mind that these new mandates are being instituted on a federal (US Government) level and mandates for individual states and counties may vary. Check with your local state website to find out exactly which mandates are required by residents in your state.

Vaccine third dose for immune suppressed

The U.S. Food and Drug Administration (FDA) has authorized the use of a third dose of COVID-19 mRNA vaccine from either Pfizer-BioNTech or Moderna in patients who are immunocompromised (have a weak immune system).  Experts have found that many patients who had to be hospitalized after vaccination are immunocompromised.  This updated emergency use authorization (EUA) allows patients with organ transplants, and others who are immunocompromised, to get an extra dose of the same brand of shot they had received for their first two doses. Using a different brand of mRNA vaccine is allowed for the third shot if the brand previously received is not available.

Patients will not need a prescription or approval from a health care provider to prove they are immunocompromised and to receive the extra dose For now, the U.S. FDA has determined that others who are fully vaccinated do not need an extra vaccine dose.  This decision does not apply to those who received the one-dose Johnson & Johnson vaccine, because the Centers for Disease Control and Prevention (CDC) says there is not yet enough data to support extra doses. Scientists are still unsure about the benefit of COVID-19 vaccine boosters for those who are not immunocompromised. Pfizer says that the efficacy of its vaccine decreases over time, and Moderna also says that booster doses may be needed, especially since the Delta variant has infected fully vaccinated people.

Getting the vaccine, step-by-step

COVID-19 is a new disease with new vaccines, so it’s very likely you may have questions about what happens before, during, and after your appointment to get vaccinated. These tips will help you know what to expect when you get vaccinated, what information your provider will give you, and resources you can use to monitor your health after you are vaccinated.

Before vaccination

  • Check your state’s guidelines to see if COVID-19 vaccination is available
  • Learn more about the different types of COVID-19 vaccines and how they work
  • Learn more about the benefits of getting a COVID-19 vaccination
  • When you get the vaccine
    • You and the healthcare worker will both need to wear masks that cover your nose and mouth
    • Stay 6 feet away from others while inside any buildings and in lines
    • Learn more about protecting yourself during visits to your doctor or a pharmacy

When it’s your turn

You should receive a paper or electronic version of a fact sheet that tells you more about the specific COVID-19 vaccine you are being offered.

Each authorized COVID-19 vaccine has its own fact sheet that contains information to help you understand the risks and benefits of receiving that specific vaccine.

After vaccination

  • Schedule your second-dose appointment

Prevent the spread after vaccination

Even after you get your vaccine, you will need to continue doing your best to protect yourself. After full vaccination, the best protection is to:

  • Wear a mask that covers your nose and mouth
  • Wash your hands often
  • Stay at least 6 feet away from other people you do not live with

Source: CDC

Vaccine types, explained

Viral vector vaccines

The COVID-19 vaccine from Johnson & Johnson is a viral vector vaccine, which uses a harmless version of a different virus, called a “vector,” to deliver information to your body's immune systems to help protect you from COVID-19.

How do viral vector vaccines work?

The vaccine teaches your body how to make copies of COVID-19 spike proteins. If you are exposed to the real virus later, your body will recognize it and know how to fight it off. The vaccine DOES NOT contain the virus that causes COVID-19 and cannot give you COVID-19. It also cannot make you sick from the virus that is used as the vector. It cannot change your DNA in any way.

mRNA vaccines

Both the Pfizer/BioNTech and Moderna COVID-19 vaccines are messenger RNA vaccines – also called mRNA vaccines, and they are a new type of vaccine to protect against infectious diseases.

To trigger an immune response, many vaccines put a weakened or inactivated germ into our bodies. Other vaccines can use a particle or tiny part of the germ to trigger an immune response.

But – mRNA vaccines do not work this way. Instead, they teach our cells how to make a protein – or even just a piece of a protein – which triggers an immune response inside our bodies. This immune response produces antibodies – and antibodies are what protects us from getting infected if the real virus enters our bodies.

Have mRNA vaccines been studied?

At this time, the only licensed mRNA vaccines in the United States are the ones from Pfizer/BioNTech and Moderna. However, researchers have been studying and working with them for decades.

Interest has grown in these vaccines because they can be developed in a laboratory using readily available materials. This means the process can be standardized and scaled up, making vaccine development faster than traditional ways of making vaccines.

mRNA vaccines have been studied before for other viruses including the flu, Zika, rabies, and cytomegalovirus (CMV). As soon as the necessary information about the virus that causes COVID-19 was available, scientists began designing the mRNA instructions for cells to build the unique spike protein into an mRNA vaccine.

Future mRNA vaccine technology may allow for one vaccine to provide protection for multiple diseases, thus decreasing the number of shots needed for protection against common vaccine-preventable diseases. mRNA vaccines have also been studied for use in cancer.

Comparison chart

Johnson & Johnson
Vaccine type
Viral Vector
2 doses
2 doses
1 dose
Days between doses
Effectiveness in preventing symptomatic COVID-19
Minimum age
It should be noted that COVID-19 vaccines are considered highly effective, and each can dramatically reduce a person's chance of hospitalization or death due to COVID-19.

Facts vs fiction

"I can get COVID-19 from the COVID-19 vaccine."


None of the authorized and recommended COVID-19 vaccines or COVID-19 vaccines currently in development in the United States contain the live virus that causes COVID-19. This means that a COVID-19 vaccine cannot make you sick with COVID-19.

"I’ve already had COVID-19, so I don’t need to get a vaccine."


Due to the severe health risks associated with COVID-19 and the fact that re-infection with COVID-19 is possible, you should get the vaccine even if you’ve already had COVID-19.

At this time, experts do not know how long someone is protected from getting sick again after recovering from COVID-19. The immunity someone gains from having an infection, called natural immunity, varies from person to person. Natural immunity may not last very long.

"A COVID-19 vaccination will protect me from getting COVID-19."


COVID-19 vaccination works by teaching your immune system how to recognize and fight the virus that causes COVID-19, and this protects you from getting sick with COVID-19.

"The COVID-19 vaccine will change my DNA."


The two vaccines that are currently available for adults in the United States, do not change or interact with your DNA in any way. None of the ingredients in a COVID-19 vaccine enters the nucleus of the cell, which is where our DNA is kept.

This means the mRNA cannot affect or interact with our DNA in any way. Instead, COVID-19 mRNA vaccines work with the body’s natural defenses to safely develop immunity to disease.

"I shouldn’t get vaccinated because I may want children someday."


People who want to get pregnant in the future should get vaccinated. Based on current knowledge, experts believe that COVID-19 vaccines are unlikely to pose a risk to a person trying to become pregnant in the short or long term.

Scientists study every vaccine carefully for side effects immediately and for years afterward.  The COVID-19 vaccines are being studied carefully now and will continue to be studied for many years, similar to the ways in which other vaccines that come to market.

"I should continue wearing a mask when I am vaccinated."


You should keep wearing a mask after you are vaccinated to help protect yourself and others from getting COVID-19.

Source: CDC

COVID-19 variants

Information about the characteristics of these variants is rapidly emerging. Scientists are working to learn more about how easily they spread, if they could cause more severe illness, and if currently authorized vaccines will protect people against them.

What we know

Viruses constantly change through mutation, and new variants of a virus are expected to occur over time. Sometimes new variants emerge and disappear. Other times, new variants emerge and persist. Multiple variants of the virus that causes COVID-19 have been documented in the United States and globally during this pandemic.

The virus that causes COVID-19 is a type of coronavirus, a large family of viruses. Coronaviruses are named for the crown-like spikes on their surfaces. Scientists monitor changes in the virus, including changes to the spikes on the surface of the virus. These studies, including genetic analyses of the virus, are helping scientists understand how changes to the virus might affect how it spreads and what happens to people who are infected with it.

Multiple variants of the virus that causes COVID-19 are circulating globally:

  • The United Kingdom (UK) identified a variant called B.1.1.7 with a large number of mutations in the fall of 2020. This variant spreads more easily and quickly than other variants. In January 2021, experts in the UK reported that this variant may be associated with an increased risk of death compared to other variant viruses, but more studies are needed to confirm this finding. It has since been detected in many countries around the world. This variant was first detected in the US at the end of December 2020.
  • In South Africa, another variant called B.1.351 emerged independently of B.1.1.7. Originally detected in early October 2020, B.1.351 shares some mutations with B.1.1.7. Cases caused by this variant have been reported in the US at the end of January 2021.
  • In Brazil, a variant called P.1 emerged that was first identified in travelers from Brazil, who were tested during routine screening at an airport in Japan, in early January. This variant contains a set of additional mutations that may affect its ability to be recognized by antibodies. This variant was first detected in the US at the end of January 2021.

These variants seem to spread more easily and quickly than other variants, which may lead to more cases of COVID-19. An increase in the number of cases will put more strain on health care resources, lead to more hospitalizations, and potentially more deaths.

So far, studies suggest that antibodies generated through vaccination with currently authorized vaccines recognize these variants. This is being closely investigated and more studies are underway.

Rigorous and increased compliance with public health mitigation strategies, such as vaccination, physical distancing, use of masks, hand hygiene, and isolation and quarantine, is essential to limit the spread of the virus that causes COVID-19 and protect public health.

What we do not know

Scientists are working to learn more about these variants, and more studies are needed to understand:

  • How widely these new variants have spread
  • How the disease caused by these new variants differs from the disease caused by other variants that are currently circulating
  • How these variants may affect existing therapies, vaccines, and tests

What happens next?

Public health officials are studying these variants quickly to learn more to control their spread. They want to understand whether the variants:

  • Spread more easily from person-to-person
  • Cause milder or more severe disease in people
  • Are detected by currently available viral tests
  • Respond to medicines currently being used to treat people for COVID-19
  • Change the effectiveness of COVID-19 vaccines

Side effects

After receiving a COVID-19 vaccination, you may have some side effects. This is a normal sign that your body is building up protection from the virus.

The side effects from COVID-19 vaccination may feel like the flu and might even affect your ability to do some daily activities, but symptoms should go away in a few days. Some of the common side effects include:

  • On the arm where you got the shot:
    • Pain
    • Swelling
  • Throughout the rest of your body:
    • Fever
    • Chills
    • Tiredness
    • Headache
  • To reduce pain and discomfort where you got the shot:
    • Apply a clean, cool, wet washcloth over the area
    • Use or exercise your arm

Contact your doctor or healthcare provider if your:

  • Your symptoms worsen, such as if redness and tenderness increase at the spot on your arm where you got your shot
  • Side effects are worrying you and are not going away after a few days
  • While mild or moderate side effects are fairly common with the COVID-19 vaccines, do not be alarmed if you do not have any side effects at all.
    According to the World Health Organization (WHO), there are many people who do not have any side effects after receiving their COVID-19 vaccine. No reaction doesn’t mean the vaccine is is not working. It just means everybody responds differently to the vaccination.
    Keep in mind, both Pfizer-BioNTech and Moderna have reported that aside from minor pain at the injection site, only about half of the people in clinical trials reported any side effects after vaccination.

Authorized vaccines

Currently, three vaccines have received Emergency Use Authorization (EUA) from the FDA and they all are recommended by the CDC. The vaccine from Pfizer-BioNTech was the first vaccine to be granted EUA. The second vaccine is from Moderna, and the third is from Johnson & Johnson.

When to get each dose

Both the Pfizer-BioNTech and Moderna COVID-19 vaccines need 2 separate shots to provide the most protection. The timing between your first and second shot depends on which vaccine you received. You should get your second shot:

  • 3 weeks (or 21 days) after your first Pfizer-BioNTech shot
  • 1 month (or 28 days) after your Moderna first shot.

You should get your second shot as close to the recommended 3-week or 1-month interval as possible. However, there is no maximum interval between the first and second doses for either vaccine. You should not get the second dose earlier than the recommended interval.

The Johnson & Johnson vaccine requires 1 shot to provide protection from COVID-19.

Allergic reactions

There have been reports that some people have experienced severe allergic reactions – also known as anaphylaxis – after getting a COVID-19 vaccine. As an example, an allergic reaction is considered severe when a person needs to be treated with epinephrine or an EpiPen© or if they must go to the hospital.

There have also been reports that some people have experienced non-severe allergic reactions within 4 hours after getting vaccinated (known as immediate allergic reactions), such as hives, swelling, and wheezing (respiratory distress).

The CDC recommends that people with a history of severe allergic reactions – not related to vaccines or injectable medications, such as foods, animals, venom, environmental, or latex allergies – should get vaccinated. People with a history of allergies to oral medications or a family history of severe allergic reactions should also get vaccinated.

Severe allergic reactions

If you have had a severe allergic reaction to any ingredient in a COVID-19 vaccine, you should not get vaccinated. If you had a severe allergic reaction after getting the first dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine, CDC recommends that you should not get the second dose.

Non-severe allergic reactions

If you have had an immediate allergic reaction—even if it was not severe—to any ingredient in an mRNA COVID-19 vaccine, CDC recommends that you should not get the Pfizer-BioNTech or Moderna COVID-19 vaccines. If you had an immediate allergic reaction after getting the first dose of an mRNA COVID-19 vaccine, you should not get the second dose. Your doctor may refer you to a specialist in allergies and immunology to provide more care or advice.

While severe allergic reactions to the Johnson & Johnson vaccine are very rare, if you have had a severe allergic reaction to any of the ingredients in the vaccine, you should not get the shot.

Allergy safety recommendations

The CDC has recommendations for COVID-19 vaccination providers about how to prepare for the possibility of a vaccine recipients having a severe allergic reaction:

  • All people who get a COVID-19 vaccine should be monitored on site
    • People who have had severe allergic reactions or who have had any type of immediate allergic reaction to a vaccine or injectable therapy should be monitored for at least 30 minutes after getting the vaccine
    • All other people should be monitored for at least 15 minutes after getting the vaccine
  • Vaccination providers should have appropriate medications and equipment – such as epinephrine (EpiPen©), antihistamines, stethoscopes, blood pressure cuffs, and timing devices to check your pulse – at all COVID-19 vaccination sites

If you experience a severe allergic reaction after getting a COVID-19 vaccine, vaccination providers should provide rapid care and call for emergency medical services. You should continue to be monitored in a medical facility for at least several hours.

Ingredients by provider

Pfizer-BioNTech COVID-19 vaccine ingredients:

mRNA (messenger ribonucleic acid), lipids ((4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate), 2 [(polyethylene glycol)-2000]-N,N-ditetradecylacetamide, 1,2-Distearoyl-sn-glycero-3-phosphocholine, and cholesterol), potassium chloride, monobasic potassium phosphate, sodium chloride, dibasic sodium phosphate dihydrate, and sucrose

Moderna COVID-19 vaccine ingredients:

mRNA (messenger ribonucleic acid), lipids (SM-102, polyethylene glycol [PEG] 2000 dimyristoyl glycerol [DMG], cholesterol, and 1,2-distearoyl-sn-glycero-3-phosphocholine [DSPC]), tromethamine, tromethamine hydrochloride, acetic acid, sodium acetate, and sucrose

Johnson & Johnson COVID-19 vaccine ingredients:

Recombinant, replication-incompetent adenovirus type 26 expressing the SARS-CoV-2 spike protein, citric acid monohydrate, trisodium citrate dihydrate, ethanol, 2-hydroxypropyl-β-cyclodextrin (HBCD), polysorbate-80, sodium chloride.

Emergency use authorization updates

In the near future, the goal is for people age 12 and younger to be able to easily receive a COVID-19 vaccination as soon as possible. The Pfizer-BioNTech vaccine has already received EUA for adolescents between the ages of 12 and 16. The COVID-19 vaccine from Moderna has has received EUA for use in people age 18 and over, is currently enrolling adolescents ages 12 to 17 in clinical trials.

What you can do right now

We know it’s been a really long year and we are all looking forward to good things in 2021. For now, the best advice is to keep doing the following:

  • Do not socialize with anyone outside your household
  • Wear a mask to protect yourself and others and stop the spread of COVID-19
  • Stay at least 6 feet (about 2 arm lengths) from others who don’t live with you, particularly in crowded areas
  • Wash your hands with soap and water for 20 seconds or use hand sanitizer with at least 60% alcohol

And keep checking back – we are frequently updating our COVID-19 information, including vaccine updates.

Effectiveness rates

While the effectiveness rates of COVID-19 vaccines are very good, we now know that people who are on immunosuppression medications for the treatment of advanced kidney disease and kidney transplant recipients, may not receive the same level of protection, also known as antibody immunity, from the COVID-19 vaccine as people who are not on immunosuppressive medication.

Most doctors agree that the benefits of the vaccine for people with chronic kidney disease at any stage, those on dialysis, and kidney transplant recipients are much greater than the risk of serious disease or complications from COVID-19. Talk to your doctor or other healthcare professional about getting a COVID-19 vaccine.


The United States Vaccine Safety System ensures that all vaccines are as safe as possible. Even though kidney transplant recipients were not included in early COVID-19 clinical trials, many doctors believe the COVID-19 vaccine is safe for these patients.

While more research is needed to learn more about the effectiveness in people with advanced CKD, those on dialysis, and transplant recipients -- these vaccines have been demonstrated to be safe in this population.

Most doctors agree that the benefits of the vaccine for people with chronic kidney disease at any stage, those on dialysis, and kidney transplant recipients are much greater than the risk of serious disease or complications from COVID-19. Talk to your doctor or other healthcare professional about getting a COVID-19 vaccine.

Blood clots have occurred in some people who have received the Johnson and Johnson COVID-19 vaccine. The chance of having this happening is considered very rare (1 in ~500,000). The clots involved blood vessels in the brain, abdomen, and legs along with low levels of platelets (blood cells that help your body stop bleeding).

In people who developed these blood clots and low levels of platelets, symptoms began ~1 - 2 weeks following vaccination. Most people who developed these blood clots and low levels of platelets were females ages 18 - 49 years.

Following these reports, the FDA and CDC underscored the confidence in the vaccine’s safety and effectiveness, following a data assessment. Available data suggested potential blood blots were rare events.

However, people should seek medical attention right away they have any of the following symptoms after receiving the Johnson and Johnson COVID-19 vaccine:


• Shortness of breath,

• Chest pain

• Leg swelling

• Persistent abdominal pain

• Severe or persistent headaches or blurred vision

• Easy bruising or tiny blood spots under the skin beyond the site of the injection


Source: FDA/CDC announcement (

Join our free Q&A webinar and Facebook Live, COVID-19 Vaccine: What Kidney Patients Need to Know, on Jan 11th, 8 am PT/ 11 am ET. 

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