Statement on Kidney Patient Prioritization for COVID-19 Vaccines and Therapeutics

December 17, 2020 All content for attribution to National Kidney Foundation

The National Kidney Foundation (NKF), representing the more than 37 million adults in the U.S. with kidney disease, their families, and the professionals who care for them, believes that a key principle of ethical vaccine allocation must be that the vaccine is made available to patients at the highest risk of severe outcomes from COVID-19 infection

Accordingly, we urge the federal government to prioritize kidney patients and kidney care professionals, along with residents of long-term care facilities and health care workers, in receiving access to COVID-19 vaccines to reduce their increased risk of severe morbidity and mortality caused by the novel coronavirus

The federal government must also prioritize the development of an infrastructure to support the dissemination of the COVID-19 vaccine to kidney patients. Over 500,000 people in the U.S. rely on life-saving dialysis to replace kidney function. Almost 90 percent of these patients dialyze in facilities, where dialysis is performed three times a week for four hours at a time. While dialysis facilities are a practical site for vulnerable kidney patients to be vaccinated, facilities may not have the supplies to safely store the vaccine. It is vital that dialysis facilities, among other sites where kidney patients receive care, have the support and supplies needed to expeditiously implement priority vaccinate practices. 

COVID-19 and its Impact on Kidney Patients

Given the relative risk of kidney patients to severe COVID-19 infection and outcomes, NKF calls on the federal government to prioritize kidney patients and their caregivers in their COVID-19 vaccine distribution plans and to work with states to ensure prompt vaccine distribution to kidney patients. Among kidney patients, we recommend prioritization based on relative risk for poor COVID-19 outcomes, using the following approach:

  • In-center dialysis patients and staff
  • Home dialysis patients
  • Transplant patients
  • Immunosuppressed chronic kidney disease (CKD) patients (e.g., patients with glomerular disease, auto-immune disorders, etc.)
  • Other CKD patients
  • Individuals living in the same household as kidney patients

Vaccine Safety and Efficacy

NKF appreciates the efforts of the Administration, specifically the leadership of the Department of Health and Human Services (HHS), the Food and Drug Administration, the National Institutes of Health (NIH), researchers, and vaccine manufacturers to ensure that vaccine candidates meet rigorous standards for safety and efficacy.  As several vaccine candidates were developed from research conducted on previous coronaviruses, evidence about safety and efficacy is promising.

It is worth noting, however, that few of the vaccine candidates were widely tested in individuals with kidney disease or in transplant recipients. NKF calls on policymakers, vaccine manufacturers, and developers to carefully monitor and collect data on vaccine safety and efficacy among kidney patients to ensure patient safety and to inform future vaccine development.

Vaccine Hesitancy 

The burdens of kidney disease and COVID-19 disproportionally on Black or African American and Hispanic or Latino communities. Recent survey data from the COVID Collaborative, Langer Research, UnidosUS and the NAACPidentify low levels of trust in a COVID-19 vaccine among both Black or African American and Hispanic or Latino people, though particularly among Black or African American adults only 14 percent of whom “completely or mostly trust that a vaccine will be safe.” [1] NKF recommends that federal, state, and local policymakers follow the recommendations of public health leaders of color on how best to encourage vaccine uptake in these communities. 

Additional details and all annotations can be found in the full position statement

About Kidney Disease

In the United States, 37 million adults are estimated to have chronic kidney disease (CKD)—and approximately 90 percent don’t know they have it.  1 in 3 adults in the U.S. is at risk for chronic kidney disease.  Risk factors for kidney disease include: diabeteshigh blood pressureheart diseaseobesity, and family history. People who are Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander are at increased risk for developing the disease. Black or African American people are almost 4 times more likely than Whites to have kidney failure. Hispanic or Latino people are 1.3 times more likely than non-Hispanics or Latinos to have kidney failure.

The National Kidney Foundation (NKF) is the largest, most comprehensive and longstanding organization dedicated to the awareness, prevention and treatment of kidney disease. For more information about NKF visit