The risk of shingles should never be underestimated for people with chronic kidney disease (CKD). Not only are CKD patients at a higher risk of developing shingles than the general population, but they are at a higher risk of exacerbating CKD because they can cause more than just pain or skin problems.
“If you have kidney disease, iron pieces are something you never overlook,” said Hwang Wong Min, a professor of nephrology at Konyang University Hospital on the Korean Society of Nephrology (KSN) YouTube channel. “CKD patients are extremely vulnerable to the herpes zoster virus. Prevention is the most important thing as having it can exacerbate CKD.”
CKD patients, dialysis patients, and kidney transplant patients have a much higher risk of shingles than the general population. “CKD patients are about 1.4 times more likely to develop shingles,” Fan said.
Hemodialysis patients have a similar proportion (approximately 1.4 times). Peritoneal dialysis patients are 3.6 times higher, with a slightly higher proportion.
“The most problematic group is always at risk of shingles, as the most problematic group is kidney transplant patients who are more than eight times more likely than the general population,” he noted.
Why is the risk of shingles increased in patients with kidney problems? According to Hwang, white blood cells activity, which fights external viruses and bad things, is significantly reduced in CKD patients. When the kidneys deteriorate, the blood becomes cloudy with toxins. “So, white blood cells that actually do good work within the body can't do their job properly,” he explained.
This is why people with kidney disease are more likely to get infected with the herpes zoster virus and get sicker than people without kidney disease. That's not the only problem. Intake of shingles in people with kidney disease is also associated with an increased risk of worsening kidney disease, especially if it is coexisted with diabetes and hypertension.
And that's not all. It is not only the kidneys that are affected by shingles, but also the risk of cardiovascular disease.
“If you have shingles, the risk of vascular disease, stroke and acute coronary artery disease increases by 1.4-2 times as much as possible due to weak blood vessels in kidney disease patients,” Fan said. “Therefore, it's better to prevent shingles, as shingles is not just a skin disease, but because it causes an inflammatory response in the blood vessels and has a variety of effects on the body due to weak immunity.”
In fact, the National Kidney Foundation recommends the shingles vaccine for people with kidney disease. For patients with CKD or renal failure on dialysis, two doses of shingles vaccine are recommended for those over 50 years of age to receive 2-6 months apart. For patients under the age of 50, they say that patients taking immunosuppressive or immunosuppressive medications may be able to consult with their health care provider and receive the shingles vaccine. The US Advisory Committee on Vaccination Practices also recommends two shingles vaccines 2 to 6 months apart for kidney transplant patients aged 19 and older.
“Based on this, in December 2024, KSN's guidelines for infection control in artificial kidney units recommended that dialysis patients age 50 and older be vaccinated with the recombinant shingles vaccine,” Fan said. “In the past, transplant patients have been extremely difficult to receive a live shiny vaccine, so they have not actually been able to receive the vaccine. Fortunately, technological advances have made it possible to receive the shingles vaccine.
The shingles vaccine that CKD patients can safely receive is GSK's recombinant vaccine Singlix, the only approved quadrant vaccine in Korea. “To prevent shingles in CKD patients, two doses of the recently released live vaccine are much more effective and lasting than previous live vaccines,” Fan said. “It also has the advantage of being safe for kidney transplant patients.”
