Flu & People with Chronic Kidney Disease

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People with chronic kidney disease (CKD) are at high risk of developing serious flu complications, which can result in hospitalization and even death. This is because CKD weakens immune response, which can make the immune system less able to fight infections. People with CKD at any stage, people who have had a kidney transplant, and people who are undergoing dialysis treatment are all at increased risk of severe illness from flu.

A Flu Vaccine is the Best Protection Against Flu

Flu vaccination is especially important for people with CKD because they are at high risk of developing serious flu complications. Flu vaccines are updated each season as needed to keep up with changing viruses. Immunity wanes over time, so annual vaccination is recommended for the best possible protection against flu. A flu vaccine protects against the flu viruses that research indicates will be most common during the upcoming season. (See Vaccine Virus Selection for this season’s exact vaccine composition.)

What is Chronic Kidney Disease (CKD)?

More than 1 in 7 US adults are estimated to have CKD, a condition in which the kidneys are damaged and can’t filter blood as well as they should. Excess fluid and waste from the blood remain in the body and may cause other health problems. Diabetes and high blood pressure are major risk factors for CKD.

For more information:

The 2020-2021 flu vaccine has been updated from last season’s vaccine to better match circulating viruses. Immunity from vaccination sets in after about two weeks.

  • Flu vaccination has been shown to reduce the risk of getting sick with flu, or reduce the risk of having a serious flu outcome like requiring a stay in the hospital or even being admitted to the intensive care unit (ICU). Some studies show that vaccinated people have lower severity of illness if they do get sick.
  • Among people with CKD, flu vaccination has been associated with reduced hospitalizationsexternal icon. See “What are the benefits of flu vaccination?” for more information.

CDC recommends that everyone 6 months and older get a seasonal flu vaccine each year by the end of October.

Flu Vaccines for People with CKD

  • Injectable influenza vaccines (flu shots) are recommended for use in people with CKD and other health conditions. The flu shot has a long, established safety record in people with CKD.
  • The live attenuated influenza vaccine (LAIV), also known as the nasal spray vaccine, is not recommended for people with some kinds of chronic health conditions because the safety and effectiveness of this vaccine in people with those conditions has not been established. The nasal spray vaccine is not recommended for people with CKD.

Your doctor or other health care professional can answer any questions you might have about flu vaccine.

Get pneumococcal vaccines.

  • Pneumococcal pneumonia is an example of a serious flu-related complication that can cause death.
  • People who have CKD should also be up to date with pneumococcal vaccination to protect against pneumococcal disease, such as pneumonia, meningitis, and bloodstream infections.
  • You can get either Pneumococcal conjugate vaccine or Pneumococcal polysaccharide vaccine (but not both) when you get the flu vaccine.
  • Talk to your doctor to find out which pneumococcal vaccines are recommended for you.

Talk with your doctor about other vaccines, including the hepatitis B vaccine, you may need if you have CKD.

Other Preventive Actions for People With CKD

Like everyone else, in addition to getting a flu shot, people with CKD should take everyday preventive actions, including avoiding people who are sick, covering coughs, and washing hands often.

Specific Health Actions for People with CKD

  • Maintain a two-week supply of your regular medications during flu season.
  • Do not stop taking your regular medications without first consulting your doctor, especially in the event that you become sick with flu or another respiratory infection.
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In the context of the COVID-19 pandemic, local governments or public health departments may recommend additional precautions be taken in your community. Follow those instructions.

Symptoms and Treatment

If you get flu symptoms, call your doctor right away. There are antiviral drugs that can treat flu illness and that may prevent serious flu complications. CDC recommends prompt flu treatment for people who have flu infection or suspected flu infection and who are at high risk of serious flu complications, such as people with CKD.


Flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea, though this is more common in children. People may be infected with flu and have respiratory symptoms without a fever.


  • Treatment should begin as soon as possible because antiviral drug treatment works best when started early (within 48 hours after symptoms start).
  • Antiviral drugs require a prescription from a doctor. These medicines fight against flu by keeping flu viruses from making more viruses in your body.
  • Antiviral drugs can make your flu illness milder and make you feel better faster. They may also prevent serious health problems that can result from flu illness.
  • There are four FDA-approved flu antiviral drugs recommended by CDC this season that can be used to treat flu.

When to Seek Emergency Medical Care

Anyone experiencing any of the following emergency warning signs of flu sickness, including people with CKD, should seek medical attention right away.

Emergency Warning Signs of Flu
Emergency Warning Signs of Flu
In children
  • Fast breathing or trouble breathing
  • Bluish lips or face
  • Ribs pulling in with each breath
  • Chest pain
  • Severe muscle pain (child refuses to walk)
  • Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
  • Not alert or interacting when awake
  • Seizures
  • Fever above 104°F
  • In children less than 12 weeks, any fever
  • Fever or cough that improve but then return or worsen
  • Worsening of chronic medical conditions
In adults
  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest or abdomen
  • Persistent dizziness, confusion, inability to arouse
  • Seizures
  • Not urinating
  • Severe muscle pain
  • Severe weakness or unsteadiness
  • Fever or cough that improve but then return or worsen
  • Worsening of chronic medical conditions

These lists are not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning.