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Following a request by the NKF for the Department of Health to issue specific advice for renal patients in respect of swine flu, the initial advice given was “that it is essential that renal patients inform any person prescribing or providing  a vaccine or other medicine in relation to swine flu, that they alert the prescriber/provider to the fact that they are a renal patient”.

The NKF believe that this is very important whether the patient is on Dialysis or Transplanted as it may be that vaccines or drugs normally given are not suitable for renal patients and that alternatives would be better or safer.

We have now received the following more detailed response:

“I have been asked to reply to your recent question regarding the use of antivirals for renal patients on dialysis and on immunosuppressants. In 2007, widespread consultation including the Renal Specialty Committee of the Royal College of Physicians (Chairperson Lawrence Goldberg) occurred on the use of antivirals in this group of patients. It is safe for them to have antivirals. I am informed that the dosage regimens/recommendations were part of the National Policy for Antiviral Treatment approved by the Dept of Health.

“I attach the up to date summary advice from the Health Protection Agency Website which should be known to all those caring for Adults and Children with renal disease. You will note that the advice states that the preferential antiviral should be zanamavir (relenza) which is inhaled. Not included in the summary advice is that those on immunosuppression can have antiviral treatment.

“If you know of clinicians who are unaware of the policy for Renal patients or require further information I would be grateful if you could let me know.”

NKF Question

Does this mean that they are useable by Transplanted Patients?

“Yes it does. Other groups of patients, not only those with transplants, are on immunosuppressants and the expert advice for all those on immunosuppressants who are an at risk group because of their immunosuppression alone is that they can have antivirals.

“I do not want to muddy the waters too much. However it is possible that some  renal patients may be given oral Tamiflu (oseltamavir) rather than inhaled zanamavir. There is an agreed dose regimen depending on the creatinine clearance and also for those on dialysis. For those with a functioning transplant again oseltamavir could be used. There may be a local circumstances when  inhaled zanamavir is not available but I would think it would be highly unlikely. However I felt that you should be aware that there is clear agreed guidance on the use of oseltamavir for renal patients should the necessity arise.

“Finally again for information I have consulted my Paediatric colleague this morning about the treatment of children with renal disease. The treatment guidance has been prepared by the British Association of Paediatric Nephrologists (BAPN) and is in the process of official/final ratification by the BAPN and the Royal College of Child Health this week. This is the final signing off , if any treatment is required in the meantime it will be given.”

NKF Question

Will the vaccine be safe for kidney patients?

“There are two main types of vaccine, live and inactivated.

“Immunosuppressed individuals should not be given live vaccines as live vaccines can, in some situations, cause severe or fatal infections in immunosuppressed individuals due to extensive replication of the vaccine strain.  Examples of a live vaccine include MMR and BCG.  However, both seasonal influenza and swine flu vaccines are inactivated vaccines and therefore can be offered to immunosuppressed individuals.

“As you can see flu vaccination is safe for those who are immunosuppressed.”

Dr Colin Hardisty,

Consultant Clinical Advisor in Pandemic Flu Planning

Click here to read the summary advice.

Click here for the latest information and guidance from the Department of Health website.

Click here to read the Evolving guidelines for the management of patients with Influenza A (H1N1) from the Renal Association Clinical Affairs Board.

Click here to read about the Vaccination programme on the DH website.

National Pandemic Flu Service

Website: www.direct.gov.uk/pandemicflu

Tel: 0800 1 513 100

Textphone: 0800 1 513 200

Swine Flu Information from the Department of Health

D of H Updates on Swine Flu

The Department of Health issues regular information on the situation regarding Swine Flu in the UK. Click the links below to read these updates.

Further information is available from NHS Choices.

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Page created: 1 May 2009

Last updated: 19 March 2010