Patients with chronic kidney disease and dialysis often have immune deficiencies and are significantly more susceptible to a variety of pathogens, especially pneumococcal and hepatitis B virus infections. The efficacy of vaccination in these patients is poorer than in the normal population, so repeat vaccinations or vaccinations above normal doses are often required. In addition, vaccination should be administered early in the course of renal disease, which is particularly important in patients who will undergo renal transplantation and long-term immunosuppressive therapy. Vaccinations recommended by the American Advisory Committee on Immunization Practices Guidelines (ACIP), whose recommendations are hepatitis B virus, influenza virus (inactivated), and pneumococcal vaccines. The ACIP (Advisory Committee on Immunization Practices Guidelines) does not recommend vaccines for patients with chronic kidney disease and dialysis patients. Children with primary immunodeficiency and patients (children and adults) with hematopoietic disorders, liver disease, and kidney transplants are at high risk for rotavirus gastroenteritis and can carry rotavirus for long periods of time. Hepatitis B virus vaccine ACIP recommends vaccination against hepatitis B virus for all patients on long-term hemodialysis treatment. Vaccination before dialysis treatment in uremic patients results in higher seroconversion rates and antibody titers (better in pediatric patients), and is therefore recommended before end-stage renal disease (dependent on hemodialysis treatment and home peritoneal dialysis treatment). 1. Dosage and timing of vaccination Patients undergoing dialysis treatment or long-term immunosuppressive therapy require multiple repeat vaccinations or vaccinations above normal doses. Currently, a special biological vaccine formulation (recombinant hepatitis B vaccine, 40 μg/mL) is available for these patients. Immunogenicity depends on the severity of renal insufficiency. + Special formulation. The Food and Drug Administration (US) recommends high-dose vaccination to achieve greater immunogenicity. If an adult patient is receiving a standard dose of vaccine prior to dialysis treatment and dialysis treatment is started before completion of vaccination, the remainder of the vaccination should be completed with more than the normal dose. the ACIP does not specifically recommend vaccination of pediatric dialysis patients with more than the normal dose. The frequency of vaccination should be increased for both children and adults who receive less than the recommended dose. 2. Immunogenicity and duration Although there are no reports on the efficacy of standard doses of vaccine in pediatric hemodialysis patients, 75-97% of patients receiving three or four high-dose (20 μg) vaccinations produce protective levels of antibody. Reports on the duration of immune memory after hepatitis B virus vaccination in dialysis patients are limited. There have been no clinical reports of severe hepatitis B infection in immunocompromised patients with protective levels of hepatitis B surface antibodies.