Hepatitis B virus (HBV), influenza, pneumococcus and herpes zoster are important infections which could result in significant morbidity and mortality in patients with chronic kidney disease (CKD). While seroconversion rates after vaccination are often lower in CKD patients compared with healthy adults due to impaired innate and adaptive immunity, vaccinations for HBV, influenza, pneumococcus and herpes zoster are generally effective in reducing the transmission and/or severity of these infections. Practical issues that have an impact on the efficacy of vaccination in the CKD population include the timing, dose, schedule of vaccination, the route of administration, and adjuncts applied at time of vaccination. This review discusses the vaccination regimens and the efficacy of HBV, influenza, pneumococcus and zoster vaccines in CKD patients, and highlights recent advances in enhancing vaccine seroconversion rates. K E Y W O R D S chronic kidney disease, hepatitis B, herpes zoster, influenza, invasive pneumococcal disease, vaccination Infection is a major cause of morbidity and mortality in patients with chronic kidney disease. Chronic infections such as that by hepatitis B virus (HBV) can lead to severe complications upon immunosuppression given for the treatment of glomerular diseases or for the prevention of kidney transplant rejection. 1-3 Therefore, for infections with effective vaccines, the prevention of infection by vaccination is of paramount importance in the CKD patient population. HBV is endemic in the Asia-Pacific region, while seasonal influenza, invasive pneumococcal disease and zoster reactivation contribute to substantial hospitalisations yearly worldwide, and are associated with increased mortality in CKD patients. 4 The transmission and severity of these infections can be effectively reduced by vaccinations. 5-8 In general, patients with CKD demonstrate a lower seroconversion rate after vaccination, and a faster decay of protective antibodies after vaccination, due to impaired innate and adaptive immune responses. 9 This review focuses on vaccination regimens for HBV, influenza, pneumococcal, and zoster infection, and recent advances in enhancing the seroconversion rate after vaccination. We searched in the PubMed database, using the following keywords: 'vaccine', 'kidney disease', 'haemodialysis', 'peritoneal dialysis', 'kidney transplant', 'hepatitis B', 'influenza', 'pneumococcal' and 'zoster', and summarized the results from relevant articles. Key recommendations of vaccination for other diseases are also summarised (Table 1). 1 | VACCINATION IMMUNOLOGY IN CKD PATIENTS Both innate and adaptive immunity are required for an effective response to immunisation. After inoculation, the epitopes of the vaccine antigens are recognized by receptors, which include toll-like receptors (TLR), macrophage scavenger receptors, and mannose-binding lectin, that are expressed on dendritic cells and macrophages. 9 The binding of these receptors activates dendritic cells and

Cognitive impairment is common among local PD patients. Even with CI, peritonitis rate in self-care PD with adequate training is similar to CI patients on assisted PD.

SUMMARYAutoclaving peritoneal dialysate fluid (PDF) degrades glucose into glucose degradation products (GDPs) that impair peritoneal mesothelial cell functions. While glycation processes leading to formation of advanced glycation end-products (AGE) were viewed commonly as being mediated by glucose present in the PDF, recent evidence indicates that certain GDPs are even more powerful inducers of AGE formation than glucose per se . In the present study, we examined the expression and modulation of AGE receptors on human peritoneal mesothelial cells (HPMC) cultured with GDPs, conventional PDF or PDF with low GDP content. HPMC cultured with GDPs differentially modulated AGE receptors (including RAGE, AGE-R1, AGE-R2 and AGE-R3) expression in a dose-dependent manner. At subtoxic concentrations, GDPs increased RAGE mRNA expression in HPMC. 2-furaldehyde (FurA), methylglyoxal (M-Glx) and 3,4-dideoxy-glucosone-3-Ene (3,4-DGE) increased the expression of AGE-R1 and RAGE, the receptors that are associated with toxic effects. These three GDPs up-regulated the AGE synthesis by cultured HPMC. In parallel, these GDPs also increased the expression of vascular endothelial growth factor (VEGF) in HPMC. PDF with lower GDP content exerted less cytotoxic effect than traditional heat-sterilized PDF. Both PDF preparations up-regulated the protein expression of RAGE and VEGF. However, the up-regulation of VEGF in HPMC following 24-h culture with conventional PDF was higher than values from HPMC cultured with PDF containing low GDP. We have demonstrated, for the first time, that in addition to RAGE, other AGE receptors including AGE-R1, AGE-R2 and AGE-R3 are expressed on HPMC. Different GDPs exert differential regulation on the expression of these receptors on HPMC. The interactions between GDPs and AGE receptors may bear biological relevance to the intraperitoneal homeostasis and membrane integrity.