This patient should receive the pneumococcal conjugate vaccine in 6 months. Because infection is a leading cause of death in patients with chronic kidney disease (CKD) and end-stage kidney disease, proper vaccination to prevent infections should improve patient outcomes. The Advisory Committee on Immunization Practices (ACIP) recommends pneumococcal vaccination for all patients with severe CKD. This patient with stage G4/A3 CKD should receive the 13-valent pneumococcal conjugate vaccine (PCV-13) 1 or more years after the 23-valent pneumococcal polysaccharide vaccine (PPSV-23). A second dose of PPSV-23 should be administered 5 or more years after the first dose. Because this patient was immunized with PPSV-23 6 months ago, he should receive PCV-13 in 6 months and PPSV-23 in 4 years and 6 months.

Other immunocompromising conditions that are indications for pneumococcal vaccination are anatomic and functional asplenia, congenital or acquired immunodeficiency (including B- or T-lymphocyte deficiency, complement deficiencies, and phagocytic disorders excluding chronic granulomatous disease), HIV infection, the nephrotic syndrome, leukemia, lymphoma, Hodgkin lymphoma, generalized malignancy, multiple myeloma, solid-organ transplant, and iatrogenic immunosuppression (including long-term systemic glucocorticoids and radiation therapy).

For patients younger than 65 years of age with CKD who have not been previously immunized against invasive pneumococcal disease, the ACIP recommends that PCV-13 be administered first followed by PPSV-23 no sooner than 8 weeks later.