Recombinant zoster vaccine and risk of kidney failure, cardiovascular, and mortality in patients with chronic kidney disease.

Individuals with chronic kidney disease are at increased risk for herpes zoster, cardiovascular events, kidney failure, and premature mortality. Although the recombinant zoster vaccine effectively prevents herpes zoster, its broader systemic effects in this population remain unclear. We conducted a retrospective cohort study of adults aged 50 years or older with incident chronic kidney disease using the U.S.-based TriNetX network from 2017 to 2024. A total of 13,218 vaccine recipients were propensity score-matched to 13,218 unvaccinated controls. The primary outcome was a kidney event, defined as progression to end-stage kidney disease or initiation of dialysis. Secondary outcomes included cardiovascular events and all-cause mortality. Cox proportional hazards models were used to estimate hazard ratios, with additional analyses of restricted mean survival time over five years and incidence rate differences. After a median follow-up of 3.0 years (IQR, 1.5-4.9), recombinant zoster vaccination was associated with significantly lower risks of kidney events (hazard ratio, 0.63; 95% CI, 0.57-0.70), cardiovascular events (hazard ratio, 0.74; 95% CI, 0.68-0.80), and all-cause mortality (hazard ratio, 0.51; 95% CI, 0.48-0.54). Greater risk reductions were observed among individuals who completed the two-dose series. These findings suggest that recombinant zoster vaccination in patients with chronic kidney disease is associated with substantial and sustained reductions in kidney disease progression, cardiovascular events, and mortality, supporting a potential role for vaccination in long-term cardiorenal protection.