This study was a randomized controlled trial to investigate the immune response of influenza vaccines when doses were increased. and a second vaccination together with an increase in the amount of vaccine in patients with chronic kidney disease receiving hemodialysis

1. Patients with chronic kidney disease undergoing dialysis will be examined by an internist.
2. Collect the necessary basic information of patients who agree to participate in the treatment.
3. Patients will be randomized to be divided into 3 groups: those who will receive an standard dose of influenza vaccine, those who will receive double standard dose of influenza vaccine (double-dose) and those who will receive double standard dose of influenza vaccine and Six months after the first dose of vaccination (double-booster-dose), 50 people per group.
4. Non-dialysis volunteers will be invited to participate in the research. to be a control group of 25 people
5. Patients with chronic kidney disease and volunteers will receive basic laboratory blood tests.
6. Patients with chronic kidney disease and volunteers will be vaccinated against influenza. shoulder muscle area according to random groups The details of using Influvac vaccine of that year are produced by Abbott.
7. Patients with chronic kidney disease and volunteers are asked about the potential side effects of vaccination. according to research guidelines both systemic side effects and injection site Each time receiving hemodialysis 3 times a week for 2 weeks after vaccination
8. Patients with chronic kidney disease and volunteers were asked about the onset of symptoms of respiratory infection throughout the 12-month study period after vaccination.
9. Patients will receive a blood test to check their immune response to influenza vaccine. (Hemagglutination inhibition assays and activation and/or exhaustion T cell markers, T cell subpopulation by flow cytometry) at 1, 6, 7 and 12 months after influenza vaccination.

Inclusion Criteria:

• Age ≥18 years
• Received kidney replacement therapy with dialysis for more than 1 month.
• Hemodialysis at least 3 times a week
• (Kt/v) greater than 1.2
• Never received an organ transplant.
• Life expectancy of more than 1 year
• Research participants or representatives are welcome to join the project by signing.

Exclusion Criteria:

• History of any vaccinations in the 4 weeks prior to the study.
• History of receiving influenza vaccine 6 months before entering this study.
• History of allergy to flu vaccine or allergic to egg white
• Fever or headache, muscle pain (influenza-like illness) 3 days before vaccination
• Thrombocytopenia
• On immunosuppressive drug (Prednisolone 15 mg daily or equivalent for two weeks in a row in the previous 3 months) or immunocompromised patient
• Patient or family history of having had Guillain-Barre disease. (Guillain-Barre syndrome)
• The research participant or his representative refuses or requests to withdraw.