Pneumococcal vaccination rates are low in chronic kidney disease stages 4-5 (CKD4-5) and nephrotic syndrome patients, despite higher incidence of pneumococcal pneumonia and increased mortality and cardiovascular complications in these patients compared with those without CKD.1,2 We implemented a quality improvement (QI) project involving a best practice alert in CKD clinics to improve pneumococcal vaccination rates among these high-risk patients over a 2-year period. This initiative was approved by the Institutional Quality Review Committee (QIIRB2097); projects approved as QI initiatives did not require informed patient consent per institutional policy.