This study examines COVID-19 infections among 4791 vaccinated and unvaccinated patients receiving dialysis and describes the longitudinal antibody-based response up to 5 to 6 months after full vaccination and its relationship with breakthrough infections in 2563 patients.
BackgroundPatients on dialysis are at increased risk for COVID-19–related complications. However, a substantial fraction of patients on dialysis belong to groups more likely to be hesitant about vaccination.MethodsWith the goal of identifying strategies to increase COVID-19 vaccine uptake among patients on hemodialysis, we conducted a nationwide vaccine acceptability survey, partnering with a dialysis network to distribute an anonymized English and Spanish language online survey in 150 randomly selected facilities in the United States. We used logistic regression to evaluate characteristics of vaccine-hesitant persons.ResultsA total of 1515 (14% of eligible) patients responded; 20% of all responders, 29% of patients aged 18–44 years, and 29% of Black responders reported being hesitant to seek the COVID-19 vaccine, even if the vaccine was considered safe for the general population. Odds of vaccine hesitancy were higher among patients aged 18–44 years versus those 45–64 years (odds ratio [OR], 1.5; 95% confidence interval [95% CI], 1.0 to 2.3), Black patients versus non-Hispanic White patients (OR, 1.9; 95% CI, 1.3 to 2.7), Native Americans or Pacific Islanders versus non-Hispanic White patients (OR, 2.0; 95% CI, 1.1 to 3.7), and women versus men (OR, 1.6; 95% CI, 1.2 to 2.0). About half (53%) of patients who were vaccine hesitant expressed concerns about side effects. Responders’ main information sources about COVID-19 vaccines were television news and dialysis staff (68% and 38%, respectively).ConclusionsA substantial proportion of patients receiving in-center hemodialysis in the United States are hesitant about seeking COVID-19 vaccination. Facilitating uptake requires outreach to younger patients, women, and Black, Native American, or Pacific Islander patients, and addressing concerns about side effects.
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