Results of the first nationwide cohort study of outcomes in dialysis and kidney transplant patients before and after vaccination for COVID-19

Abstract

Background Patients with kidney replacement therapy (KRT) have been identified as a vulnerable group during the COVID-19 pandemic. This study reports the outcomes of COVID-19 in KRT patients in Sweden, a country where patients on KRT were prioritized early in the vaccination campaign. Methods Patients with KRT between January 2019 and December 2021 in the Swedish Renal Registry were included. Data were linked to national healthcare registries. The primary outcome was monthly all-cause mortality over three-years follow-up. The secondary outcomes were monthly COVID-19 related deaths and hospitalizations. The results were compared with the general population using standardized mortality ratios. The difference in risk for COVID-19 related outcomes between dialysis and kidney transplant recipients was assessed in multivariable logistic regression models before and after vaccinations started. Results On January 1, 2020, there were 4097 patients on dialysis (median age 70) and 5905 kidney transplant recipients (median age 58). Between March 2020 and February 2021, mean all-cause mortality rates increased by 10% (from 720 to 804 deaths) and 22% (from 158 to 206 deaths) in dialysis and kidney transplant recipients respectively compared with the same period 2019. After vaccinations started, all-cause mortality rates during the third wave (April 2021) returned to pre COVID-19 mortality rates among dialysis patients, while mortality rates remained increased among transplant recipients. Dialysis patients had a higher risk for COVID-19 hospitalizations and death before vaccinations started aOR 2.1 (95% CI 1.7–2.5), but a lower risk after vaccination, aOR 0.5 (95% CI 0.4–0.7) compared to kidney transplant recipients. Conclusions The COVID-19 pandemic in Sweden resulted in increased mortality and hospitalization rates among KRT patients. After vaccinations started, a distinct reduction in hospitalization and mortality rates was observed among dialysis patients, but not in kidney transplant recipients. Early and prioritized vaccinations of KRT patients in Sweden probably saved many lives.

SARS-CoV-2 Neutralization Capacity in Hemodialysis Patients with and without a Fifth Vaccination with the Updated Comirnaty Original/Omicron BA.4-5 Vaccine

“…A recently published study by Wijkström et al demonstrated the increased morbidity and all-cause mortality of patients on renal replacement therapy in a large Swedish cohort during the first year of the pandemic when no vaccinations were available [ 6 ]. While all-cause mortality in kidney transplant patients remained increased after vaccines were available, in patients on renal replacement therapy, it was comparable to pre-pandemic times [ 6 ].…”

“…A recently published study by Wijkström et al demonstrated the increased morbidity and all-cause mortality of patients on renal replacement therapy in a large Swedish cohort during the first year of the pandemic when no vaccinations were available [ 6 ]. While all-cause mortality in kidney transplant patients remained increased after vaccines were available, in patients on renal replacement therapy, it was comparable to pre-pandemic times [ 6 ]. This underscores the importance of consistent immunization of hemodialysis patients and the close monitoring of the immunization success, especially since humoral immunity against COVID-19 is declining over time even after repeated vaccination [ 7 ].…”