Vaccination and COVID-19 Dynamics in Dialysis Patients

Abstract

Background and objectivesDialysis patients have a high mortality risk after coronavirus disease 2019 (COVID-19) and an altered immunologic response to vaccines, but vaccine clinical effectiveness remains unknown in this population.Design, setting, participants, & measurementsUsing Bayesian multivariable spatiotemporal models, we estimated the association between vaccine exposure and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) severe infections (with hospital admission) in dialysis patients from simultaneous incidence in the general population. For dialysis patients, cases were reported within the French end-stage kidney disease REIN registry from March 11, 2020, to April 29, 2021, and vaccine exposure (first dose) was reported in weekly national surveys since January 2021. Cases in the general population were obtained from the national exhaustive inpatient surveillance system (SI-VIC database), and vaccination coverage (first dose) was obtained from the national surveillance system (VAC-SI database).ResultsDuring the first wave, incidence in dialysis patients was approximately proportional to the general population. However, we showed a lower relative incidence for dialysis patients during the second wave (compared with that observed in nondialysis patients), suggesting an effect of prevention measures. Moreover, from the beginning of the vaccination rollout, incidence in dialysis patients was lower compared with predictions based on the first and second waves. Adding vaccination coverages in dialysis and nondialysis patients as predictors allowed the reported cases to be fit correctly (3685 predicted cases, 95% confidence interval, 3552 to 3816, versus 3620 reported). Incidence rate ratios were 0.37 (95% confidence interval, 0.18 to 0.71) for vaccine exposure in dialysis patients and 0.50 (95% confidence interval, 0.40 to 0.61) per 10% higher in vaccination coverage in the same-age general population, meaning that vaccine exposure in dialysis patients and the general population was independently associated with lower hospitalization rate of dialysis patients.ConclusionsOur findings suggest that vaccination may yield a protective effect against severe forms of COVID-19 in dialysis patients, despite altered immunologic vaccine responses.

SARS-CoV-2 spike protein antibody titers 6 months after SARS-CoV-2 mRNA vaccination among patients undergoing hemodialysis in Japan

“…Patients with chronic kidney disease (CKD), especially those with end-stage kidney disease (ESKD) undergoing maintenance hemodialysis (HD), are at high risk of COVID-19 severity and death [ 7 , 8 ]. Although patients undergoing HD are often excluded from vaccine trials for safety reasons, the results of many cohort studies have shown that SARS-CoV-2 mRNA vaccination reduces the risk of COVID-19 infection, severe illness, and death in patients receiving dialysis [ 9 , 10 ]. Therefore, SARS-CoV-2 mRNA vaccination is now recommended for patients undergoing HD.…”

Durability of Humoral and Cellular Immunity after an Extended Primary Series with Heterologous Inactivated SARS-CoV-2 Prime-Boost and ChAdOx1 nCoV-19 in Dialysis Patients (ICON3)

“…Vaccines 2022, 10, 1064 2 of 14 rate in this population [3,4]. In comparison with other vaccine platforms, the inactivated SARS-CoV-2 vaccine appears to induce weaker humoral immunity (HMI) in immunocompromised persons [5], including those on dialysis [6][7][8].…”

“…Dialysis patients are at increased risk of infection and mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), owing to immunological dysfunction and comorbidities [ 1 , 2 ]. Despite the impaired vaccine response in dialysis patients, COVID-19 immunization reduces the COVID-19 incidence and hospitalization rate in this population [ 3 , 4 ]. In comparison with other vaccine platforms, the inactivated SARS-CoV-2 vaccine appears to induce weaker humoral immunity (HMI) in immunocompromised persons [ 5 ], including those on dialysis [ 6 , 7 , 8 ].…”

Improved SARS-CoV-2 neutralization of Delta and Omicron variants of concern after fourth vaccination in hemodialysis patients

“…In hemodialysis patients, a SARS-CoV-2 infection is associated with a markedly increased morbidity and mortality in comparison to the general population with a mortality rate of more than 20% in hospitalized patients [1][2][3] . In the last two years we have learned that double vaccination might not be enough to achieve adequate long-term immune protection in all hemodialysis patients and triple vaccination offers significantly better protection against COVID-19 in this patient group 1,4 . Even if an infection cannot always be prevented after booster vaccination, the course of the COVID-19 disease in general is milder depending on the number of vaccinations in hemodialysis patients 5 .…”