SARS-CoV-2 Vaccine Acceptability in Patients on Hemodialysis: A Nationwide Survey

Abstract

Background: Patients 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.

Methods: With 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.

Results: A 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).

Conclusions: A 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.

Podcast: This article contains a podcast at https://www.asn-online.org/media/podcast/JASN/2021_07_07_JASN2021010104.mp3.

Keywords: COVID-19; ESKD; SARS-CoV-2; dialysis; vaccine.

Graphical abstract

Figure 1.

Responses to four vaccine acceptability questions by age and race/ethnicity. Responders in the age group 18–44 years had the lowest likelihood of vaccine acceptancy. Overall rates of vaccine hesitancy improved if vaccine was offered at dialysis facilities. Rates of definitive “no” were low ranging from 6% to 7.5% in the four vaccine acceptability questions.

Figure 2.

Correlates of vaccine hesitancy. The likelihood of vaccine hesitancy on one of four questions was lower among older, non-Black, and college-educated responders. Men, responders living in the West, responders in whose family or close circle someone had died from COVID-19, and responders who had received an influenza vaccine also had lower levels of vaccine hesitancy.

Figure 3.

Reasons for vaccine hesitancy. In total, 53% of participants who were hesitant to receive the COVID-19 vaccine were concerned about its side effects; 12% believed it was dangerous; 19% were concerned about its efficacy, but a sizeable fraction was influenced by their general beliefs (19%) about or prior reaction to (9%) vaccines.