Vaccination and COVID-19 Dynamics in Dialysis Patients

Abstract

Background and objectives: Dialysis 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, & measurements: Using 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).

Results: During 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.

Conclusions: Our findings suggest that vaccination may yield a protective effect against severe forms of COVID-19 in dialysis patients, despite altered immunologic vaccine responses.

Keywords: COVID-19; SARS-CoV-2; dialysis; hemodialysis; hospitalization; immunology; vaccination.

Graphical abstract

Figure 1.

Nationwide vaccination coverage and severe acute respiratory syndrome coronavirus 2 severe infections in patients needing maintenance dialysis and in the general population (adults aged ≥25 years). (A) Vaccine policies started in mid-January and first targeted patients with compromising health conditions such as dialysis patients among whom vaccination quickly reached a high coverage. National vaccination policies in the healthy population first targeted older individuals (nursing homes patients from December 27, patients aged >75 years from January 18, patients aged >65 years from early March, and patients aged >50 years from late March). (B) Incidence of severe infections in dialysis patients was approximately proportional to the dynamics in the general population during the first two pandemic waves. The relative incidence in dialysis patients dropped in early 2021 after the beginning of the vaccine policies. (C) Model M₁ fitted on first-wave data failed to capture an incidence drop in dialysis patient incidence from the beginning of the second wave. Model M₂ fitted on first- and second-wave data failed to capture the early 2021 dynamics of incidence in dialysis patients, contrary to model M₃ using vaccine exposures as additional predictors.