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Observational Study
. 2022 Jun;17(6):843-850.
doi: 10.2215/CJN.16621221.

Severity of COVID-19 after Vaccination among Hemodialysis Patients: An Observational Cohort Study

Damien R Ashby  1   2 , Ben Caplin  3 , Richard W Corbett  1 , Elham Asgari  4 , Nicola Kumar  4 , Alexander Sarnowski  5 , Richard Hull  5 , David Makanjuola  6 , Nicholas Cole  6 , Jian Chen  7 , Sofia Nyberg  7 , Kieran McCafferty  7 , Faryal Zaman  8 , Hugh Cairns  8 , Claire Sharpe  8 , Kate Bramham  8 , Reza Motallebzadeh  9 , Kashif Jamil Anwari  9 , Alan D Salama  3 , Debasish Banerjee  5 ; Pan-London COVID-19 Renal Audit Group
Collaborators, Affiliations
Observational Study

Severity of COVID-19 after Vaccination among Hemodialysis Patients: An Observational Cohort Study

Damien R Ashby et al. Clin J Am Soc Nephrol. 2022 Jun.

Abstract

Background and objectives: Patients receiving hemodialysis are at high risk from coronavirus disease 2019 (COVID-19) and demonstrate impaired immune responses to vaccines. There have been several descriptions of their immunologic responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, but few studies have described the clinical efficacy of vaccination in patients on hemodialysis.

Design, setting, participants, & measurements: In a multicenter observational study of the London hemodialysis population undergoing surveillance PCR testing during the period of vaccine rollout with BNT162b2 and AZD1222, all of those positive for SARS-CoV-2 were identified. Clinical outcomes were analyzed according to predictor variables, including vaccination status, using a mixed effects logistic regression model. Risk of infection was analyzed in a subgroup of the base population using a Cox proportional hazards model with vaccination status as a time-varying covariate.

Results: SARS-CoV-2 infection was identified in 1323 patients of different ethnicities (Asian/other, 30%; Black, 38%; and White, 32%), including 1047 (79%) unvaccinated, 86 (7%) after first-dose vaccination, and 190 (14%) after second-dose vaccination. The majority of patients had a mild course; however, 515 (39%) were hospitalized, and 172 (13%) died. Older age, diabetes, and immune suppression were associated with greater illness severity. In regression models adjusted for age, comorbidity, and time period, prior two-dose vaccination was associated with a 75% (95% confidence interval, 56 to 86) lower risk of admission and 88% (95% confidence interval, 70 to 95) fewer deaths compared with unvaccinated patients. No loss of protection was seen in patients over 65 years or with increasing time since vaccination, and no difference was seen between vaccine types.

Conclusions: These data demonstrate a substantially lower risk of severe COVID-19 after vaccination in patients on dialysis who become infected with SARS-CoV-2.

Keywords: COVID-19; clinical epidemiology; hemodialysis; vaccination.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Study populations and relationship to the whole dialysis population. The whole population at risk contains all of those receiving hemodialysis (in center) during the observation period. Weekly PCR screening was carried out in this population, with additional PCR testing as indicated by symptoms or contact with a case. The main study population (gray shading) contains all severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections defined by positive PCR (in any setting) during the observation period, and it is used to assess the risk of severe disease in those with infection. The supplementary study population (striped shading) contains a subset of the whole population at risk, for which full vaccination data were available, and it is used to assess the risk of developing infection. aWithin 14 days of positive PCR. bWithin 28 days of positive PCR.
Figure 2.
Figure 2.
Epidemic time course showing the number of new SARS-CoV-2 infections by date and vaccination status. Months with fewer cases were amalgamated to make six time periods (shown at the top). The community proportions of Alpha and Delta variants (dominant during the study) are provided for time periods with adequate data as percentages (not known in periods 1 and 2).
Figure 3.
Figure 3.
Estimated vaccine efficacy in preventing severe illness in those with SARS-CoV-2. Severe coronavirus disease 2019 outcomes associated with second-dose vaccination, unadjusted and in the adjusted model, and the adjusted effectiveness in subgroups are shown. N is the number of SARS-CoV-2 infections at least 10 days after the second vaccine dose in each group. Efficacy is calculated as 1 – odds ratio. 95% CI, 95% confidence interval. aWithin 14 days of positive PCR. bWithin 28 days of positive PCR.
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Comment in

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