Clinical Efficacy of SARS-CoV-2 Vaccination in Hemodialysis Patients

Abstract

Introduction: The COVID-19 pandemic is a global public health problem. Patients with end-stage renal disease on hemodialysis are at a higher risk of infection and mortality than the general population. Worldwide, a vaccination campaign has been developed that has been shown to reduce severe infections and deaths in the general population. However, there are currently limited data on the clinical efficacy of vaccinations in the hemodialysis population.

Methods: A national multicenter observational cohort was performed in Chile to evaluate the clinical efficacy of anti-SARS-CoV-2 vaccination in end-stage renal disease patients on chronic hemodialysis from February 2021 to August 2021. In addition, the BNT162b2 (Pfizer-BioNTech) and CoronaVac (Sinovac) vaccines were evaluated. The efficacy of vaccination in preventing SARS-CoV-2 infection, hospitalizations, and deaths associated with COVID-19 was determined.

Results: A total of 12,301 patients were evaluated; 10,615 (86.3%) received a complete vaccination (2 doses), 490 (4.0%) received incomplete vaccination, and 1196 (9.7%) were not vaccinated. During follow-up, 1362 (11.0%) patients developed COVID-19, and 150 died (case fatality rate: 11.0%). The efficacy of the complete vaccination in preventing infection was 18.1% (95% confidence interval [CI]:11.8-23.8%), and prevention of death was 66.0% (95% CI:60.6-70.7%). When comparing both vaccines, BNT162b2 and CoronaVac were effective in reducing infection and deaths associated with COVID-19. Nevertheless, the BNT162b2 vaccine had higher efficacy in preventing infection (42.6% vs. 15.0%) and deaths (90.4% vs. 64.8%) compared to CoronaVac.

Conclusion: The results of our study suggest that vaccination against SARS-CoV-2 in patients on chronic hemodialysis was effective in preventing infection and death associated with COVID-19.

Keywords: COVID-19; SARS-CoV-2; epidemiology; hemodialysis; mortality; renal dialysis.

Graphical abstract

Figure 1

Flowchart of patients evaluated in the study. Patients on chronic hemodialysis over 15 years were evaluated between February 2, 2021 and August 31, 2021. Patients who had had SARS-CoV-2 infection prior to February 2, 2021, patients on other renal replacement therapies, or with incomplete information on vaccination status were excluded.

Figure 2

Cumulative number of vaccine doses administrated during follow-up period. The number of vaccine doses administrated between February 2, 2021 and August 31, 2021, in patients who received the complete vaccination (green bar = first dose, blue bar = second dose) or only 1 dose (yellow bar) during follow-up period are presented.

Figure 3

COVID-19 infection rate and case fatality rate during follow-up, according to vaccination status. Hemodialysis patients were classified according to their vaccination status: unvaccinated (n = 1196 – red line), incomplete vaccination (n = 490 – blue line) and complete vaccination (n = 10,615 – green line). (A) Cumulative incidence rate of COVID-19 infection. (B) Case fatality rate in patients who developed COVID-19.