Effectiveness of 2023-2024 COVID-19 vaccines against COVID-19-associated hospitalizations among adults aged ≥18 years with end stage kidney disease - United States, September 2023-April 2024
- PMID: 40184817
- DOI: 10.1016/j.vaccine.2025.127010
Effectiveness of 2023-2024 COVID-19 vaccines against COVID-19-associated hospitalizations among adults aged ≥18 years with end stage kidney disease - United States, September 2023-April 2024
Abstract
Background: Persons with end stage kidney disease (ESKD) on dialysis are at high risk for severe COVID-19 disease. In September 2023, 2023-2024 COVID-19 vaccination was recommended in the United States for all persons aged ≥6 months. Due to possible immune dysfunction, advanced age, and high prevalence of additional underlying conditions, including immunocompromising conditions, among individuals with ESKD, reduced vaccine effectiveness (VE) is a concern. Understanding effectiveness of 2023-2024 COVID-19 vaccine among persons with ESKD can inform COVID-19 vaccine recommendations for this population.
Methods: A retrospective cohort investigation was conducted among Medicare fee-for-service beneficiaries aged ≥18 years with ESKD receiving dialysis using Medicare enrollment and claims records. Follow-up began on September 17, 2023, and continued until the earliest occurrence of claim for a COVID-19-associated outcome, other censoring event, or end of follow-up. A marginal structural Cox model was used to estimate VE (calculated as [1 - hazard ratio]*100 %), interpreted as the benefit of 2023-2024 COVID-19 vaccination compared with no 2023-2024 vaccine dose. VE was estimated by presence of additional immunocompromising conditions, age group, and time since vaccination.
Results: During September 17, 2023 - April 13, 2024, 17,749/112,250 (16 %) Medicare beneficiaries aged ≥18 years with ESKD without additional immunocompromising conditions received a 2023-2024 COVID-19 vaccine dose, with a maximum 209 days of follow-up since vaccination. During the follow-up period 6539 medically attended COVID-19 events, including 3605 COVID-19-associated hospitalizations, 789 COVID-19-associated deaths, and 896 COVID-19-associated thromboembolic events, were recorded. VE against COVID-19-associated hospitalization was 55 % (95 % confidence interval [CI]: 42 % - 65 %) at 7-59 days after vaccination and 47 % (95 % CI: 35 % - 57 %) at ≥60 days after vaccination. VE against COVID-19-associated death was 71 % (95 % CI: 46 % - 84 %) at 7-59 days after vaccination and 51 % (95 % CI: 24 % - 69 %) ≥60 days after vaccination. VE against COVID-19-associated thromboembolic events was 44 % (95 % CI, 24 %, 59 %).
Conclusions: The 2023-2024 COVID-19 vaccines provided protection against COVID-19-associated hospitalization, death, and thromboembolic events among adults with ESKD. These data support the recommendation that adults with ESKD receive the updated COVID-19 vaccine.
Keywords: COVID-19 vaccines; Medicare; Renal dialysis; SARS-CoV-2.
Copyright © 2024. Published by Elsevier Ltd.
Conflict of interest statement
Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Eduardo Lacson, Jr. reports a relationship with Dialysis Clinic Inc. that includes: employment. Lorien Dalrymple reports a relationship with Fresenius Medical Care that includes: employment and equity or stocks. Lorien Dalrymple reports a relationship with General Electric Company that includes: equity or stocks. Lorien Dalrymple reports a relationship with General Electric Healthcare that includes: equity or stocks. Lorien Dalrymple reports a relationship with The Permanente Medical Group Inc. that includes: equity or stocks. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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