Severity of COVID-19 after Vaccination among Hemodialysis Patients: An Observational Cohort Study. Issue 6 (June 2022)

• Record Type: Journal Article
• Authors: Ashby, Damien R.; Caplin, Ben; Corbett, Richard W.; Asgari, Elham; Kumar, Nicola; Sarnowski, Alexander; Hull, Richard; Makanjuola, David; Cole, Nicholas; Chen, Jian; Nyberg, Sofia; McCafferty, Kieran; Zaman, Faryal; Cairns, Hugh; Sharpe, Claire; Bramham, Kate; Motallebzadeh, Reza; Anwari, Kashif Jamil; Salama, Alan D.; Banerjee, Debasish
• Other Names: author non-byline.; Ashby Damien R. author non-byline.; Caplin Ben author non-byline.; Corbett Richard W. author non-byline.; Asgari Elham author non-byline.; Kumar Nicola author non-byline.; Sarnowski Alexander author non-byline.; Hull Richard author non-byline.; Makanjuola David author non-byline.; Cole Nicholas author non-byline.; Chen Jian author non-byline.; Nyberg Sofia author non-byline.; McCafferty Kieran author non-byline.; Zaman Faryal author non-byline.; Cairns Hugh author non-byline.; Sharpe Claire author non-byline.; Bramham Kate author non-byline.; Motallebzadeh Reza author non-byline.; Anwari Kashif Jamil author non-byline.; Salama Alan D. author non-byline.; Banerjee Debasish author non-byline.; Ali Omer author non-byline.; Antonelou Marilina author non-byline.; Bennet-Richards Katy author non-byline.; Blunden Mark author non-byline.; Booth John author non-byline.; Charif Rawya author non-byline.; Chaudhury Saurabh author non-byline.; Cove-Smith Andrea author non-byline.; Dobbie Hamish author non-byline.; Dodd Phillippa author non-byline.; Dreyer Gavin author non-byline.; Duncan Neill author non-byline.; Forbes Suzanne author non-byline.; Goodlad Catriona author non-byline.; Griffith Megan author non-byline.; Hassan Sevda author non-byline.; Hemmilla Ulla author non-byline.; Hendra Heidy author non-byline.; Hill Peter author non-byline.; James Ajith author non-byline.; Jones Daniel author non-byline.; Laurence Anila author non-byline.; Loucaidou Marina author non-byline.; Lucisano Gaetano author non-byline.; Mahalingasivam Viyaasan author non-byline.; Manson Bethia author non-byline.; McGuiness Daniel author non-byline.; McLean Adam author non-byline.; Montero Rosa author non-byline.; Muthuppalaniappan Vasantha author non-byline.; Oates Tom author non-byline.; Palmer Andrew author non-byline.; Rajakariar Ravi author non-byline.; Salisbury Emma author non-byline.; Samad Nasreen author non-byline.; Sandhu Eleanor author non-byline.; Stern Edward author non-byline.; Tandaric Damir author non-byline.; Tomlinson James author non-byline.; Vajgel Gisele author non-byline.; Webster Phil author non-byline.; White William author non-byline.; Wiles Kate author non-byline.; Wright David author non-byline.; Yousef Sajeda author non-byline.;
• Is Part Of: Clinical journal of the American Society of Nephrology. Volume 17:Issue 6(2022)
• Page Start: 843
• Page End: 850
• Publication Date: 2022-06
• Subjects: clinical epidemiology -- COVID-19 -- vaccination -- hemodialysis
• DOI: 10.2215/CJN.16621221
• Languages: English
• ISSNs: 1555-9041

Abstract

Visual Abstract: 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.