The Impact of Vaccination on Incidence and Outcomes of SARS-CoV-2 Infection in Patients with Kidney Failure in Scotland. Issue 4 (April 2022)

• Record Type: Journal Article
• Authors: Bell, Samira; Campbell, Jacqueline; Lambourg, Emilie; Watters, Chrissie; O'Neil, Martin; Almond, Alison; Buck, Katharine; Carr, Edward J.; Clark, Laura; Cousland, Zoe; Findlay, Mark; Joss, Nicola; Metcalfe, Wendy; Petrie, Michaela; Spalding, Elaine; Traynor, Jamie P.; Sanu, Vinod; Thomson, Peter; Methven, Shona; Mark, Patrick B.
• Is Part Of: Journal of the American Society of Nephrology. Volume 33:Issue 4(2022)
• Page Start: 677
• Page End: 686
• Publication Date: 2022-04
• Subjects: clinical epidemiology -- vaccination -- COVID-19 -- dialysis -- transplantation -- kidney replacement therapy
• DOI: 10.1681/ASN.2022010046
• Languages: English
• ISSNs: 1046-6673

Abstract

Significance Statement: Patients with kidney failure requiring KRT are at high risk of poor outcomes following SARS-CoV-2 infection, with variable antibody responses to vaccination reported. Ninety-three percent of patients on KRT in Scotland received a SARS-CoV-2 vaccine. The effectiveness of two vaccine doses was only 33% (95% CI, 0 to 52) against SARS-CoV-2 infection and 38% (95% CI, 0 to 57) against hospitalization in patients requiring KRT. Within 28 days of a positive SARS-CoV-2 PCR test, 9.2% of fully vaccinated patients died (7% patients on dialysis and 10% transplant recipients). These data suggest that a primary vaccine course of two doses does not provide adequate protection in patients receiving KRT and highlight the urgent need for adjunctive strategies to reduce risk of both SARS-CoV-2 infection and its complications. Visual Abstract: Abstract : Background: Patients with kidney failure requiring KRT are at high risk of complications and death following SARS-CoV-2 infection, with variable antibody responses to vaccination reported. We investigated the effects of COVID-19 vaccination on the incidence of infection, hospitalization, and death from COVID-19 infection. Methods: The study design was an observational data linkage cohort study. Multiple health care datasets were linked to ascertain all SARS-CoV-2 testing, vaccination, hospitalization, and mortality data for all patients treated with KRT in Scotland from the start of the pandemic over a period of 20 months. Descriptive statistics, survival analyses, and vaccine effectiveness were calculated. Results: As of September 19, 2021, 93% ( n =5281) of the established KRT population in Scotland had received two doses of an approved SARS-CoV-2 vaccine. Over the study period, there were 814 cases of SARS-CoV-2 infection (15.1% of the KRT population). Vaccine effectiveness rates against infection and hospitalization were 33% (95% CI, 0 to 52) and 38% (95% CI, 0 to 57), respectively. Within 28 days of a SARS-CoV-2–positive PCR test, 9.2% of fully vaccinated individuals died (7% patients on dialysis and 10% kidney transplant recipients). This compares to <0.1% of the vaccinated general Scottish population admitted to the hospital or dying due to COVID-19 during that period. Conclusions: These data demonstrate that a primary vaccine course of two doses has limited effect on COVID-19 infection and its complications in patients with KRT. Adjunctive strategies to reduce risk of both COVID-19 infection and its complications in this population are urgently required.