Dialysis patients vaccinated against COVID-19 have fewer hospitalizations, deaths

Patients undergoing dialysis who received a COVID-19 vaccination experienced fewer associated hospitalizations and deaths than those who did not receive a vaccination, according to data published in the American Journal of Kidney Diseases.

Further, vaccine effectiveness was higher before the delta period of the pandemic than during the delta wave.

“SARS-CoV-2 vaccine effectiveness and the association between antibody levels and severe COVID-19 clinical outcomes (ie, hospitalization or death) among maintenance dialysis patients is poorly defined,” Harold J. Manley, PharmD, from Dialysis Clinic Inc. in Nashville, and colleagues wrote. They added, “Barring changes associated with new SARS-CoV-2 variants, our findings demonstrate high effectiveness of SARS-CoV-2 vaccines and suggest that monitoring SARS-CoV-2 antibody levels and administering additional vaccine doses to maintain adequate immunity may be beneficial.”

In a retrospective, observational study, researchers examined 16,214 patients receiving dialysis without COVID-19 history between Feb. 1, 2021, and Dec. 18, 2021, at a Dialysis Clinic Inc. clinic. Researchers conducted a follow-up through Jan. 17, 2022.

For the purpose of the study, researchers followed the CDC definitions for “unvaccinated” (to include the period extending up to 13 days after the first vaccine dose), “partially vaccinated” (applicable to mRNA vaccines only; defined as the period starting 14 days after the first mRNA vaccine dose up to 13 days after the [second] mRNA vaccine dose) and “fully vaccinated” (14 days after two mRNA-1273/Moderna or BNT162b2/Pfizer vaccines or one Ad26.COV2.S/Janssen vaccine). Using logistic regression, researchers determined COVID-19 case rates and vaccine effectiveness.

Of the study population, 75% were fully vaccinated, 4% were partially vaccinated and 21% were unvaccinated by the end of follow-up. Overall, 1,225 COVID-19 cases were identified, 45% of which occurred in unvaccinated patients. Further, 73% of cases occurred during the delta period of the pandemic (June 26, 2021, to Dec. 18, 2021).

Researchers observed 84% vaccine effectiveness against hospitalization or death before the delta period of the pandemic, then a drop to 70% effectiveness during the delta period.

Additionally, lower anti-spike levels correlated with an increased case rate per 10,000 days and adjusted HRs for infection and COVID-related hospitalization or death among the subset of 3,202 vaccinated patients with at least one immunoglobulin G spike antibody assessment.

“In conclusion, SARS-CoV-2 vaccines were effective in maintenance dialysis patients, reducing the risk of both COVID-19 cases and COVID-related hospitalization or death during pre-delta and delta-dominant periods. COVID-19 cases surged during the delta variant-dominant period and current immunosuppression criteria are limited in identifying dialysis patients at highest breakthrough risk,” Manley and colleagues wrote. “Further research is needed to evaluate SARS-CoV-2 vaccine effectiveness and the utility of antibody titer monitoring to determine patients at highest risk for COVID-19 and to guide the timing of additional vaccine administration.”

Editor's Note: On Dec. 15, the headline of this article was corrected to clarify that the researchers reported dialysis patients vaccinated against COVID-19 have fewer hospitalizations and deaths. The editors regret the error.