Efficacy of COVID-19 Vaccination in Dialysis Patients

Patients with end-stage renal disease (ESRD) are at increased risk for adverse outcomes from COVID-19 infection. The gold standard for prevention of mortality associated with COVID-19 is vaccination. Jose E. Navarrete, MD, and colleagues at Emory University, Atlanta, Georgia, performed an analysis to examine the efficacy of the COVID-19 vaccine in patients with ESRD receiving dialysis.

Results of the analysis were reported during a poster session at the American Society of Nephrology Kidney Week 2022. The poster was titled COVID-19 Infection in Dialysis Patients: Efficacy of Vaccination.

The study population included all patients undergoing dialysis at Emory dialysis centers from December 1, 2020, until February 2022. The date of vaccine series completion was recorded, and confirmed cases of COVID-19 were registered.

The researchers also recorded time from vaccination to COVID-19 and from COVID-19 to death. The risk of COVID-19-related mortality was compared between vaccinated and unvaccinated patients. Patients who received vaccination following an episode of COVID-19 were excluded from the analysis (n=89).

During the study period, 935 patients received maintenance dialysis at Emory dialysis centers. Of those, 68% completed two doses of COVID-19 vaccine, and 46% of vaccinated patients received a booster after a mean 294 days following completion of the primary vaccination series. Nonvaccinated patients were younger (55 years of age vs 60 years of age) and had shorter dialysis vintage (1.0 years vs 2.8 years) compared with vaccinated patients.

The two groups were similar in the proportion of home and in-center dialysis modality. The prevalence of diabetes, congestive heart failure, peripheral vascular disease, chronic obstructive pulmonary disease, atrial fibrillation, and previous transplants was also similar between vaccinated and nonvaccinated patients.

During follow-up, 11% of patients in the vaccinated group (n=71) died after 196 days compared with 24% of patients in the nonvaccinated group (n=70) who died after 86 days (P<.001). Following adjustment for age, dialysis vintage, and congestive heart failure, vaccinated patients with ESRD had a 78% reduction in mortality risk.

A total of 73 patients (11%) in the vaccinated group developed COVID-19 after 250 days compared with 48 unvaccinated patients (16%) who developed COVID-19 after 64 days (P<.001). Among the unvaccinated patients, the mortality odds ratio (OR) after infection with COVID-19 was 3.9 at 30 days after infection, 4.7 at 60 days, and 4.1 at 90 days.

“Vaccination against COVID-19 infection resulted in a 78% reduction in mortality risk in patients receiving dialysis. Nonvaccinated patients diagnosed with COVID-19 had higher mortality rates than vaccinated patients (OR, 4.1 at 90 days postinfection),” the researchers said.

Source: Navarrete JE, Cobb J, Apata IW, Masud T, Lea JP. COVID-19 infection in dialysis patients: efficacy of vaccination. TH-PO930. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2022; November 3, 2022; Orlando, Florida.