Severity of COVID-19 after Vaccination among Hemodialysis Patients: An Observational Cohort Study.
COVID-19
clinical epidemiology
hemodialysis
vaccination
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
received:
23
12
2021
accepted:
22
03
2022
pubmed:
2
6
2022
medline:
10
6
2022
entrez:
1
6
2022
Statut:
ppublish
Résumé
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. 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. 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. These data demonstrate a substantially lower risk of severe COVID-19 after vaccination in patients on dialysis who become infected with SARS-CoV-2.
Sections du résumé
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.
Identifiants
pubmed: 35649718
pii: 01277230-202206000-00014
doi: 10.2215/CJN.16621221
pmc: PMC9269655
doi:
Substances chimiques
ChAdOx1 nCoV-19
B5S3K2V0G8
BNT162 Vaccine
N38TVC63NU
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
843-850Investigateurs
Damien R Ashby
(DR)
Ben Caplin
(B)
Richard W Corbett
(RW)
Elham Asgari
(E)
Nicola Kumar
(N)
Alexander Sarnowski
(A)
Richard Hull
(R)
David Makanjuola
(D)
Nicholas Cole
(N)
Jian Chen
(J)
Sofia Nyberg
(S)
Kieran McCafferty
(K)
Faryal Zaman
(F)
Hugh Cairns
(H)
Claire Sharpe
(C)
Kate Bramham
(K)
Reza Motallebzadeh
(R)
Kashif Jamil Anwari
(KJ)
Alan D Salama
(AD)
Debasish Banerjee
(D)
Omer Ali
(O)
Marilina Antonelou
(M)
Katy Bennet-Richards
(K)
Mark Blunden
(M)
John Booth
(J)
Rawya Charif
(R)
Saurabh Chaudhury
(S)
Andrea Cove-Smith
(A)
Hamish Dobbie
(H)
Phillippa Dodd
(P)
Gavin Dreyer
(G)
Neill Duncan
(N)
Suzanne Forbes
(S)
Catriona Goodlad
(C)
Megan Griffith
(M)
Sevda Hassan
(S)
Ulla Hemmilla
(U)
Heidy Hendra
(H)
Peter Hill
(P)
Ajith James
(A)
Daniel Jones
(D)
Anila Laurence
(A)
Marina Loucaidou
(M)
Gaetano Lucisano
(G)
Viyaasan Mahalingasivam
(V)
Bethia Manson
(B)
Daniel McGuiness
(D)
Adam McLean
(A)
Rosa Montero
(R)
Vasantha Muthuppalaniappan
(V)
Tom Oates
(T)
Andrew Palmer
(A)
Ravi Rajakariar
(R)
Emma Salisbury
(E)
Nasreen Samad
(N)
Eleanor Sandhu
(E)
Edward Stern
(E)
Damir Tandaric
(D)
James Tomlinson
(J)
Gisele Vajgel
(G)
Phil Webster
(P)
William White
(W)
Kate Wiles
(K)
David Wright
(D)
Sajeda Yousef
(S)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2022 by the American Society of Nephrology.
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