COVID-19 vaccination reduces mortality in patients on maintenance hemodialysis

Leszek Tylicki; Bogdan Biedunkiewicz; Ewelina Puchalska-Reglińska; Ryszard Gellert; Michel Burnier; Jacek Wolf; Alicja Dȩbska-Ślizień

doi:10.3389/fmed.2022.937167

COVID-19 vaccination reduces mortality in patients on maintenance hemodialysis

Front Med (Lausanne). 2022 Sep 8:9:937167. doi: 10.3389/fmed.2022.937167. eCollection 2022.

Authors

Leszek Tylicki¹, Bogdan Biedunkiewicz¹, Ewelina Puchalska-Reglińska², Ryszard Gellert³, Michel Burnier^{4

5}, Jacek Wolf⁵, Alicja Dȩbska-Ślizień¹

Affiliations

¹ Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland.
² Dialysis Unit, 7th Naval Hospital in Gdansk, Gdańsk, Poland.
³ Department of Nephrology and Internal Medicine, Medical Center for Postgraduate Education, Warsaw, Poland.
⁴ Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
⁵ Translational Medicine Centre, Medical University of Gdańsk, Gdańsk, Poland.

Abstract

Patients with chronic kidney disease on maintenance hemodialysis (HD) have a very high risk of death in the course of COVID-19. The aim of the study was to assess the effectiveness of COVID-19 vaccination to reduce the incidence of COVID-19 and the fatality rate in HD patients. A retrospective registry-based cohort study was performed in all HD adult patients in the Pomeranian Voivodeship. Vaccinations were carried out from January to April 2021 with mRNA vaccines, either BNT162b2 or mRNA-1273 with two-dose schedule. In the first analysis (2nd pandemic wave), 1,160 unvaccinated patients were included (59.7% males, 25.7% diabetic). In the second analysis (4th pandemic wave), 1,131 (59.4% male, 30.7% diabetic) individuals were included, 1,042 (92.13%) were fully vaccinated. Three hundred and fifteen HD patients (27.2%) were COVID-19 positive during the 2nd wave, and 6.9% (78/1,131) during the 4th wave. Within the fully vaccinated patients of the 4th wave, 60 were COVID-19 positive, 5.8 vs. 20.2% of unvaccinated COVID-19 positive patients in 2nd wave, respectively. COVID-19 incidence rate ratio (IRR) was 0.21 (4th wave-vaccinated vs. 2nd wave-unvaccinated) indicating a 79% reduction. The IRR between vaccinated and unvaccinated patients of the 4th wave was 0.28 in favor of vaccinated patients with 72% reduction. In the 2nd wave, 93 patients died as a result of COVID-19 (fatality rate: 29.5%). The fatality rate of fully vaccinated patients during the 4th wave was 6.7% (p = 0.004), while the fatality rate in the 4th wave within unvaccinated patients accounted for 11.1%. Significant clinical effectiveness of COVID-19 vaccination was demonstrated in a multicenter study in HD patients.

Keywords: COVID-19; fatality rate; incidence; maintenance dialysis; vaccination.