COVID-19 Vaccination Imperatives in People on Maintenance Dialysis: An International Perspective

Investigation of COVID-19 vaccination among maintenance hemodialysis patients in Sichuan, China

AIM

To investigate the current status of COVID-19 vaccination in maintenance hemodialysis (MHD) patients and its influencing factors.

METHODS

In total, 585 patients undergoing regular hemodialysis in Sichuan Province of China from January to March 2022 were selected to complete a questionnaire survey on their knowledge, attitudes and practices regarding COVID-19 vaccination. Independent t tests and logistic multivariate analysis were used to analyze the influencing factors of COVID-19 vaccination in hemodialysis patients.

RESULTS

The survey showed that 37.44% of MHD patients had been vaccinated with the COVID-19 vaccine. Being married was associated with COVID-19 vaccination in patients with MHD (odds ratio [OR] = 1.969 95% CI 0 .870 ~ 4.453). MHD patients living in county areas have higher rates of COVID-19 vaccination (OR = 0.572 95% CI 0.301 ~ 1.087). Family /relatives/friends who are healthcare workers are associated with COVID-19 vaccination for MHD patients (OR = 1.840 95% CI 1.140 ~ 2.970). Other vaccination history within 5 years was a factor in COVID-19 vaccination for MHD patients (OR = 5.592 95% CI 2.997 ~ 10.434). Attitude (OR = 0.885 95% CI 0.808 ~ 0.905), and practice (OR = 0.756 95% CI 0.697 ~ 0.819) scores on the COVID-19 vaccination knowledge and practice questionnaire were related to the vaccination status of MHD patients.

CONCLUSIONS

MHD patients had lower rates of COVID-19 vaccination. Marital status, living environment, whether family/relatives/friends were medical workers, and the score of the COVID-19 vaccine knowledge and practice questionnaire were the factors influencing their vaccination status. Clinical attention should be given to the adverse reactions of COVID-19 vaccination in MHD patients to improve the awareness of primary medical staff on hemodialysis, and families and society should pay more attention to COVID-19 vaccination in MHD patients.

The Impact and Treatment of COVID-19 in Hemodialysis Patients

BACKGROUND

Patients with coronavirus disease 2019 (COVID-19) undergoing maintenance hemodialysis have a poor prognosis and limited treatment options.

METHODS

This paper outlines the impact of COVID-19, its treatment, and the efficacy of vaccines in Japanese patients undergoing hemodialysis with a review of the literature.

RESULTS

Patients undergoing dialysis in dialysis facilities are at greater risk of exposure to severe acute respiratory syndrome coronavirus 2 than the general population due to limited isolation capabilities. Therefore, vaccines are expected to be effective for patients undergoing dialysis. In addition, effective use of available medications is important because treatment options are limited.

CONCLUSIONS

Efforts should be made to prevent the spread of the infection to high-risk patients undergoing dialysis while ensuring the effective use of vaccines.

Efficacy of SARS-CoV-2 Vaccination in Dialysis Patients: Epidemiological Analysis and Evaluation of the Clinical Progress

This study investigated the impact of the fourth COVID-19 pandemic wave on dialysis patients of Romagna territory, assessing the associations of vaccination status with infection risk, clinical severity and mortality. From November 2021 to February 2022, an epidemiological search was conducted on 829 patients under dialysis treatment for at least one month. The data were then analyzed with reference to the general population of the same area. A temporal comparison was also carried out with the previous pandemic waves (from March 2020 to October 2021). The epidemiological evolution over time in the dialysis population and in Romagna citizens replicated the global trend, as the peak of the fourth wave corresponded to the time of maximum diffusion of omicron variant (B.1.1.529). Of 771 prevalent dialysis patients at the beginning of the study, 109 (14.1%) contracted SARS-CoV-2 infection during the 4-month observation period. Vaccine adherence in the dialysis population of the reference area was above 95%. Compared to fully or partially vaccinated subjects, the unvaccinated ones showed a significantly higher proportion of infections (12.5% vs. 27.0% p = 0.0341), a more frequent need for hospitalization (22.2% vs. 50.0%) and a 3.3-fold increased mortality risk. These findings confirm the effectiveness of COVID-19 vaccines in keeping infectious risk under control and ameliorating clinical outcomes in immunocompromised patients.

Takotsubo cardiomyopathy after vaccination for coronavirus disease 2019 in a patient on maintenance hemodialysis

Coronavirus disease-2019 (COVID-19) has affected more than 220 million individuals since the global pandemic began. There is an urgent need for safe and effective vaccines, and vaccinations, such as mRNA vaccines, have been initiated worldwide. However, the adverse effects of these vaccines remain unclear. We herein present a case of an 80-year-old female on maintenance hemodialysis who developed takotsubo cardiomyopathy 4 days after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine. There was no obvious trigger for the onset of takotsubo cardiomyopathy other than the COVID-19 vaccination, which was the most significant event preceding her presentation. Echocardiograms obtained during her admission allowed us to monitor and show the recovery of left ventricular wall motion. We confirmed the diagnosis of takotsubo cardiomyopathy based on the findings, including transient left ventricular dysfunction, electrocardiographic abnormalities, an elevated troponin level, and the absence of occlusive coronary artery disease. In the present case, the vaccination may have triggered emotional or physical stress. Although difficulties are associated with proving the causal relationship in the present case, the temporal relationship between the vaccination and the onset of takotsubo cardiomyopathy is highly suggestive. The adverse effects associated with the vaccine are typical of COVID-19 vaccines administered to date, most of which are acceptable. Therefore, despite our experience of the present case, we still recommend the vaccination for COVID-19 because takotsubo cardiomyopathy induced by the COVID-19 vaccine is extremely rare and the prognosis of the patient was good. We herein present the first case of a patient on hemodialysis who developed takotsubo cardiomyopathy after receiving COVID-19 vaccination.

COVID-19 Vaccine Efficacy and Immunogenicity in End-Stage Renal Disease Patients and Kidney Transplant Recipients

Purpose of Review

To summarize the current literature with respect to COVID-19 vaccine efficacy patients with end-stage renal disease on dialysis and kidney transplant recipients.

Recent Findings

Immunosuppressed patients are at greater risk of morbidity and mortality from COVID-19 infection. Patients with ESRD and KTR are immunosuppressed and mount a weaker antibody response to COVID-19 mRNA vaccination, and factors including immunosuppressant medications have been implicated for this weakened response. Third and fourth doses of vaccine doses have been shown to increase seropositivity and antibody production in kidney transplant recipients and patients on dialysis. Retrospective studies have demonstrated decreased mortality in vaccinated, immunosuppressed patients.

Summary

ESRD and KTR patients have decreased antibody response to COVID-19 vaccines, but third and fourth doses have been shown to increase antibody production. Though a correlate of protection between antibody production and efficacy has yet to be fully established in this subset of the population, all US professional bodies who treat ESRD and KTR patients advocate for full vaccination against SARS-CoV-2 based on the data available. Studies demonstrating decreased mortality in vaccinated patients are promising on efficacy. Importantly, because KTR patients mount a weaker antibody response than ESRD patients, vaccination prior to kidney transplantation is critical.

Vaccine Effectiveness Against SARS-CoV-2 Infection and Severe Outcomes in the Maintenance Dialysis Population in Ontario, Canada

BACKGROUND

Vaccination studies in the hemodialysis population have demonstrated decreased antibody response compared with healthy controls, but vaccine effectiveness for preventing SARS-CoV-2 infection and severe disease is undetermined.

METHODS

We conducted a retrospective cohort study in the province of Ontario, Canada, between December 21, 2020, and June 30, 2021. Receipt of vaccine, SARS-CoV-2 infection, and related severe outcomes (hospitalization or death) were determined from provincial health administrative data. Receipt of one and two doses of vaccine were modeled in a time-varying cause-specific Cox proportional hazards model, adjusting for baseline characteristics, background community infection rates, and censoring for non-COVID death, recovered kidney function, transfer out of province, solid organ transplant, and withdrawal from dialysis.

RESULTS

Among 13,759 individuals receiving maintenance dialysis, 2403 (17%) were unvaccinated and 11,356 (83%) had received at least one dose by June 30, 2021. Vaccine types were BNT162b2 (n=8455, 74%) and mRNA-1273 (n=2901, 26%); median time between the first and second dose was 36 days (IQR 28-51). The adjusted hazard ratio (HR) for SARS-CoV-2 infection and severe outcomes for one dose compared with unvaccinated was 0.59 (95% CI, 0.46 to 0.76) and 0.54 (95% CI, 0.37 to 0.77), respectively, and for two doses compared with unvaccinated was 0.31 (95% CI, 0.22 to 0.42) and 0.17 (95% CI, 0.1 to 0.3), respectively. There were no significant differences in vaccine effectiveness among age groups, dialysis modality, or vaccine type.

CONCLUSIONS

COVID-19 vaccination is effective in the dialysis population to prevent SARS-CoV-2 infection and severe outcomes, despite concerns about suboptimal antibody responses.