학술논문
Severity of COVID-19 after Vaccination among Hemodialysis Patients: An Observational Cohort Study.
Document Type
Academic Journal
Author
Ashby DR; Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.; Department of Immunology and Inflammation, Imperial College London, London, United Kingdom.; Caplin B; Department of Renal Medicine, University College London, London, United Kingdom.; Corbett RW; Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.; Asgari E; Kidney Services, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.; Kumar N; Kidney Services, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.; Sarnowski A; Renal and Transplantation, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.; Hull R; Renal and Transplantation, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.; Makanjuola D; South West Thames Renal and Transplantation Unit, Epsom and St. Helier University Hospitals NHS Trust, London, United Kingdom.; Cole N; South West Thames Renal and Transplantation Unit, Epsom and St. Helier University Hospitals NHS Trust, London, United Kingdom.; Chen J; Renal Service, Barts Health NHS Trust, London, United Kingdom.; Nyberg S; Renal Service, Barts Health NHS Trust, London, United Kingdom.; McCafferty K; Renal Service, Barts Health NHS Trust, London, United Kingdom.; Zaman F; Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom.; Cairns H; Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom.; Sharpe C; Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom.; Bramham K; Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom.; Motallebzadeh R; Renal Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom.; Anwari KJ; Renal Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom.; Salama AD; Department of Renal Medicine, University College London, London, United Kingdom.; Banerjee D; Renal and Transplantation, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.
Source
Publisher: Wolters Kluwer Health Country of Publication: United States NLM ID: 101271570 Publication Model: Print Cited Medium: Internet ISSN: 1555-905X (Electronic) Linking ISSN: 15559041 NLM ISO Abbreviation: Clin J Am Soc Nephrol Subsets: MEDLINE
Subject
Language
English
Abstract
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.
(Copyright © 2022 by the American Society of Nephrology.)
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.
(Copyright © 2022 by the American Society of Nephrology.)