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Abstract: SA-OR07

SARS-CoV-2 Vaccine Impact on COVID-19 Incidence in Maintenance Dialysis Patients

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Lacson, Eduardo K., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Manley, Harold J., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Aweh, Gideon N., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Ladik, Vladimir, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Frament, Jill M., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Hsu, Caroline M., Tufts Medical Center, Boston, Massachusetts, United States
  • Miskulin, Dana, Tufts Medical Center, Boston, Massachusetts, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Johnson, Doug, Dialysis Clinic Inc, Nashville, Tennessee, United States
Background

Maintenance dialysis patients are highly susceptible to SARS-CoV-2 and historically, when infected, >60% need emergency department or hospital care and mortality approaches 20% in 90 days. We evaluated the impact of vaccination against SARS-CoV-2 on incident COVID-19 cases in dialysis patients from 260 clinics in 28 states.

Methods

All adult maintenance dialysis patients without prior COVID-19 treated by Dialysis Clinic, Inc. who received one dose of vaccine were classified as “partially vaccinated” and at 14+ days after completing the manufacturer recommended series were classified as “fully vaccinated”; else were “unvaccinated”. During the study period from 2/1/21 to 5/19/21, all new test-confirmed COVID-19 cases were documented. Every day at-risk for each patient was assigned to vaccination status and contributed to the denominator. Case rates per 10,000 days at-risk were compared using logistic regression.

Results

Among 13,717 eligible patients contributing 1,426,187 days at-risk, 327 new COVID-19 occurred. Only 4% were in fully vaccinated patients, with 25% in partially vaccinated and 70% in unvaccinated patients. Unvaccinated patients had 10-fold higher risk of COVID-19 than fully vaccinated patients (Table). Only 3 of 13 (23%) breakthrough cases were symptomatic, and 1 of 13 (8%) was hospitalized for COVID-19 with no deaths due to COVID-19. In contrast, 67 (29%) of unvaccinated and 34 (40%) of partially vaccinated patients were hospitalized for COVID-19, with 6 and 2 deaths, respectively.

Conclusion

Overall incidence of COVID-19 declined compared to rates prior to the study period. Regardless, there is marked risk reduction of incident COVID-19 for SARS-CoV-2 vaccinated maintenance dialysis patients, and most breakthrough infections were asymptomatic in fully vaccinated patients. These preliminary results support aggressive vaccination and a plan for maintenance of immunity to alleviate the devastating COVID-19 toll for dialysis patients.

COVID-19 Incidence from 2/1/21 to 5/19/21
Status# Unique Patients*Patient-Days at-Risk# New COVID-19new COVID-19/10,000 Pt-DaysOdds Ratio
Unvaccinated3891666,9222303.410.4 (6.9,18.2)
Partially Vaccinated1112366,775842.36.9 (3.9,12.4)
Fully Vaccinated8714392,490130.3Reference

* Mutually exclusive status at the end of follow-up (may have contributed time at-risk in other statuses).