Abstract: SA-OR07
SARS-CoV-2 Vaccine Impact on COVID-19 Incidence in Maintenance Dialysis Patients
Session Information
- COVID-19 and Kidney Diseases: From Bedside to Bench
November 06, 2021 | Location: Simulive, Virtual Only
Abstract Time: 04:30 PM - 06:00 PM
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-19 | new COVID-19/10,000 Pt-Days | Odds Ratio |
| Unvaccinated | 3891 | 666,922 | 230 | 3.4 | 10.4 (6.9,18.2) |
| Partially Vaccinated | 1112 | 366,775 | 84 | 2.3 | 6.9 (3.9,12.4) |
| Fully Vaccinated | 8714 | 392,490 | 13 | 0.3 | Reference |
* Mutually exclusive status at the end of follow-up (may have contributed time at-risk in other statuses).