Damien R Ashby1,2, Ben Caplin3, Richard W Corbett4, Elham Asgari5, Nicola Kumar5, Alexander Sarnowski6, Richard Hull6, David Makanjuola7, Nicholas Cole7, Jian Chen8, Sofia Nyberg8, Kieran McCafferty8, Faryal Zaman9, Hugh Cairns9, Claire Sharpe9, Kate Bramham9, Reza Motallebzadeh10, Kashif Jamil Anwari10, Alan D Salama3, Debasish Banerjee. 1. Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom damien.ashby@nhs.net. 2. Department of Immunology and Inflammation, Imperial College London, London, United Kingdom. 3. Department of Renal Medicine, University College London, London, United Kingdom. 4. Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom. 5. Kidney Services, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. 6. Renal and Transplantation, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom. 7. South West Thames Renal and Transplantation Unit, Epsom and St. Helier University Hospitals NHS Trust, London, United Kingdom. 8. Renal Service, Barts Health NHS Trust, London, United Kingdom. 9. Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom. 10. Renal Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom.
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.
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.
Authors: Hana M El Sahly; Lindsey R Baden; Brandon Essink; Susanne Doblecki-Lewis; Judith M Martin; Evan J Anderson; Thomas B Campbell; Jesse Clark; Lisa A Jackson; Carl J Fichtenbaum; Marcus Zervos; Bruce Rankin; Frank Eder; Gregory Feldman; Christina Kennelly; Laurie Han-Conrad; Michael Levin; Kathleen M Neuzil; Lawrence Corey; Peter Gilbert; Holly Janes; Dean Follmann; Mary Marovich; Laura Polakowski; John R Mascola; Julie E Ledgerwood; Barney S Graham; Allison August; Heather Clouting; Weiping Deng; Shu Han; Brett Leav; Deb Manzo; Rolando Pajon; Florian Schödel; Joanne E Tomassini; Honghong Zhou; Jacqueline Miller Journal: N Engl J Med Date: 2021-09-22 Impact factor: 176.079
Authors: Candice L Clarke; Maria Prendecki; Amrita Dhutia; Jaslyn Gan; Claire Edwards; Virginia Prout; Liz Lightstone; Eleanor Parker; Federica Marchesin; Megan Griffith; Rawya Charif; Graham Pickard; Alison Cox; Myra McClure; Richard Tedder; Paul Randell; Louise Greathead; Mary Guckian; Stephen P McAdoo; Peter Kelleher; Michelle Willicombe Journal: Kidney Int Date: 2021-03-25 Impact factor: 10.612
Authors: Ann R Falsey; Magdalena E Sobieszczyk; Ian Hirsch; Stephanie Sproule; Merlin L Robb; Lawrence Corey; Kathleen M Neuzil; William Hahn; Julie Hunt; Mark J Mulligan; Charlene McEvoy; Edwin DeJesus; Michael Hassman; Susan J Little; Barbara A Pahud; Anna Durbin; Paul Pickrell; Eric S Daar; Larry Bush; Joel Solis; Quito Osuna Carr; Temitope Oyedele; Susan Buchbinder; Jessica Cowden; Sergio L Vargas; Alfredo Guerreros Benavides; Robert Call; Michael C Keefer; Beth D Kirkpatrick; John Pullman; Tina Tong; Margaret Brewinski Isaacs; David Benkeser; Holly E Janes; Martha C Nason; Justin A Green; Elizabeth J Kelly; Jill Maaske; Nancy Mueller; Kathryn Shoemaker; Therese Takas; Richard P Marshall; Menelas N Pangalos; Tonya Villafana; Antonio Gonzalez-Lopez Journal: N Engl J Med Date: 2021-09-29 Impact factor: 176.079
Authors: Eduardo Lacson; Christos P Argyropoulos; Harold J Manley; Gideon Aweh; Andrew I Chin; Loay H Salman; Caroline M Hsu; Doug S Johnson; Daniel E Weiner Journal: J Am Soc Nephrol Date: 2021-08-04 Impact factor: 10.121
Authors: Ben Caplin; Damien Ashby; Kieran McCafferty; Richard Hull; Elham Asgari; Martin L Ford; Nicholas Cole; Marilina Antonelou; Sarah A Blakey; Vinay Srinivasa; Dandisonba C B Braide-Azikwe; Tayeba Roper; Grace Clark; Helen Cronin; Nathan J Hayes; Bethia Manson; Alexander Sarnowski; Richard Corbett; Kate Bramham; Eirini Lioudaki; Nicola Kumar; Andrew Frankel; David Makanjuola; Claire C Sharpe; Debasish Banerjee; Alan D Salama Journal: Clin J Am Soc Nephrol Date: 2021-06-01 Impact factor: 10.614
Authors: Damien R Ashby; Ben Caplin; Richard W Corbett; Elham Asgari; Nicola Kumar; Alexander Sarnowski; Richard Hull; David Makanjuola; Nicholas Cole; Jian Chen; Sofia Nyberg; Suzanne Forbes; Kieran McCafferty; Faryal Zaman; Hugh Cairns; Claire Sharpe; Kate Bramham; Reza Motallebzadeh; Kashif Anwari; Tayeba Roper; Alan D Salama; Debasish Banerjee Journal: Nephrol Dial Transplant Date: 2022-09-22 Impact factor: 7.186