Effectiveness of COVID-19 vaccines in a large European hemodialysis cohort

Ana Paula Bernardo; Paola Carioni; Stefano Stuard; Peter Kotanko; Len A Usvyat; Vratislava Kovarova; Otto Arkossy; Francesco Bellocchio; Antonio Tupputi; Federica Gervasoni; Anke Winter; Yan Zhang; Hanjie Zhang; Pedro Ponce; Luca Neri

doi:10.3389/fneph.2022.1037754

Effectiveness of COVID-19 vaccines in a large European hemodialysis cohort

Front Nephrol. 2022 Nov 15:2:1037754. doi: 10.3389/fneph.2022.1037754. eCollection 2022.

Authors

Ana Paula Bernardo^{1

2}, Paola Carioni³, Stefano Stuard⁴, Peter Kotanko^{5

6}, Len A Usvyat⁷, Vratislava Kovarova⁴, Otto Arkossy⁴, Francesco Bellocchio³, Antonio Tupputi³, Federica Gervasoni³, Anke Winter⁴, Yan Zhang⁴, Hanjie Zhang⁵, Pedro Ponce⁸, Luca Neri³

Affiliations

¹ Fresenius Medical Care Portugal / Nephrocare Portugal, Vila Nova de Gaia, Portugal.
² Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), Porto University, Oporto, Portugal.
³ Fresenius Medical Care Italia SpA, Palazzo Pignano, Italy.
⁴ Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
⁵ Renal Research Institute, New York, NY, United States.
⁶ Icahn School of Medicine at Mount Sinai, New York, NY, United States.
⁷ Fresenius Medical Care, Waltham, MA, United States.
⁸ Fresenius Medical Care Portugal / Nephrocare Portugal, Lisboa, Portugal.

Abstract

Background: Hemodialysis patients have high-risk of severe SARS-CoV-2 infection but were unrepresented in randomized controlled trials evaluating the safety and efficacy of COVID-19 vaccines. We estimated the real-world effectiveness of COVID-19 vaccines in a large international cohort of hemodialysis patients.

Methods: In this historical, 1:1 matched cohort study, we included adult hemodialysis patients receiving treatment from December 1, 2020, to May 31, 2021. For each vaccinated patient, an unvaccinated control was selected among patients registered in the same country and attending a dialysis session around the first vaccination date. Matching was based on demographics, clinical characteristics, past COVID-19 infections and a risk score representing the local background risk of infection at vaccination dates. We estimated the effectiveness of mRNA and viral-carrier COVID-19 vaccines in preventing infection and mortality rates from a time-dependent Cox regression stratified by country.

Results: In the effectiveness analysis concerning mRNA vaccines, we observed 850 SARS-CoV-2 infections and 201 COVID-19 related deaths among the 28110 patients during a mean follow up of 44 ± 40 days. In the effectiveness analysis concerning viral-carrier vaccines, we observed 297 SARS-CoV-2 infections and 64 COVID-19 related deaths among 12888 patients during a mean follow up of 48 ± 32 days. We observed 18.5/100-patient-year and 8.5/100-patient-year fewer infections and 5.4/100-patient-year and 5.2/100-patient-year fewer COVID-19 related deaths among patients vaccinated with mRNA and viral-carrier vaccines respectively, compared to matched unvaccinated controls. Estimated vaccine effectiveness at days 15, 30, 60 and 90 after the first dose of a mRNA vaccine was: for infection, 41.3%, 54.5%, 72.6% and 83.5% and, for death, 33.1%, 55.4%, 80.1% and 91.2%. Estimated vaccine effectiveness after the first dose of a viral-carrier vaccine was: for infection, 38.3% without increasing over time and, for death, 56.6%, 75.3%, 92.0% and 97.4%.

Conclusion: In this large, real-world cohort of hemodialyzed patients, mRNA and viral-carrier COVID-19 vaccines were associated with reduced COVID-19 related mortality. Additionally, we observed a strong reduction of SARS-CoV-2 infection in hemodialysis patients receiving mRNA vaccines.

Keywords: COVID-19; SARS-CoV-2; effectiveness; hemodialysis; mRNA vaccines; viral-carrier vaccines.