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COVID vaccination especially important for dialysis patients

Clinical Journal of the American Society of Nephrology
Reuters Health -  01/06/2022 - A large observational study from the U.K. highlights the importance of COVID-19 vaccination for patients with kidney failure on hemodialysis.

Vaccinated hemodialysis patients who catch COVID are less apt to suffer severe COVID-19 than unvaccinated counterparts, the analysis found.

"COVID-19 continues to be common in patients on dialysis, causing hospital admissions and death, but fortunately it is milder with two doses of the vaccine," Dr. Debasish Banerjee of St. George's University Hospitals NHS Foundation Trust, in London, said in a news release.

The researchers studied 1,323 SARS-CoV-2-positive hemodialysis patients of different ethnicities (30% Asian/other, 38% Black and 32% white), of whom 79% were unvaccinated, 7% had had their first-dose of vaccine and 190 14% had had two doses of SARS-CoV-2 vaccine.

Most patients had a mild course of COVID-19, but 515 (39%) were hospitalized and 172 (13%) died.

Factors significantly associated with greater COVID-19 severity were older age, diabetes and immune suppression.

In regression models adjusted for age, comorbidity and time period, patients who had two doses of vaccine had a 75% lower risk of hospital admission and an 88% lower risk of dying, compared with unvaccinated peers.

"This suggests a substantial clinical benefit from vaccination in a population that is particularly vulnerable. Some efficacy was seen after a single dose, underlining the importance of early vaccination in vulnerable groups," the study team writes in the Clinical Journal of the American Society of Nephrology.

Additionally, there was no loss of protection against COVID-19 in patients older than 65 years, or with increasing time since vaccination, and no difference between the Pfizer-BioNTech vaccine and the AstraZeneca vaccine.

The authors of a linked editorial note that currently available vaccine-efficacy studies show that COVID-19 vaccines provide "moderate protection against contracting SARS-CoV-2 infection, but the vaccine efficacy for preventing severe outcomes is clinically more important for patients on dialysis because their risk of these events is high."

"Although these encouraging results prove the vaccine efficacy of COVID-19 vaccines for patients on dialysis, there is still much work to be done," write Dr. Matthew Oliver and Dr. Peter Blake with the Ontario Rental Network, Toronto, Canada.

"The COVID-19 pandemic required the chronic kidney disease (CKD) community to react quickly and offer vaccination to patients without high-level evidence of benefit, and this was clearly justified. However, we must look back and carefully evaluate the clinical effect of these decisions," they say.

"The SARS-CoV-2 virus continues to mutate, serology studies show waning, and third and fourth doses of vaccine have been administered to patients. New research is required to determine the VE of COVID-19 vaccines in these new scenarios, including in earlier stages of CKD," the editorialists add.

The study had no funding. Dr. Banerjee has received research funding from AstraZeneca, the British Heart Foundation, ESR AstraZeneca, and Kidney Research UK; and honoraria from AstraZeneca, Pfizer, and Viforpharma.

SOURCE: https://bit.ly/38WhYkH and https://bit.ly/3x3lOAe Clinical Journal of the American Society of Nephrology, online June 1, 2022.

By Reuters Staff

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