Vaccination and COVID-19 Dynamics in Dialysis Patients

Khalil El Karoui (1, 2) , Maryvonne Hourmant (3) , Carole Ayav (4, 5) , François Glowacki (6, 4, 7) , Cécile Couchoud (4) , Nathanaël Lapidus (8, 9)

1 IMRB - Institut Mondor de Recherche Biomédicale
2 Hôpital Henri Mondor
3 Service de Néphrologie et Immunologie Clinique [CHU de Nantes]
4 Agence de la biomédecine [Saint-Denis la Plaine]
5 Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy
6 Service de Néphrologie et Transplantation rénale [CHRU-lille]
7 CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277
8 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
9 CHU Saint-Antoine [AP-HP]

Background and objectives Dialysis patients have a high mortality risk after coronavirus disease 2019 (COVID-19) and an altered immunologic response to vaccines, but vaccine clinical effectiveness remains unknown in this population. Design, setting, participants, & measurements Using Bayesian multivariable spatiotemporal models, we estimated the association between vaccine exposure and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) severe infections (with hospital admission) in dialysis patients from simultaneous incidence in the general population. For dialysis patients, cases were reported within the French end-stage kidney disease REIN registry from March 11, 2020, to April 29, 2021, and vaccine exposure (first dose) was reported in weekly national surveys since January 2021. Cases in the general population were obtained from the national exhaustive inpatient surveillance system (SI-VIC database), and vaccination coverage (first dose) was obtained from the national surveillance system (VAC-SI database). Results During the first wave, incidence in dialysis patients was approximately proportional to the general population. However, we showed a lower relative incidence for dialysis patients during the second wave (compared with that observed in nondialysis patients), suggesting an effect of prevention measures. Moreover, from the beginning of the vaccination rollout, incidence in dialysis patients was lower compared with predictions based on the first and second waves. Adding vaccination coverages in dialysis and nondialysis patients as predictors allowed the reported cases to be fit correctly (3685 predicted cases, 95% confidence interval, 3552 to 3816, versus 3620 reported). Incidence rate ratios were 0.37 (95% confidence interval, 0.18 to 0.71) for vaccine exposure in dialysis patients and 0.50 (95% confidence interval, 0.40 to 0.61) per 10% higher in vaccination coverage in the same-age general population, meaning that vaccine exposure in dialysis patients and the general population was independently associated with lower hospitalization rate of dialysis patients. Conclusions Our findings suggest that vaccination may yield a protective effect against severe forms of COVID-19 in dialysis patients, despite altered immunologic vaccine responses.

Domaines: Sciences du Vivant [q-bio]

Khalil El Karoui, Maryvonne Hourmant, Carole Ayav, François Glowacki, Cécile Couchoud, et al.. Vaccination and COVID-19 Dynamics in Dialysis Patients. Clinical Journal of the American Society of Nephrology, 2022, 17 (3), pp.395--402. ⟨10.2215/CJN.10300721⟩. ⟨hal-03777518⟩