The Impact of Vaccination on Incidence and Outcomes of SARS-CoV-2 Infection in Patients with Kidney Failure in Scotland

Background Patients with kidney failure requiring KRT are at high risk of complica-tions and death following SARS-CoV-2 infection, with variable antibody responses to vaccination reported. We investigated the effects of COVID-19 vaccination on the incidence of infection, hospitalization, and death from COVID-19 infection.Methods The study design was an observational data linkage cohort study. Multiple health care datasets were linked to ascertain all SARS-CoV-2 testing, vaccination, hospitalization, and mortality data for all patients treated with KRT in Scotland from the start of the pandemic over a period of 20 months. Descriptive statistics, survival analyses, and vaccine effectiveness were calculated.Results As of September 19, 2021, 93% (n55281) of the established KRT popula-tion in Scotland had received two doses of an approved SARS-CoV-2 vaccine. Over the study period, there were 814 cases of SARS-CoV-2 infection (15.1% of the KRT population). Vaccine effectiveness rates against infection and hospitalization were 33% (95% CI, 0 to 52) and 38% (95% CI, 0 to 57), respectively. Within 28 days of a SARS-CoV-2-positive PCR test, 9.2% of fully vaccinated individuals died (7% patients on dialysis and 10% kidney transplant recipients). This compares to ,0.1% of the vaccinated general Scottish population admitted to the hospital or dying due to COVID-19 during that period. Conclusions These data demonstrate that a primary vaccine course of two doses has limited effect on COVID-19 infection and its complications in patients with KRT. Adjunctive strategies to reduce risk of both COVID-19 infection and its complica-tions in this population are urgently required.

Automated summary

The study in Scotland found that 93% of KRT-treated patients had received two doses of an approved COVID-19 vaccine, but the effectiveness of the vaccine against infection and hospitalization was only 33% and 38%, respectively. Fully vaccinated patients had higher mortality rates and additional strategies are urgently needed to reduce the risk of COVID-19 infection and complications in this population.