COVID-19 Vaccination Among Patients Receiving Maintenance Renal Replacement Therapy: Immune Response, Real-World Effectiveness, and Implications for the Future

Chronic kidney disease affects more than 800 million people worldwide and often progresses to end-stage renal disease, which requires maintenance dialysis. Patients receiving dialysis are at higher risk for severe respiratory infections, including SARS-CoV-2 (the causative agent of COVID-19). In addition, many patients who receive dialysis also receive immunosuppressive treatments for conditions such as systemic vasculitis, systemic lupus erythematosus, or malignancies. Many studies have shown that while mRNA COVID-19 vaccines induce some level of immune response in patients receiving dialysis, the magnitude of response is often lower than that of healthy individuals, and responses rapidly wane. Importantly, the risk of COVID-19-related hospitalization and mortality for patients receiving dialysis is 4- to 8-fold higher compared with the general population. In this article, we summarize recent immunogenicity and real-world outcomes of COVID-19 mRNA vaccination among patients receiving dialysis, with a focus on the 3-dose extended primary series and additional (fourth) doses.

Automated summary

Chronic kidney disease affects over 800 million people globally and can lead to end-stage renal disease necessitating maintenance dialysis. Dialysis patients have an increased risk for serious respiratory infections, including COVID-19. Studies have shown that mRNA COVID-19 vaccines elicit immune responses in dialysis patients, although the response is often attenuated and wanes quickly. Furthermore, dialysis patients have a significantly higher risk of COVID-19 hospitalization and mortality compared to the general population. This article reviews the immunogenicity and real-world outcomes of COVID-19 mRNA vaccination in dialysis patients, focusing on the extended primary series and additional doses.