Increased risk of COVID-19 hospitalization and death in vaccinated patients with end-stage renal disease and dialysis: initial results from INFORM, a retrospective health database observational study in England

Presenter: Sabade Dube, PhD, director of epidemiology in the Vaccines and Immune Therapies unit, AstraZeneca, Cambridge, United Kingdom.

BOSTON 13 OCTOBER 2023—Compared with the overall population, patients with end-stage kidney disease are at increased risk and have higher rates of severe COVID-19 outcomes despite 3 or more vaccinations, according to Sabade Dube, PhD, director of epidemiology in the Vaccines and Immune Therapies unit, AstraZeneca, Cambridge, United Kingdom.

COVID-19 hospitalizations and deaths have decreased in the general population during the Omicron era, yet COVID-19 remains a major cause of severe disease for immunocompromised individuals.1 Despite vaccination, people with immunocompromising conditions have higher risks of COVID-19 morbidity and death. Even though patients with end-stage kidney disease are considered to be immunocompromised and have a weaker antibody response to COVID-19 vaccination,2 preexposure prophylaxis is not currently recommended in some guidelines,3 Dube stated, because boosters are believed to increase seropositivity and antibody production in those receiving dialysis.

The overarching aim of the INFORM study (Investigation of COVID-19 Risk Among Immunocompromised Populations)4 was to comprehensively assess COVID-19 impact, risk, and cost among immunocompromised and other high-risk populations since the start of the pandemic in England using National Health Service databases. Dube reported initial INFORM results between January 1, 2022 and December 31, 2022. Only outcomes with COVID-19 recorded as the primary diagnosis were included.

In a large random sample of the UK population, about 0.2% of people had end-stage kidney disease, yet this group accounted for 2.8% of all COVID-19 hospitalizations. The adjusted incidence rate ratio was 3.83 for patients with end-stage kidney disease compared with the overall population; excluding kidney transplant recipients, it was 3.07. Similarly, patients with end-stage kidney disease accounted for 3.0% of all COVID-19 deaths, with an incidence rate ratio of 3.81 (3.24 after excluding kidney transplant recipients).

Dube noted further that people with end-stage kidney disease, compared with the overall population, were more likely to have multiple comorbidities and to have received 3 or more COVID-19 vaccine doses. Nevertheless, 72.9% of the hospitalized patients with end-stage kidney disease had received 3 or more vaccine doses, as did 69.0% of patients with end-stage kidney disease who died.

Immunocompromised patients, said Dube, mount inadequate responses to COVID-19 vaccination. In the INFORM study, despite vaccination, populations with end-stage kidney disease had higher rates of severe COVID-19 outcomes compared with the overall population. The risk was particularly elevated for those on dialysis, Dube said.

“The key message,” Dube concluded, “is that these results from INFORM suggest that individuals with end-stage kidney disease should be included as a high-priority group in recommendations for COVID-19 interventions additional to vaccination.”

Disclosure. Dr. Dube disclosed being an employee of AstraZeneca and may hold AstraZeneca stock.

References

  1. Bahremand T, Yao JA, Mill C, Piszczek J, Grant JM, Smolina K. COVID-19 hospitalisations in immunocompromised individuals in the Omicron era: a population-based observational study using surveillance data in British Columbia, Canada. Lancet Reg Health Am 2023; 20:100461. doi:10.1016/j.lana.2023.100461
  2. Moreno NF, McAdams R, Goss JA, Galvan NTN. COVID-19 Vaccine efficacy and immunogenicity in end-stage renal disease patients and kidney transplant recipients. Curr Transplant Rep 2022; 9(3):174–184. doi:10.1007/s40472-022-00366-1
  3. Joint Committee on Vaccination and Immunisation (JCVI). Joint Committee on Vaccination and Immunisation (JCVI) advice on third primary dose vaccination. UK Department of Health & Social Care, September 1, 2021. https://www.gov.uk/government/publications/third-primary-covid-19-vaccine-dose-for-people-who-are-immunosuppressed-jcvi-advice/joint-committee-on-vaccination-and-immunisation-jcvi-advice-on-third-primary-dose-vaccination. Accessed October 19, 2023
  4. Evans RA, Dube S, Lu Y, et al. Impact of COVID-19 on immunocompromised populations during the Omicron era: insights from the observational population-based INFORM study. Lancet Reg Health Eur 2023. In press. https://doi.org/10.1016/j.lanepe.2023.100747. Accessed October 19, 2023.

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