Ma Becky Mingyao, Tam Anthony Raymond, Chan Kam Wa, Ma Maggie Kam Man, Hung Ivan Fan Ngai, Yap Desmond Yat Hin, Chan Tak Mao
Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Division of Infectious Diseases, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Front Med (Lausanne). 2022 Mar 9;9:827859. doi: 10.3389/fmed.2022.827859. eCollection 2022.
Systematic data on the efficacy and safety of COVID-19 vaccine in patients on renal replacement therapy (RRT) remains limited. We conducted a meta-analysis on the efficacy and safety of COVID-19 vaccine in patients on RRT.
Eligible studies were identified by systematic literature search in four electronic databases. Twenty-seven studies (4,264 patients) were included for meta-analysis. 99% patients received mRNA vaccine.
Patients on RRT showed inferior seropositivity after two-dosed COVID-19 vaccine, 44% lower than the general population. Kidney transplant recipients (KTRs) had significantly lower seropositivity than patients on haemodialysis (HD) or peritoneal dialysis (PD) (26.1 vs. 84.3% and 92.4% respectively, < 0.001 for both). Compared with healthy controls, KTRs, HD and PD patients were 80% (95% CI: 62-99%), 18% (95% CI: 9-27%) and 11% (95% CI: 1-21%) less likely to develop antibodies after vaccination ( < 0.001, <0.001 and 0.39 respectively). In KTRs, every 1% increase in using mycophenolate was associated with 0.92% reduction in seropositivity (95% CI: -1.68, -0.17, = 0.021) at population level. The overall adverse event rate attributed to vaccination was 2.1%. Most events were mild.
Patients on RRT, particularly KTRs, had significantly reduced antibody response after two-dosed COVID-19 vaccination. Vaccination is generally well tolerated.
https://www.crd.york.ac.uk/prospero/, identifier: CRD42021261879.
关于新冠病毒疫苗在接受肾脏替代治疗（RRT）患者中的疗效和安全性的系统性数据仍然有限。我们对新冠病毒疫苗在接受RRT患者中的疗效和安全性进行了一项荟萃分析。
通过在四个电子数据库中进行系统性文献检索来确定符合条件的研究。纳入27项研究（4264例患者）进行荟萃分析。99%的患者接种了mRNA疫苗。
接受RRT的患者在接种两剂新冠病毒疫苗后血清阳性率较低，比普通人群低44%。肾移植受者（KTRs）的血清阳性率显著低于血液透析（HD）或腹膜透析（PD）患者（分别为26.1%对84.3%和92.4%，两者均P<0.001）。与健康对照相比，KTRs、HD和PD患者接种疫苗后产生抗体的可能性分别低80%（95%CI：62-99%）、18%（95%CI：9-27%）和11%（95%CI：1-21%）（分别为P<0.001、P<0.001和P = 0.39）。在KTRs中，在群体水平上，霉酚酸酯使用量每增加1%，血清阳性率降低0.92%（95%CI：-1.68，-0.17，P = 0.021）。归因于疫苗接种的总体不良事件发生率为2.1%。大多数事件为轻度。
接受RRT的患者，尤其是KTRs，在接种两剂新冠病毒疫苗后抗体反应显著降低。疫苗接种总体耐受性良好。
