Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Department of Immunology and Inflammation, Imperial College London, London, United Kingdom.
Clin J Am Soc Nephrol. 2022 Jun;17(6):843-850. doi: 10.2215/CJN.16621221.
Patients receiving hemodialysis are at high risk from coronavirus disease 2019 (COVID-19) and demonstrate impaired immune responses to vaccines. There have been several descriptions of their immunologic responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, but few studies have described the clinical efficacy of vaccination in patients on hemodialysis.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a multicenter observational study of the London hemodialysis population undergoing surveillance PCR testing during the period of vaccine rollout with BNT162b2 and AZD1222, all of those positive for SARS-CoV-2 were identified. Clinical outcomes were analyzed according to predictor variables, including vaccination status, using a mixed effects logistic regression model. Risk of infection was analyzed in a subgroup of the base population using a Cox proportional hazards model with vaccination status as a time-varying covariate.
SARS-CoV-2 infection was identified in 1323 patients of different ethnicities (Asian/other, 30%; Black, 38%; and White, 32%), including 1047 (79%) unvaccinated, 86 (7%) after first-dose vaccination, and 190 (14%) after second-dose vaccination. The majority of patients had a mild course; however, 515 (39%) were hospitalized, and 172 (13%) died. Older age, diabetes, and immune suppression were associated with greater illness severity. In regression models adjusted for age, comorbidity, and time period, prior two-dose vaccination was associated with a 75% (95% confidence interval, 56 to 86) lower risk of admission and 88% (95% confidence interval, 70 to 95) fewer deaths compared with unvaccinated patients. No loss of protection was seen in patients over 65 years or with increasing time since vaccination, and no difference was seen between vaccine types.
These data demonstrate a substantially lower risk of severe COVID-19 after vaccination in patients on dialysis who become infected with SARS-CoV-2.
接受血液透析的患者感染 2019 年冠状病毒病（COVID-19）的风险较高，并且对疫苗的免疫反应受损。已经有几项关于他们对严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）疫苗免疫反应的描述，但很少有研究描述透析患者接种疫苗的临床疗效。
设计、设置、参与者和测量方法：在一项对伦敦血液透析人群的多中心观察性研究中，在疫苗推出期间使用 BNT162b2 和 AZD1222 进行监测 PCR 检测，所有 SARS-CoV-2 阳性者均被识别。根据预测变量（包括接种状态）分析临床结局，使用混合效应逻辑回归模型。使用 Cox 比例风险模型，将接种状态作为时变协变量，在基础人群的亚组中分析感染风险。
在不同种族（亚洲/其他，30%；黑人，38%；白人，32%）的 1323 名患者中发现了 SARS-CoV-2 感染，其中 1047 名（79%）未接种疫苗，86 名（7%）接种了第一剂疫苗，190 名（14%）接种了第二剂疫苗。大多数患者病情较轻；然而，515 名（39%）住院，172 名（13%）死亡。年龄较大、糖尿病和免疫抑制与更严重的疾病严重程度相关。在调整年龄、合并症和时间段的回归模型中，与未接种疫苗的患者相比，两剂疫苗接种可降低 75%（95%置信区间，56 至 86）的住院风险和 88%（95%置信区间，70 至 95）的死亡率。在 65 岁以上的患者或随着接种时间的延长，没有发现保护作用的丧失，两种疫苗类型之间也没有差异。
这些数据表明，在感染 SARS-CoV-2 的透析患者中，接种疫苗后 COVID-19 严重程度的风险显著降低。
