Tylicki Leszek, Biedunkiewicz Bogdan, Puchalska-Reglińska Ewelina, Gellert Ryszard, Burnier Michel, Wolf Jacek, Dȩbska-Ślizień Alicja
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland.
Dialysis Unit, 7th Naval Hospital in Gdansk, Gdańsk, Poland.
Front Med (Lausanne). 2022 Sep 8;9:937167. doi: 10.3389/fmed.2022.937167. eCollection 2022.
Patients with chronic kidney disease on maintenance hemodialysis (HD) have a very high risk of death in the course of COVID-19. The aim of the study was to assess the effectiveness of COVID-19 vaccination to reduce the incidence of COVID-19 and the fatality rate in HD patients. A retrospective registry-based cohort study was performed in all HD adult patients in the Pomeranian Voivodeship. Vaccinations were carried out from January to April 2021 with mRNA vaccines, either BNT162b2 or mRNA-1273 with two-dose schedule. In the first analysis (2nd pandemic wave), 1,160 unvaccinated patients were included (59.7% males, 25.7% diabetic). In the second analysis (4th pandemic wave), 1,131 (59.4% male, 30.7% diabetic) individuals were included, 1,042 (92.13%) were fully vaccinated. Three hundred and fifteen HD patients (27.2%) were COVID-19 positive during the 2nd wave, and 6.9% (78/1,131) during the 4th wave. Within the fully vaccinated patients of the 4th wave, 60 were COVID-19 positive, 5.8 vs. 20.2% of unvaccinated COVID-19 positive patients in 2nd wave, respectively. COVID-19 incidence rate ratio (IRR) was 0.21 (4th wave-vaccinated vs. 2nd wave-unvaccinated) indicating a 79% reduction. The IRR between vaccinated and unvaccinated patients of the 4th wave was 0.28 in favor of vaccinated patients with 72% reduction. In the 2nd wave, 93 patients died as a result of COVID-19 (fatality rate: 29.5%). The fatality rate of fully vaccinated patients during the 4th wave was 6.7% ( = 0.004), while the fatality rate in the 4th wave within unvaccinated patients accounted for 11.1%. Significant clinical effectiveness of COVID-19 vaccination was demonstrated in a multicenter study in HD patients.
维持性血液透析（HD）的慢性肾脏病患者在感染新型冠状病毒肺炎（COVID-19）过程中有非常高的死亡风险。本研究的目的是评估COVID-19疫苗接种在降低HD患者中COVID-19发病率和死亡率方面的有效性。在波美拉尼亚省所有成年HD患者中进行了一项基于登记的回顾性队列研究。2021年1月至4月使用mRNA疫苗BNT162b2或mRNA-1273按照两剂方案进行疫苗接种。在首次分析（第二波疫情）中，纳入了1160名未接种疫苗的患者（男性占59.7%，糖尿病患者占25.7%）。在第二次分析（第四波疫情）中，纳入了1131名患者（男性占59.4%，糖尿病患者占30.7%），其中1042名（92.13%）完成了全程接种。在第二波疫情期间，315名HD患者（27.2%）COVID-19检测呈阳性，在第四波疫情期间这一比例为6.9%（78/1131）。在第四波疫情中完成全程接种的患者中，有60人COVID-19检测呈阳性，分别占第二波疫情中未接种疫苗的COVID-19阳性患者的5.8%和20.2%。COVID-19发病率比（IRR）为0.21（第四波接种疫苗者与第二波未接种疫苗者相比）表明降低了79%。第四波疫情中接种疫苗者与未接种疫苗者之间的IRR为0.28，表明接种疫苗者降低了72%，更有利于接种疫苗的患者。在第二波疫情中，93名患者死于COVID-19（死亡率：29.5%）。第四波疫情中完成全程接种患者的死亡率为6.7%（P = 0.004），而第四波疫情中未接种疫苗患者的死亡率为11.1%。在HD患者的多中心研究中证明了COVID-19疫苗接种具有显著的临床有效性。
