COVID-19 Vaccination and Kidney Disease: SARS-CoV-2 Vaccine Effect on Risk of Infection and Subsequent Outcomes in Patients with Chronic Kidney Disease

BACKGROUND: Benefit of SARS-CoV-2 vaccinations to reduce the risk of infection and subsequent outcomes in patients with impaired kidney function beyond end-stage kidney disease (ESKD) remains uncertain.

OBJECTIVES: To evaluate the vaccination effect on rates of SARS-CoV-2 infection and subsequent risk of 30-day mortality outcomes in patients with kidney disease.

METHODS: Population-based retrospective cohort on nationwide data from multiple national health care registers between February 2021 and June 2022. All vaccine uptake and efficacy were evaluated in granular eGFR categories with comparison of age- and gender-standardized rates of SARS-CoV-2 infection and subsequent risks of 30-day mortality between unvaccinated, vaccinated, and booster-vaccinated persons.

RESULTS: Based on a population of 982,047 adults with kidney disease, a total of 359,428 SARS-CoV-2 infections (Alpha: n = 7861, Delta: n = 27,868, Omicron: n = 323,699) were identified. Vaccination and booster vaccination were associated with benefits on rates of SARS-CoV-2 infection and subsequent 30-day mortality, with age- and gender-standardized rate ratios for SARS-CoV-2 infection of 0.24 (95% CI 0.21-0.28), 0.33 (95% CI 0.22-0.50), 0.32 (95% CI 0.19-0.54), 0.91 (95% CI 0.32-2.58), and 0.24 (95% CI 0.08-0.73) and age- and gender-standardized 30-day mortality differences of -1.5 (95% CI -1.7, -1.2), -5.8 (95% CI -7.1, -4.5), -12.4 (95% CI -15.3, -9.5), -16.9 (95% CI -21.9, -11.8), and -10.7 (95% CI -16.6, -4.8) for booster vaccinations compared with no vaccination for eGFR ≥ 60 mL/min/1.73 m2, 45-59 mL/min/1.73 m2, 30-44 mL/min/1.73 m2, and < 30 mL/min/1.73 m2 and dialysis, respectively.

CONCLUSIONS: Vaccination and booster vaccination against SARS-CoV-2 were associated with benefits on rates of SARS-CoV-2 infections and associated 30-day mortality risk irrespective of kidney function.