Real-World Effectiveness and Immunogenicity of BNT162b2 and mRNA-1273 SARS-CoV-2 Vaccines in Patients on Hemodialysis

Patients on hemodialysis have an elevated risk for COVID-19 but were not included in efficacy trials of SARS-CoV-2 vaccines. We conducted a retrospective, observational study to estimate the real-world effectiveness and immunogenicity of two mRNA SARS-CoV-2 vaccines in a large, representative popula...

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Published in:Journal of the American Society of Nephrology 2022-01, Vol.33 (1), p.49-57
Main Authors: Sibbel, Scott, McKeon, Katherine, Luo, Jiacong, Wendt, Karl, Walker, Adam G, Kelley, Tara, Lazar, Rachael, Zywno, Meredith L, Connaire, Jeffrey J, Tentori, Francesca, Young, Amy, Brunelli, Steven M
Format: Article
Language:English
Subjects:
2019-nCoV Vaccine mRNA-1273 - administration & dosage
2019-nCoV Vaccine mRNA-1273 - immunology
Aged
Aged, 80 and over
Antibodies, Viral - blood
BNT162 Vaccine - administration & dosage
BNT162 Vaccine - immunology
COVID-19 - immunology
COVID-19 - prevention & control
Dose-Response Relationship, Immunologic
Female
Humans
Male
Middle Aged
Prospective Studies
Rapid Communications
Renal Dialysis - adverse effects
Retrospective Studies
Risk Factors
SARS-CoV-2 - immunology
Treatment Outcome
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Summary:Patients on hemodialysis have an elevated risk for COVID-19 but were not included in efficacy trials of SARS-CoV-2 vaccines. We conducted a retrospective, observational study to estimate the real-world effectiveness and immunogenicity of two mRNA SARS-CoV-2 vaccines in a large, representative population of adult hemodialysis patients in the United States. In separate, parallel analyses, patients who began a vaccination series with BNT162b2 or mRNA-1273 in January and February 2021 were matched with unvaccinated patients and risk for outcomes were compared for days 1-21, 22-42, and ≥43 after first dose. In a subset of consented patients, blood samples were collected approximately 28 days after the second dose and anti-SARS-CoV-2 immunoglobulin G was measured. A total of 12,169 patients received the BNT162b2 vaccine (matched with 44,377 unvaccinated controls); 23,037 patients received the mRNA-1273 vaccine (matched with 63,243 unvaccinated controls). Compared with controls, vaccinated patients' risk of being diagnosed with COVID-19 postvaccination became progressively lower during the study period (hazard ratio and 95% confidence interval for BNT162b2 was 0.21 [0.13, 0.35] and for mRNA-1273 was 0.27 [0.17, 0.42] for days ≥43). After a COVID-19 diagnosis, vaccinated patients were significantly less likely than unvaccinated patients to be hospitalized (for BNT162b2, 28.0% versus 43.4%; for mRNA-1273, 37.2% versus 45.6%) and significantly less likely to die (for BNT162b2, 4.0% versus 12.1%; for mRNA-1273, 5.6% versus 14.5%). Antibodies were detected in 98.1% (309/315) and 96.0% (308/321) of BNT162b2 and mRNA-1273 patients, respectively. In patients on hemodialysis, vaccination with BNT162b2 or mRNA-1273 was associated with a lower risk of COVID-19 diagnosis and lower risk of hospitalization or death among those diagnosed with COVID-19. SARS-CoV-2 antibodies were detected in nearly all patients after vaccination. These findings support the use of these vaccines in this population.
ISSN:1046-6673
1533-3450
DOI:10.1681/asn.2021060778