Mortality and hospitalization impact of covid vaccination on dialysis patient in latin america

Abstract BACKGROUND AND AIMS COVID-19 vaccination had showed high efficacy in general population. Given patients with kidney failure are at higher risk for death and hospitalization, it is important to understand efficacy of vaccines within this group. Our aim was to analyze the impact of COVID-19 vaccination in mortality and hospitalization for a large dialysis population from Fresenius Medical Care Latin America (FME LatAm). METHOD Patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) in FME LatAm centers at any time between December 2020 and June 2021 were included. They were classified according to their vaccination status in June 2021 as Not Vaccinated (NV, patients who did not receive any dose), Incompleted Vaccinated (IV, incomplete dosing according to label) or Complete Vaccinated (CV, full scheme dosing according to label). Patient's risk started at December 2020 for NV or 15 days after last dose for IV and CV. Risk finished at death, hospitalization, lost to follow-up or end of the study. All-cause hospitalization and mortality rates were analyzed between groups during the observation period. Kaplan–Meier (KM) was used for univariate analysis while Cox regression models were constructed to control for several confounders. Values are expressed as mean ± SD. RESULTS A total of 41 728 patients from 257 centres in 6 countries (Argentina, Brazil, Chile, Colombia, Ecuador and Perú) were included. As expected, based on selection bias by vaccination policies at early stages of COVID pandemic, patients who received CV were older than IV and NV (CV: 62.5 ± 14.5 years; IV: 57.6 ± 14.8; NV: 54.6 ± 17.3; P < 0.0001). Similarly, prevalence of diabetes was higher in CV (CV: 22.6%; IV: 16%; NV: 16.8%; P < 0.0001). Survival analysis showed a significant difference between groups (log rank test = 115.9 P < 0.005), while hospitalizations showed similar differences (log rank test = 3022 P < 0.005), being patients with CV those with the lowest risk of death or hospitalization events (Figure 1). After adjusting for demographics and laboratory values, Cox regression models showed increased risk of death for NV {HR = 5.42, [95% confidence interval (95% CI): 3.96–7.44]} and IV (HR = 4.32, 95% CI: 3.15–5.91) and increased risk of hospitalization for NV (HR = 18.6, 95% CI: 15.9–21.7) and IV (HR = 1.8, 95% CI: 0.79–1.5) as compared with CV (Table 1). CONCLUSION CV patients showed better survival as compared with IV and NV in univariate models. While CV showed different demographics characteristics, multivariate models still showed, after control for age, gender, diabetic status and main lab values, a 5-fold increase in mortality risk and 18-fold increase in hospitalization risk for NV as compared with CV. All efforts should be focused on vaccinating dialysis population to temper the impact of the disease.