Results of the first nationwide cohort study of outcomes in dialysis and kidney transplant patients before and after vaccination for COVID-19.
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Wijkström J, Caldinelli A, Bruchfeld A, Nowak A, Artborg A, Stendahl M, Segelmark M, Lindholm B, Bellocco R, Rydell H, Evans M
Nephrol Dial Transplant - (-) - [2023-07-11; online 2023-07-11]
Patients with kidney replacement therapy (KRT) have been identified as a vulnerable group during the COVID-19 pandemic. This study reports the outcomes of COVID-19 in KRT patients in Sweden, a country where patients on KRT were prioritized early in the vaccination campaign. Patients with KRT between January 2019 and December 2021 in the Swedish Renal Registry were included. Data were linked to national healthcare registries. The primary outcome was monthly all-cause mortality over three-years follow-up. The secondary outcomes were monthly COVID-19 related deaths and hospitalizations. The results were compared with the general population using standardized mortality ratios. The difference in risk for COVID-19 related outcomes between dialysis and kidney transplant recipients was assessed in multivariable logistic regression models before and after vaccinations started. On January 1, 2020, there were 4097 patients on dialysis (median age 70) and 5905 kidney transplant recipients (median age 58). Between March 2020 and February 2021, mean all-cause mortality rates increased by 10% (from 720 to 804 deaths) and 22% (from 158 to 206 deaths) in dialysis and kidney transplant recipients respectively compared with the same period 2019. After vaccinations started, all-cause mortality rates during the third wave (April 2021) returned to pre COVID-19 mortality rates among dialysis patients, while mortality rates remained increased among transplant recipients. Dialysis patients had a higher risk for COVID-19 hospitalizations and death before vaccinations started aOR 2.1 (95% CI 1.7-2.5), but a lower risk after vaccination, aOR 0.5 (95% CI 0.4-0.7) compared to kidney transplant recipients. The COVID-19 pandemic in Sweden resulted in increased mortality and hospitalization rates among KRT patients. After vaccinations started, a distinct reduction in hospitalization and mortality rates was observed among dialysis patients, but not in kidney transplant recipients. Early and prioritized vaccinations of KRT patients in Sweden probably saved many lives.
PubMed 37433606
DOI 10.1093/ndt/gfad151
Crossref 10.1093/ndt/gfad151
pii: 7222920