Effectiveness of Messenger RNA Vaccines against SARS-CoV-2 Infection in Hemodialysis Patients: A Case–Control Study

Patients with end-stage kidney disease (ESKD) are at increased risk for SARS-CoV-2 infection and its complications compared with the general population. Several studies evaluated the effectiveness of COVID-19 vaccines in the dialysis population but showed mixed results. The aim of this study was to determine the effectiveness of COVID-19 mRNA vaccines against confirmed SARS-CoV-2 infection in hemodialysis (HD) patients in the State of Qatar. We included all adult ESKD patients on chronic HD who had at least one SARS-CoV-2 PCR test done after the introduction of the COVID-19 mRNA vaccines on 24 December 2020. Vaccinated patients who were only tested before receiving any dose of their COVID-19 vaccine or within 14 days after receiving the first vaccine dose were excluded from the study. We used a test-negative case–control design to determine the effectiveness of the COVID-19 vaccination. Sixty-eight patients had positive SARS-CoV-2 PCR tests (cases), while 714 patients had negative tests (controls). Ninety-one percent of patients received the COVID-19 mRNA vaccine. Compared with the controls, the cases were more likely to be older (62 ± 14 vs. 57 ± 15, p = 0.02), on dialysis for more than one year (84% vs. 72%, p = 0.03), unvaccinated (46% vs. 5%, p p < 0.0001). The effectiveness of receiving two doses of COVID-19 mRNA vaccines against confirmed SARS-CoV-2 infection was 94.7% (95% CI: 89.9–97.2) in our HD population. The findings of this study support the importance of using the COVID-19 mRNA vaccine in chronic HD patients to prevent SARS-CoV-2 infection in such a high-risk population

Risk Factors for Unplanned Initiation of Dialysis in Patients with Advanced Chronic Kidney Disease: A Retrospective Cohort Study

Many patients with advanced chronic kidney disease (CKD) managed in a specialized multidisciplinary clinic start dialysis urgently during hospitalization rather than electively as outpatients. This study aimed to identify risk factors for starting unplanned dialysis among patients with advanced CKD who attended multidisciplinary low-clearance clinics between January 1, 2020, and December 31, 2021. Of these, 175 patients started dialysis: 101 (26.7%) started it urgently, whereas 74 (19.5%) started it electively. Patients with urgent initiation of dialysis received less education, had fewer clinic visits and follow-up and were seen less often in the vascular clinic. In the univariate regression analysis, congestive heart failure significantly increased the risk of acute dialysis. Moreover, the risk increased in patients who did not receive dialysis education. The risk increased in patients who were not seen in a vascular clinic and did not have a vascular access plan. Moreover, high albumin levels at initial presentation to the clinic had a lower risk for elective initiation of dialysis. In the multivariate regression analysis, use of renin-angiotensin-aldosterone system inhibitors and attending a vascular clinic reduced the risk of unplanned dialysis by 73% and 96%, respectively. Acute unplanned initiation of dialysis is common even in CKD patients followed in low-clearance clinics. Early referral to multidisciplinary low clearance clinics, timely education, compliance with timely follow-up periods, and creation of access in patients at risk may reduce hospital admissions, hospital stays, admission to intensive care units, costs, and morbidity in these patients