Journal Article

Effectiveness of 2023–2024 COVID-19 vaccines against COVID-19–associated hospitalizations among adults aged ≥18 years with end stage kidney disease — United States, September 2023–April 2024

Wallace, Megan, Wiegand, Ryan, Lufkin, Bradley, Link-Gelles, Ruth, Najdowski, Morgan, Lacson, Eduardo, Novosad, Shannon, Payne, Amanda B., Sung, Heng-Ming, Zhang, Yue, Chillarige, Yoganand, Dalrymple, Lorien S., Gomes, Danica J., Gomez Victor, Carla S.

2025

Overview

Persons with end stage kidney disease (ESKD) on dialysis are at high risk for severe COVID-19 disease. In September 2023, 2023–2024 COVID-19 vaccination was recommended in the United States for all persons aged ≥6 months. Due to possible immune dysfunction, advanced age, and high prevalence of additional underlying conditions, including immunocompromising conditions, among individuals with ESKD, reduced vaccine effectiveness (VE) is a concern. Understanding effectiveness of 2023–2024 COVID-19 vaccine among persons with ESKD can inform COVID-19 vaccine recommendations for this population. A retrospective cohort investigation was conducted among Medicare fee-for-service beneficiaries aged ≥18 years with ESKD receiving dialysis using Medicare enrollment and claims records. Follow-up began on September 17, 2023, and continued until the earliest occurrence of claim for a COVID-19–associated outcome, other censoring event, or end of follow-up. A marginal structural Cox model was used to estimate VE (calculated as [1 – hazard ratio]*100 %), interpreted as the benefit of 2023–2024 COVID-19 vaccination compared with no 2023–2024 vaccine dose. VE was estimated by presence of additional immunocompromising conditions, age group, and time since vaccination. During September 17, 2023 – April 13, 2024, 17,749/112,250 (16 %) Medicare beneficiaries aged ≥18 years with ESKD without additional immunocompromising conditions received a 2023–2024 COVID-19 vaccine dose, with a maximum 209 days of follow-up since vaccination. During the follow-up period 6539 medically attended COVID-19 events, including 3605 COVID-19-associated hospitalizations, 789 COVID-19-associated deaths, and 896 COVID-19-associated thromboembolic events, were recorded. VE against COVID-19-associated hospitalization was 55 % (95 % confidence interval [CI]: 42 % - 65 %) at 7–59 days after vaccination and 47 % (95 % CI: 35 % – 57 %) at ≥60 days after vaccination. VE against COVID-19-associated death was 71 % (95 % CI: 46 % - 84 %) at 7–59 days after vaccination and 51 % (95 % CI: 24 % – 69 %) ≥60 days after vaccination. VE against COVID-19-associated thromboembolic events was 44 % (95 % CI, 24 %, 59 %). The 2023–2024 COVID-19 vaccines provided protection against COVID-19-associated hospitalization, death, and thromboembolic events among adults with ESKD. These data support the recommendation that adults with ESKD receive the updated COVID-19 vaccine. •End stage kidney disease (ESKD) is associated with increased risk of severe COVID-19.•Uptake of 2023–2024 COVID-19 vaccination among adults with ESKD was low.•COVID-19 vaccination was effective against severe COVID-19 among adults with ESKD.•COVD-19 vaccine effectiveness among adults with ESKD waned with more time since vaccination.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Adolescent / Adult / Adults / Age / Age groups / Aged / Aged, 80 and over / Allergy and Immunology / Beneficiaries / Computer centers / confidence interval / COVID-19 / COVID-19 - epidemiology / COVID-19 - prevention & control / COVID-19 infection / COVID-19 vaccines / COVID-19 Vaccines - administration & dosage / COVID-19 Vaccines - immunology / death / Dialysis / Drug dosages / Effectiveness / Female / Government programs / hazard ratio / Hemodialysis / Hospice care / Hospitalization / Hospitalization - statistics & numerical data / Humans / Immunization / Influenza / Insurance coverage / Kidney diseases / Kidney Failure, Chronic - complications / Kidney Failure, Chronic - epidemiology / Kidney Failure, Chronic - therapy / Kidney transplants / Kidneys / Male / Medicare / Middle Aged / Nursing homes / Population / Renal Dialysis / Retrospective Studies / risk / SARS-CoV-2 / SARS-CoV-2 - immunology / Security management / Software / Thromboembolism / United States - epidemiology / Vaccination / Vaccine Efficacy / Vaccines / Young Adult