Korean J Transplant.  2023 Nov;37(Suppl 1):S175. 10.4285/ATW2023.F-7631.

Impact of COVID-19 vaccination to SARS-Cov-2 infection and outcomes among end-stage renal disease patients in South Korea

• Kwon E
• Kim Jh
• Jo A
• Yun G
• Park S
• Lee J
• Jeong JC

• KMID: 2551795
• DOI: http://doi.org/10.4285/ATW2023.F-7631

Abstract

Background
End-stage renal disease (ESRD) patients are known to have high morbidity and mortality from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We investigated the impact of single dose or multiple doses of vaccination on SARS-CoV-2 infection, hospitalization rate, and mortality in a nationwide scale using a claim database.
Methods
This study used Korea Disease Control and Prevention Agency coronavirus disease 2019 (COVID-19) Korean National Health Insurance Service cohort data. ESRD patients were study population. SARS-CoV-2 infections, hospitalizations from SARS-CoV-2 infections, and 30-day mortality after SARS-CoV-2 infections were study outcomes. We used public COVID-19 infection database which contains available data since October 8, 2020. Vaccination started since February 26, 2021. The study period was from February 26, 2021 to December 31, 2021. Patients with prior COVID-19 infection before ESRD or before vaccination were excluded. In the multivariable logistic regression models, age, sex, comorbidities (hypertension, diabetes mellitus, chronic kidney disease), and ESRD duration were adjusted as covariables. This research was funded by Seoul National University Bundang Hospital (No.2022-04590).
Results
Total 109,671 ESRD patients were COVID-19 vaccinated. Among 85,971 dialysis patients, 2,550 (3.0%) received single dose, and 83,421 (97.0%) received multiple doses. Among 23,700 kidney transplantation (KT) recipients, 452 (1.9%) received single dose and 23,248 (98.1%) received multiple doses. KT recipients who were vaccinated multiple doses showed reduced SARS-CoV-2 infection (odds ratio [OR], 0.450; 95% confidence interval [CI], 0.237–0.856; P=0.015), reduced 30-day mortality (OR, 0.139; 95% CI, 0.089–0.432; P=0.016). Dialysis patients with multiple vaccination doses also showed reduced COVID-19 infection (OR, 0.612; 95% CI, 0.436–0.858; P=0.004), and reduced 30-day mortality (OR, 0.196; 95% CI, 0.089–0.432; P<0.001). In both populations, multiple doses of COVID-19 vaccination did not reduce COVID-19-related hospitalization.
Conclusions
We present the first nationwide scale evidence that multiple doses of SARS-CoV-2 vaccination significantly reduced 30-day mortality, and SARS-CoV-2 infection rate in the dialysis population and KT recipients.