Evolving impact of the COVID-19 pandemic in chronic dialysis recipients over the course of pandemic waves and COVID-19 vaccination rollout: a French national study
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Background
This observational study aims to assess the impact of the pandemic on the evolving of kidney transplantations, survival, and vaccination in chronic dialysis recipients (CDR) over the COVID-19 pandemic subperiods.
Methods
Using the French national health claims database, incident persons with end stage kidney disease in years 2015 to 2021 treated with dialysis were followed-up until December 31, 2022. Kidney transplantion and survival over pandemic subperiods versus the prepandemic period were investigated using longitudinal models with time-dependent covariates. Moreover, the impact of cumulative doses of COVID-19 vaccine on hospitalization and survival were compared between CDR and matched-control individuals.
Findings
Follow-up of the 71,583 CDR and 143,166 controls totalized 639,341 person-years (CDR: 184,909; controls: 454,432). The likelihood of receiving a kidney transplant decreased during all pandemic subperiods except one. Mortality in CDR increased during the 3 wave subperiods (hazard ratio (HR [95% confidence interval]): 1·19 [1·13–1·27], 1·19 [1·15–1·23], and 1·12 [1·07–1·17], respectively). While vaccine coverage declined with each booster dose, receiving such doses was associated with lower risks of COVID-19-related hospitalization (0·66 [0·56–0·77], 0·83 [0·72–0·94] for 1 st booster versus 2 nd dose and 2 nd booster versus 1 st booster, respectively) and death (corresponding HR: 0·55 [0·51–0·59], 0·88 [0·83–0·95]). Evolving patterns in mortality and vaccination outcomes were similar in CDR and controls.
Interpretation
The impact of the pandemic in CDR was not specific of the kidney disease per se . Study results also suggest future research aimed at increasing adherence to vaccine booster doses.
