Multicenter analysis of SARS-CoV-2 vaccination and infection in patients with end-stage kidney disease

BACKGROUND: End-stage kidney disease (ESKD) patients on dialysis or post-kidney transplantation (KT) are at high risk of coronavirus disease 2019 (COVID-19). METHOD: We retrospectively enrolled ESKD patients on hemodialysis (HD), peritoneal dialysis (PD), and post-KT between January 2020 to December 2022 across eight medical centers in Taiwan. This study analyzed demographics, vaccination coverage, antiviral use, and COVID-19 severity in these patients. RESULTS: A total of 5950 ESKD patients were analyzed: 3233 (54.3 %) on HD, 1592 (26.8 %) on PD, and 1125 (18.9 %) post-KT. Overall, 83.1 % of patients received at least one dose of vaccine. HD patients had the highest vaccination coverage (89.9 %) but also the highest infection rates (26.2 %), antiviral use (82.4 %), and COVID-19-related mortality (5.3 %). KT recipients had the lowest vaccination coverage (66.8 %) and the highest intensive care unit (ICU) admission (9.3 %), while PD patients had the lowest mortality (0.4 %). Regionally, vaccination was lowest among Northern KT recipients (20.7 %), infection peaked among Eastern HD patients (41.2 %), and severe outcomes were concentrated in Eastern KT recipients, who also had the highest mortality (14.7 %). Logistic regression analysis demonstrated that older age increased the risks of hospitalization and mortality, while vaccination provided a clear dose-dependent protective effect across all outcomes. CONCLUSIONS: Vaccination was associated with reduced hospitalization and death among ESKD patients. HD patients bore the highest infection burden, KT recipients were most vulnerable to severe outcomes, and PD patients had the most favorable prognosis. These finding emphasize the importance of improving vaccine coverage, particularly among KT recipients.