ABSTRACT
Vaccination is a critical strategy to prevent COVID-19. We describe the effects of a vaccine drive implemented in Emory Dialysis centers on COVID-19 vaccine uptake, infection rates and outcomes. Emory Dialysis, serving an urban population, conducted a COVID-19 vaccination drive (i.e. vaccine education and onsite vaccine administration) across its 4 dialysis centers (~750 patients) from March—April 2021. Monthly COVID-infection and vaccination rates were tracked from March 2020—September 2021. We assessed the effect of the drive on the COVID-19 vaccine uptake, infection rates and outcomes including hospitalizations and 30-day mortality. Patients were included if they were diagnosed with COVID-19, 14 days after the vaccination drive (to reflect fully vaccinated status). Patients were stratified by vaccination status and descriptive statistics were performed. From March 2020–April 2021, monthly COVID-19 infection rates were 0.41—4.97% and vaccination rates were 0–6%. From May–September 2021 (post-vaccination drive), the monthly COVID-19 infection rates ranged from 0–2.50% and vaccination rates were 67.4–76.1%. In the post-vaccination period, 34 patients were diagnosed with COVID-19;26 were fully vaccinated and 8 were unvaccinated. Among the 34 patients, the median age was 57 years [interquartile range (IQR) 47–73], 29% were female and 79.4% were Black. Compared to unvaccinated group, the vaccinated group was older (62 years [IQR 50-73] vs. 50 years [IQR 41-60], p=0.06), and had a higher prevalence of cardiovascular disease (46.2% vs. 25.0%, p=0.62);otherwise, patient characteristics were similar between the groups. Twelve patients (48.1%) in the vaccinated group vs. 6 patients (75.0%) in the unvaccinated group were hospitalized for COVID-infection (p=0.26). Three patients (11.5%) in the vaccinated group vs. 2 patients (25%) in the unvaccinated group (p=0.35) died within 30-days of COVID-19 diagnosis. Providing vaccinations at dialysis centers may improve COVID-19 vaccine uptake and outcomes. Studies evaluating the long-term effects of vaccination programs in dialysis centers are needed.
ABSTRACT
Background: Effective dialysis care during the C19 pandemic has required implemetation of new policies and procedures to ensure adequate care, to avoid contagion in dialysis centers and to minimize unnecesary expossure to medical personnel. Methods: Emory dialysis program provides dialysis care for ~ 750 patients in 4 hemodialysis centers and 3 home dialysis locations in the metro Atlanta area. The first cases of C19 in Georgia were reported on March 2, 2020 and plans to contain the spreading of the disease were implemented in our dialysis units, including mask use, triaging of patients and personnel based on symptoms, telemedicine rounds, cohorting of C19+ patients in a single shift in a designated unit, and physical isolation of nursing home residents while receiving hemodialysis. This report describe the clinical outcomes related to these interventions. Results: Until May 30/2020, 106 patients had been tested (14%). 22 patients were positive for C19 (2.9%) of which 20 were on HD and 2 on PD. Five C19+ patients died (mortality 23%). Patients that tested positive were older (65±13 vs 60±13y/o), mainly African-Americans (90%) with a higher BMI (29 vs 26), more likely to be diabetics (51% vs 44%) and to reside in a Nursing Home (20 vs 10%), with higher prevalence of cardiovascular disease (45 vs 30%). Dialysis-related parameters (albumin, hemoglobin, phophorus, PTH, Kt/V and blood pressure) were similar between those that tested positive vs negative. 4% (31 patients) of our entire dialysis population resides in Nursing Homes. 12 of them have been tested and 8 were C19+ (26%). The dialysis patients that expired were older (69 vs 57y), all were African-Americans and had higher BMI (30 vs 26) and time on dialysis (12.3 vs 5.6 y) than those that survived. We did not observe an increase frequency of hospitalizations or deaths compared to previous months (Figure 1). Conclusions: In our dialysis population the incidence of C19 infection was 2.9% with 14% of patients tested. Mortality was 24%. Deceased patients were older, had a higher BMI and were on dialysis for longer time compared to those that survived. We did not observe an increase rate of hospitalizations or deaths during initial 3 months of the pandemic.