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. (preprint)

ABSTRACT

BackgroundThis 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. MethodsUsing 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. FindingsFollow-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{middle dot}19 [1{middle dot}13-1{middle dot}27], 1{middle dot}19 [1{middle dot}15-1{middle dot}23], and 1{middle dot}12 [1{middle dot}07-1{middle dot}17], respectively). While vaccine coverage declined with each booster dose, receiving such doses was associated with lower risks of COVID-19-related hospitalization (0{middle dot}66 [0{middle dot}56-0{middle dot}77], 0{middle dot}83 [0{middle dot}72-0{middle dot}94] for 1st booster versus 2nd dose and 2nd booster versus 1st booster, respectively) and death (corresponding HR 0{middle dot}55 [0{middle dot}51-0{middle dot}59], 0{middle dot}88 [0{middle dot}83-0{middle dot}95]). Evolving patterns in mortality and vaccination outcomes were similar in CDR and controls. InterpretationThe 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.