The Impact of COVID-19 on Dialysis Patients

In 2020, the COVID-19 pandemic caused a major crisis worldwide. On January 30, the World Health Organization (WHO) announced COVID-19 as a global public health emergency. This led to lockdowns in many countries, including France, to control the spread of the virus. Early findings showed that people on dialysis due to serious kidney issues faced a higher chance of being hospitalized or dying from COVID-19. After vaccinations started, studies suggested that those on dialysis had weaker responses to the Vaccines and their immunity faded more quickly than in the general public. This meant they needed more booster shots within a few months after their initial vaccinations. However, not much was known about how willing these patients were to get these extra doses.

A recent review looked at many studies connecting health beliefs and thoughts about COVID-19 vaccines but found that only a small number discussed booster shots. With just one study examining hesitance towards booster shots specifically in dialysis patients, researchers decided to focus on understanding how well these patients received booster vaccinations.

Another serious consequence of the pandemic was the drop in kidney Transplants. Data showed that there were over 8,500 fewer kidney transplants across 22 countries, with France seeing a decline of over 1,000 transplants just within 2020. Despite knowing that COVID-19 Hospitalizations impacted the survival of dialysis patients, no thorough analyses had been done on how the pandemic affected their chances of getting a kidney transplant.

To get a clearer picture of how the COVID-19 pandemic affected these dialysis patients, researchers conducted a significant study looking at French data throughout the pandemic. The goals were to assess the risks of dying and the chances of receiving a transplant for dialysis patients during different phases of the pandemic. They also wanted to consider the indirect effects such as COVID-19 hospitalizations and vaccination outcomes for these patients. To do this accurately, they compared these dialysis patients against a control group without kidney disease but similar in other health aspects.

The study used data from a national health database in France that captures nearly all healthcare claims, making it a valuable resource for real-world data studies. The focus was on patients who started dialysis treatment from January 2015 to February 2020 and had the first treatment related to their kidney issues. For analysis, each dialysis patient was matched with two similar individuals who did not have kidney disease, ensuring a fair comparison.

The researchers defined the prepandemic period as before March 1, 2020, and the pandemic period as starting from then until December 31, 2022. They divided the pandemic period into phases based on COVID-19 hospitalization rates. Vaccinations began rolling out in France on December 27, 2020.

The study followed patients from when they started dialysis until the end of 2022. Those who received a transplant or died during the follow-up were no longer included in the analysis. Patients entering dialysis treatment during the prepandemic period and surviving into the pandemic were transitioned into the pandemic follow-up group when it began.

Researchers looked at how COVID-19 impacted these dialysis patients by studying various factors. They considered COVID-19 hospitalizations, age, sex, and other health conditions like diabetes and cardiovascular diseases. Some of these factors could change over time, so they adjusted the analysis to account for them.

Survival models were used to see how the pandemic affected the chances of receiving a transplant and the risk of death among dialysis patients. They also examined the relationship between how many vaccine doses a patient received and their chances of being hospitalized or dying from COVID-19.

Ethically, the data used did not require individual consent, as it was completely anonymous and complied with national regulations.

By the end of 2022, almost 90% of dialysis patients received two doses of the COVID-19 vaccine, but the percentage decreased for follow-up booster doses. The study showed that being fully vaccinated significantly reduced the risk of hospitalization due to COVID-19 and lowered overall mortality rates for these patients.

The results further indicated that throughout the pandemic, dialysis patients were less likely to receive a kidney transplant compared to before the pandemic, especially during the first wave of COVID-19. Those who had been hospitalized due to COVID-19 faced an even steeper decline in the likelihood of getting a transplant.

The risk of death for dialysis patients increased during the pandemic compared to earlier periods. However, those without a history of COVID-19 hospitalization had similar risks of death as before the pandemic, highlighting that the indirect impacts of the pandemic might have been managed well for that group. In contrast, those who were hospitalized had a much higher risk of death.

The findings also showed that the vaccination coverage dropped with each additional booster dose. Although some patients hesitated to receive booster shots, those who did had better outcomes regarding hospitalization and overall survival. The results support future efforts to encourage more dialysis patients to get vaccinated, especially the booster shots.

In conclusion, the study highlights the significant challenges faced by dialysis patients during the COVID-19 pandemic regarding access to kidney transplants and increased mortality risks. Despite some successes in managing indirect impacts through vaccinations, more needs to be done to ensure these vulnerable populations receive the care and support they need, especially in terms of booster vaccinations. Further research is essential to develop policies aimed at improving vaccination rates in these groups.