The impact of COVID-19 vaccines for patients with chronic kidney disease

Drs. Matthew Oliver (University of Toronto) and Peter Blake (Western University) published an editorial in the Clinical Journal of the American Society of Nephrology assessing the clinical impact of COVID-19 vaccines on protecting people living with chronic kidney disease (CKD). They review multiple studies and the impact of study designs on determining vaccine effectiveness in this population, as well as their mechanisms of evaluating the impact of COVID-19 vaccination on the CKD population.

COVID-19 has had a disproportionate impact on people with CKD and undergoing regular hemodialysis. Early in the pandemic, it was estimated that nearly 1 in 4 CKD patients who had contracted SARS-CoV-2 died from the illness, and many of those who survived were left with lingering long-term effects, including long COVID.

Key points:

• Researchers have used multiple study designs to evaluate vaccine effectiveness (VE) for individuals with CKD. Standard designs, however, such as the test-negative design to evaluate vaccine effectiveness may not be appropriate for those with CKD, who may suffer from chronic symptoms like that of COVID-19.
• Across cohort designs, test-negative designs, pseudo-test-negative design, vaccines were shown to provide moderate protection against infection from SARS-CoV-2 for individuals with CKD, but are highly protective against severe outcomes. However, efficacy is still substantially less than that seen in healthy participants.
• As the virus mutates, it continues to pose a significant risk for this vulnerable population group and novel/tailored study designs should be used to examine VE from different perspectives to improve understanding of how to enhance their protection.