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

Abstract

SummaryBackgroundThis 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]): 1.19 [1.13–1.27], 1.19 [1.15–1.23], and 1.12 [1.07–1.17], respectively). While vaccine coverage declined with each booster dose, receiving such doses was associated with lower risks of COVID-19-related hospitalization (0.66 [0.56–0.77], 0.83 [0.72–0.94] for 1stbooster versus 2nddose and 2ndbooster versus 1stbooster, respectively) and death (corresponding HR: 0.55 [0.51–0.59], 0.88 [0.83–0.95]). 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 diseaseper se. Study results also suggest future research aimed at increasing adherence to vaccine booster doses.FundingInitiative Économie de la Santé de Sorbonne Université (Idex Sorbonne Université, programmes Investissements d’Avenir) ; Ministère de la Solidarité et de la Santé (PREPS 20-0163).