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

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Summary Background This 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. Methods Using 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. Findings Follow-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 1 st booster versus 2 nd dose and 2 nd booster versus 1 st booster, 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. Interpretation The 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. Funding Initiative 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).

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