Exploring the Effects of Comorbidities on COVID-19 Vaccine Response in Patients Receiving Hemodialysis Restricted; Files Only
Khan, Nadia (Spring 2022)
Background: Patients undergoing hemodialysis have a higher risk of infection as well as an immunocompromised state due to kidney disease. This makes them more likely to be impacted by infection due to SARS-CoV-2. In addition to risk of infection, dialysis patients have historically shown a reduced immune response to vaccination. Therefore, it is of great importance to examine immune response to SARS-CoV-2 vaccination and identification of risk factors for impaired immunologic response among hemodialysis patient populations.
Methods: The SARS-CoV2 Serosurveillance in Hemodialysis Patients (SHEP) study is a prospective surveillance study that began on September 1st, 2020, during the first two waves of the SARS-CoV-2 pandemic in the United States. Around 800 outpatient hemodialysis patients across four Emory Dialysis Clinics had serum tested monthly for SARS-CoV-2 antibodies. This analysis uses serology data collected from November 1st , 2020, until May 31st , 2021, and focuses on a cohort of 303 people based on vaccination and serology test criteria. Logistic regression was used to assess the impacts of age and other biological covariates on COVID-19 vaccine response, measured by DiaSorin LIAISON® SARS-CoV-2 S1/S2 IgG assay.
Results: In multivariable regression, weighted Elixhauser Score had a statistically significant inverse association with the likelihood of response to the COVID-19 vaccine (OR 0.97, 95% CI 0.93-1.00, p=0.03). Meanwhile, older patients had lower odds of seroconversion compared to younger patients, but the difference was not statistically significant. Similarly, immunosuppression and albumin level did not have significant associations with COVID-19 vaccine response.
Conclusions: Patients receiving hemodialysis do undergo seroconversion after the COVID-19 vaccine. However, the more comorbid conditions present the more likely it was that the patient didn’t respond to the vaccine, demonstrated by the significant inverse association between weighted Elixhauser Score and post-vaccine response. Therefore, it could benefit dialysis providers to monitor the serologic status of certain subsets of patients, such as those with comorbidities outlined in the Elixhauser Score. These results can be used to customize vaccine booster dose protocols, keeping in mind these risk factors for seroconversion.
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