Adverse events following the first, second and third doses of a COVID-19 vaccine in hemodialysis patients

Abstract

Background

This study aimed to identify adverse events following the first three doses of COVID-19 vaccines in hemodialysis (HD) patients. Risk factors associated with postvaccination adverse events were explored.

Methods

Postvaccination adverse events in 438 HD patients who received 3 doses of COVID-19 vaccines were prospectively assessed. The adverse events among three doses were compared using generalized linear mixed models. Factors associated with adverse events were assessed with multivariate analyses.

Results

The vast majority of participants received Oxford/AstraZeneca ChAdOx1 as their first two doses and Moderna mRNA-1273 as their third dose. Overall, 79%, 50% and 84% of the participants experienced at least one adverse event after their first, second, and third doses, respectively. These adverse events were mostly minor, short-lived and less than 5% reported daily activities being affected. Compared with the first dose, the second dose caused a lower rate of adverse events. Compared with the first dose, the third dose elicited a higher rate of injection site reactions and a lower rate of systemic reactions. Multivariate analyses showed that every 10-year increase of age (odds ratio 0.67, 95% confidence intervals 0.57-0.79) was associated with decreased risk of adverse events, while female sex (2.82, 1.90-4.18) and arteriovenous fistula (1.73, 1.05–2.84) were associated with increased risk of adverse events. Compared with Oxford/AstraZeneca ChAdOx1, Moderna mRNA-1273 was associated with an increased risk of injection site reactions.

Conclusions

COVID-19 vaccination was well tolerated in HD patients. Age, sex, dialysis vascular access and vaccine types were associated with postvaccination adverse events.

Keywords:

• Hemodialysis
• adverse event
• vaccination
• COVID-19
• ChAdOx1
• mRNA-1273

Acknowledgments

We would like to thank the staff of Far Eastern Memorial Hospital, particularly the chief nurse, Hui-Ming Lu, and the chronic kidney disease educator, Yi-Han Lin, for assisting in conducting the study and the dialysis nurses for assisting the participants in completing the questionnaire during hemodialysis.

Ethical approval

This prospective observational study was reviewed and approved by the institutional review board at Far Eastern Memorial Hospital (FEMH-110101-E).

Author contributions

MFP, WCT and KTT were responsible for the concept and design of the study. KTT, SPH, YSP, JYY, HYW, YLC, and KHS made important contributions to data collection and acquisitions. WCT and WYL performed the statistical analysis. WCT and MFP drafted the manuscript and were responsible for submission and revision.

Disclosure statement

The authors declare that they have no conflicts of interest in this work.

Data availability statement

Individual-level deidentified participant data will be made available upon request by emailing the corresponding author. The data will be available for 3 years after publication.

Additional information

Funding

This study was supported by research grants to Dr. Wan-Chuan Tsai from Far Eastern Memorial Hospital, New Taipei City, Taiwan (FEMH-2021-C-044, FEMH-2022-C-007 and FEMH-2023-C-008). The funders had no role in the design or execution of the study; the collection, management, analysis, or interpretation of the data; the preparation, writing, review, or approval of the manuscript; or the decision to submit the manuscript for publication.