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COVID-19 infection and severe clinical outcomes in patients with kidney disease by vaccination status: a nationwide cohort study in Korea
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Jieun Woo, Ahhyung Choi, Jaehun Jung, Ju-Young Shin
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Epidemiol Health. 2024;46:e2024065. Published online July 17, 2024
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DOI: https://doi.org/10.4178/epih.e2024065
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 Abstract
Summary
 PDF Supplementary Material
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Abstract
OBJECTIVES
Patients with kidney disease have been prioritized for coronavirus disease 2019 (COVID-19) vaccination due to their susceptibility to COVID-19 infection. However, little evidence exists regarding these patients’ vulnerability to COVID-19 post-vaccination. Thus, we evaluated the risk of COVID-19 in patients with kidney disease compared to individuals without kidney disease according to vaccination status.
METHODS A retrospective cohort study was conducted using the Korean nationwide COVID-19 registry linked with National Health Insurance Service claims data (2018-2021). Among individuals aged 12 years or older, 2 separate cohorts were constructed: a COVID-19-vaccinated cohort and an unvaccinated cohort. Within each cohort, the risk of COVID-19 infection and all-cause mortality, hospitalization, and emergency room visits within 30 days of COVID-19 infection were compared between patients with and without kidney disease. To adjust for potential confounding, we used propensity score matching. Hazard ratios (HRs) for each outcome were estimated using a Cox proportional hazard model.
RESULTS We identified 785,390 and 836,490 individuals in the vaccinated and unvaccinated cohorts, respectively. Compared to patients without kidney disease, patients with kidney disease were at a higher risk of COVID-19 infection in both the vaccinated cohort (HR, 1.08; 95% confidence interval [CI], 1.02 to 1.16) and the unvaccinated cohort (HR, 1.09; 95% CI, 0.99 to 1.20). Likewise, patients with kidney disease generally were at higher risk for severe clinical outcomes within 30 days of COVID-19 infection. Subgroup and sensitivity analyses showed generally consistent results.
CONCLUSIONS Our study observed excess risk of COVID-19 in patients with kidney disease, highlighting the importance of ongoing attention to these patients even post-vaccination.
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Summary
Korean summary
본 연구는 신장 질환이 없는 사람과 비교하여 신장 질환이 있는 환자의 COVID-19 위험을 백신 접종 여부에 따라 평가하였습니다. 백신 접종 여부와 상관없이 신장 질환이 있는 환자는 신장 질환이 없는 환자에 비해 코로나19 감염 및 코로나19 감염 이후 사망, 입원, 응급실 방문의 위험이 더 높았습니다. 즉, 이러한 연구 결과는 백신 접종 후에도 신장 질환이 있는 환자에 대한 코로나19에 대한 지속적인 주의가 필요함을 시사합니다.
Key Message
This study evaluated the risk of COVID-19 in patients with kidney disease compared to patients without kidney disease according to vaccination status. Compared to patients without kidney disease, patients with kidney disease were at a higher risk of COVID-19 infection and severe clinical outcomes after COVID-19 infection in both the vaccinated cohort and the unvaccinated cohort. These findings highlighted the importance of ongoing attention to these patients even post-vaccination.
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