Kidney Care UK is campaigning for patients who have in-centre haemodialysis to be moved up from priority group four to priority group one for COVID-19 vaccination.
There are 24,000 UK patients with end stage kidney disease who have in-centre haemodialysis (ICHD) three times a week. These patients are at the highest risk of death from COVID-19 of all the clinically extremely vulnerable groups but, unlike other clinically extremely vulnerable patients, they are necessarily exposed to greater risk of COVID-19 due to the need to travel to hospital three times a week for life-maintaining dialysis treatment. Yet, despite their level of risk, these patients have been categorised as priority group four for COVID-19 vaccination and will have to wait months to receive a vaccine.
1. End-stage kidney disease patients have a higher risk of death due to COVID-19 than the over-80 age group
- UK Renal Registry and Public Health England data indicate that there was an approximately one in five (20%) risk of death within 14 days for dialysis patients who were diagnosed with COVID-19 in the first wave of the pandemic
- The risks were high even among young dialysis patients: the risk of death from COVID-19 for a patient aged 40-59 yrs receiving in-centre dialysis from the beginning of the pandemic to the end of June was around 2.5 times as high as an 80+ year old in the general population
- By 11 November 2020, nearly 3% of patients (662 people) receiving in-centre dialysis in the UK had died of COVID-19; approximately half of these patients were below 65 years of age
2. Health inequalities will be exacerbated by delays to vaccination
- Only 18% of kidney patients receiving dialysis are aged 80 or more and therefore the majority of patients won’t be vaccinated in the current prioritisation until group four, despite their greatly increased risk. The median age of patients receiving ICHD in the UK is 67.4 years, and patients of South Asian or black ethnicity receiving dialysis are even younger than people of white ethnicity
- End-stage kidney disease that requires dialysis is 3-4 times more common in people from South Asian and black backgrounds and is also independently associated with deprivation. These are groups of people who particularly affected by COVID-19. Prioritising COVID-19 vaccination programmes patients requiring ICHD will help address pre-existing health inequalities
3. COVID-19 is severely impacting transplant programmes
- The treatment of choice for end-stage kidney disease is kidney transplantation, offering patients improved survival and quality of life, as well as capacity and cost savings to the NHS. Delays in receiving transplantation are associated with an increased risk of death and transplant programmes have been severely disrupted by COVID-19
- The majority of patients on kidney transplant waiting lists are receiving in-centre dialysis while they wait. COVID-19 vaccination of waiting list patients before transplantation will enable full re-opening of kidney transplant programmes, with major benefits to patients and the NHS
4. Dialysis patients have easy access to vaccination through hospital renal services
- COVID-19 vaccination can be provided to patients having ICHD during their dialysis treatment. The renal community routinely provides hepatitis B and seasonal influenza vaccine to dialysis patients and could rapidly and efficiently deliver the COVID-19 vaccine to all consenting patients if given priority access to the vaccine
- Based on the numbers of patients who have died to date, and assuming the risk of COVID-19 remains high in the next four months, we calculate that the number of dialysis patients needed to vaccinate to avoid one death from COVID-19 is as low as 35. There are 70 renal services providing ICHD in the UK, so on average, up to 10 patients per centre could be saved from premature death from COVID-19 if they were vaccinated in the first priority group.
- The renal community is also in a position to accurately monitor immune response and, through the UK Renal Registry, monitor impact on COVID-19 rates
- To ensure that patients requiring dialysis receive COVID-19 vaccination, renal professional groups are working closely with NHS England on the requirements for implementation of COVID-19 vaccination at dialysis units. Many dialysis units have staff trained in vaccination and renal services across the UK are committed to deliver vaccination at dialysis units. Together this will provide maximum coverage of this high risk group of patients
Renal health care professionals have made extraordinary efforts to mitigate dialysis patients’ risk but, while COVID-19 is endemic, patients receiving in-centre haemodialysis will continue to be at high risk of death from COVID-19.
Lives will be saved by reprioritising kidney patients having in-centre haemodialysis as priority one for COVID-19 vaccination.
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