20% of Dialysis Patients Are Hesitant About COVID-19 Vaccine

Mitchel L. Zoler, PhD

April 19, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Among US patients who regularly undergo hemodialysis, 20% had some degree of hesitancy about receiving a COVID-19 vaccine in a survey of 1515 patients conducted during January and February 2021.

The most frequently cited concern associated with hesitancy over vaccination against the SARS-CoV-2 virus was with regard to possible adverse effects. This was cited by more than half of the patients who were concerned about being vaccinated.

Hesitancy rates were highest among people aged 44 years or younger, women, people who identified as non-Hispanic Black or non-Hispanic other (generally Native American or Pacific Islander), those with less than some college education, and those without a history of influenza vaccination, Pablo Garcia, MD, reported at the National Kidney Foundation (NKF) 2021 Spring Clinical Meetings.

Hesitancy or Access?

Overall, however, the findings suggest that the main barrier to COVID-19 vaccine uptake is "access rather than hesitancy," explained Garcia, a nephrologist at Stanford University School of Medicine, Stanford, California. He predicts that this barrier will soon resolve, in part because of a Centers for Disease Control and Prevention program launched in March 2021 that is supplying COVID-19 vaccine to US dialysis centers to administer to their patients.

"This will facilitate access to the vaccine" for patients who regularly receive hemodialysis, Garcia said during his presentation.

"Administering vaccines in dialysis clinics will help. Patients are already accustomed to receiving influenza vaccine in the clinic," commented Joseph A. Vassalotti, MD, a nephrologist at Mount Sinai Hospital, New York City, and chief medical officer for the NKF.

Vassalotti cited the importance of protecting the vulnerable population of people who regularly receive hemodialysis. Among those patients, there was a 37% spike in all-cause mortality during peak weeks of the pandemic compared with similar periods during 2017–2019.

Any Level of Vaccine Hesitancy Is Concerning"

In an interview, he said, "Vaccination is the key to reducing this burden, so any level of vaccine hesitancy is concerning" with regard to patients who regularly undergo dialysis.

Hesitancy among patients who undergo dialysis appears to be less than in the general US population, according to a series of surveys conducted from April through December 2020. In that series, hesitancy rates approached 50% in a sample of more than 8000 people

Hesitancy among people overall may have recently increased, at least for the short term, because of concerns over rare thrombotic events among people who receive certain types of COVID-19 vaccine, Vassalotti noted.

Garcia and his associates conducted their survey from January 8 to February 11, 2021, among patients who regularly received hemodialysis at any of 150 randomly selected dialysis clinics that treat 30 or more patients and are managed by US Renal Care. The study enrolled patients in 22 states. Most of the patients were aged 45 to 79 years; 30% were non-Hispanic White; 30% were Black, and 24% were Hispanic. The survey included 24 questions and took about 10 minutes to complete.

In reply to the statement, "If COVID-19 vaccine was proven safe and effective for the general population I would seek to get it," 20% gave a reply of definitely not, probably not, or unsure; 79% answered either probably or definitely yes.

Another question asked about willingness to receive a vaccine if it was shown to be safe and effective for people receiving dialysis. In answer to that question, 19% said definitely not, probably not, or unsure.

Possible Adverse Effects an Issue

Asked the reason why they were hesitant to receive the vaccine, 53% cited possible adverse effects; 19% cited general unease about vaccines; 19% said they did not think the COVID-19 vaccines would work; 17% said they did not think they needed a COVID-19 vaccine; and 15% said they had read or heard that COVID-19 vaccines were dangerous.

A set of questions asked survey respondents about their primary source of information about COVID-19 vaccines. About three quarters cited television news; about 35% cited members of their dialysis clinic staff; about 30% cited friends and family; 20% cited social media; 20% cited their nephrologist; and roughly 15% cited newspapers.

The results suggest that potentially effective interventions to promote vaccine uptake include showing informational videos to patients during dialysis sessions and encouraging the staff at dialysis centers to proactively educate patients about COVID-19 vaccines and to promote uptake, suggest Garcia and Vassalotti.

Vassalotti noted that in a recent single-center survey of 90 US patients undergoing hemodialysis that included 75 (85%) Black persons, the prevalence of hesitancy about COVID-19 vaccines was 50%. Hesitancy was often linked with gaps in patient education.

"We need broad educational measures, as well as targeting specific demographic groups" among whom the level of hesitancy is high, said Vassalotti.

He noted that patients who undergo dialysis are receptive to messages from dialysis clinic staff members and that this offers an "opportunity to understand misconceptions that underlie hesitancy and address them on an individual basis."

The NKF has prepared a fact sheet for educating patients with kidney disease about the efficacy and safety of COVID-19 vaccines, Vassalotti noted.

Garcia has disclosed no relevant financial relationships. Vassalotti is an advisor and consultant to Renalytix AI and is a consultant to Janssen.

National Kidney Foundation (NKF) 2021 Spring Clinical Meetings: Abstract 329. Presented April 7, 2021.

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