Prior COVID-19 Vaccination May Improve Kidney Outcomes, Survival in CKD

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Prior vaccination against COVID-19 may play a critical role in improving renal outcomes and overall survival in patients with chronic kidney disease (CKD) and COVID-19, according to findings from a recent study.1

Leveraging real-world data from the TriNetX database, the global retrospective cohort study found prior vaccination against COVID-19 reduced the risks of major adverse kidney events (MAKEs) and all-cause mortality in those with CKD and COVID-19 infection, especially with ≥ 3 vaccine doses.1

“There is a critical gap in understanding the potential renal implications of COVID-19 vaccination, particularly in CKD patients,” I-Ning Yang, of the division of nephrology at Chi Mei Medical Center and the Institute of Clinical Pharmacy and Pharmaceutical Sciences at National Cheng Kung University, and colleagues wrote.1 “To the best of our knowledge, no research has specifically addressed this critical issue.”

While COVID-19 was initially recognized for its respiratory manifestations, emerging evidence indicates SARS-CoV-2 infection can lead to long-term complications affecting multiple organ systems, including the kidneys. Recent research has linked severe COVID-19 infection to kidney damage, even in patients who had no underlying kidney problems before they were infected with the coronavirus.2 However, less is known about the impact of COVID-19 vaccination on outcomes in patients with kidney disease.1

To assess the real-world impact of prior COVID-19 vaccination on MAKEs and mortality in CKD patients with COVID-19, investigators examined data for adults ≥18 years of age with CKD enrolled in the TriNetX network from January 2020 to May 2024 who were diagnosed with COVID-19 based on ICD-10-CM codes or a positive polymerase chain reaction test result. Of note, they excluded individuals undergoing dialysis and those with a history of transplantation due to their potentially different immune responses.1

The study cohort was divided into 2 groups based on COVID-19 vaccination status. The vaccinated group encompassed CKD individuals who received ≥ 1 dose of the mRNA vaccines, BNT162b2 (Pfizer/BioNTech) and mRNA-1273 (Moderna), within 1 year to 7 days before the index date. Conversely, the unvaccinated group included CKD individuals with no documented history of COVID-19 vaccination.1

Investigators used propensity score matching accounting for demographics, lifestyles, comorbidities, medication usage, and laboratory data to create a 1:1 cohort of 8520 vaccinated and 8520 unvaccinated CKD patients with COVID-19.1

The primary outcome was a composite endpoint of MAKEs or all-cause mortality. MAKEs were defined by the first occurrence of any of the following procedure and diagnostic codes: dialysis services and procedures, dialysis procedure other than hemodialysis, dependence on renal dialysis, hemodialysis, hemodialysis access, intervascular cannulation for extracorporeal circulation, shunt insertion procedures on arteries and veins, or hemodialysis procedures. Both groups were followed from the first day to 30 days after the index date to estimate the risk of incident MAKEs or mortality.1

During the 30-day follow-up period, compared with the unvaccinated group, investigators noted the vaccinated group exhibited a significantly reduced risk of development of MAKEs or all-cause mortality (8.85% vs 13.29%; hazard ratio [HR], 0.637; 95% CI, 0.581–0.689) and an increased probability of event-free survival at 30 days (log-rank test, P <.0001). Additionally, those receiving vaccination had a lower risk of MAKEs (HR, 0.792; 95% CI, 0.698–0.898) and all-cause mortality (HR, 0.549, 95% CI, 0.484–0.622), respectively.1

Of note, the beneficial effects of COVID-19 vaccination on the primary outcome were consistent across subgroup analyses for sex, age, CKD status, and diabetes status.1

Investigators also called attention to a statistically significant reduced risk of MAKEs or all-cause mortality among individuals with vaccination status of > 3 doses (HR, 0.449; 95% CI, 0.397–0.508). A significant interaction was observed in patients receiving ≥ 3 doses (P <.0001), a trend that was similarly significant in the analysis of MAKEs and all-cause mortality (P = .0208 and P <.0001).1

“Our findings suggested that prior vaccination against COVID-19 might play a critical role in reducing the incidence of MAKEs and all-cause mortality in this vulnerable population and provided important real-world insights for clinicians concerning the post-vaccination risks of subsequent kidney diseases,” investigators concluded.1

References
  1. Huang CY, Wu JY, Lin GY, et al. Impact of prior COVID-19 vaccination on major adverse kidney events in patients with non-dialysis dependent chronic kidney disease: a global retrospective study. Expert Rev Vaccines. doi:10.1080/14760584.2025.2536077
  2. Brooks A. COVID-19 Infection Linked to Faster Kidney Function Decline Than Pneumonia. HCPLive. January 1, 2025. Accessed July 21, 2025. https://www.hcplive.com/view/covid-19-infection-linked-faster-kidney-function-decline-than-pneumonia

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