Background Studies have demonstrated that mRNA-based SARS-CoV-2 vaccines are highly effective among dialysis patients. Because individual vaccines may be differentially available or acceptable to patients, it is important to understand comparative effectiveness relative to other vaccines, such those based on adenovirus technologies. Methods In this retrospective study, we compared the clinical effectiveness of adenovirus vector-based Ad26.COV2.S (Janssen/Johnson & Johnson) to mRNA-based BNT162b2 (Pfizer/BioNTech) in a contemporary cohort of dialysis patients. Patients who received a first BNT162b2 dose were matched 1:1 to Ad26.COV2.S recipients based on date of first vaccine receipt, US state of residence, site of dialysis care (in-center versus home), prior history of COVID-19, and propensity score. The primary outcome was the comparative rate of COVID-19 diagnoses starting in the seventh week postvaccination. In a subset of consented Ad26.COV2.S patients, blood samples were collected ≥28 days after vaccination and anti-SARS-Cov-2 immunoglobulin G antibodies were measured Results A total of 2572 matched pairs of patients qualified for analysis. Cumulative incidence rates of COVID-19 did not differ for BNT162b2 versus Ad26.COV2.S. No differences were observed in peri-COVID-19 hospitalizations and deaths among patients receiving BNT162b2 versus Ad26.COV2.S who were diagnosed with COVID-19 during follow-up. Results were similar when excluding patients with prior history of COVID-19, in subgroup analyses restricted to patients who completed the two-dose BNT162b2 regimen, and in patients receiving in-center hemodialysis. SARS-CoV-2 antibodies were detected in 59.4% of 244 patients who received Ad26.COV2.S. Conclusions In a large real-world cohort of dialysis patients, no difference was detected in clinical effectiveness of BNT162b2 and Ad26.COV2.S over the first 6 months postvaccination, despite an inconsistent antibody response to the latter.

The majority of end-stage kidney disease (ESKD) patients start dialysis without adequate pre-dialysis planning. Of these patients, the vast majority initiate in-centre haemodialysis using a central venous catheter (ICHD-CVC). A minority utilise urgent-start peritoneal dialysis (USPD), whereby a peritoneal dialysis catheter is placed and used for dialysis without the usual 2–4-week waiting period. In this multicentre, retrospective study of adult patients initiating dialysis during 2018, we compared outcomes among patients utilising these two dialysis initiation routes. Patients who initiated dialysis via ICHD-CVC were matched 1:1 to patients who utilised USPD on the basis of aetiology of ESKD, race, diabetes status and insurance type. Hospitalisation and mortality were evaluated from dialysis initiation through the first of death, transplant, loss to follow-up or study end (30 June 2019). Outcomes were compared using models adjusted for age and sex. A total of 717 USPD patients were matched to ICHD-CVC patients. During follow-up, USPD patients were hospitalised at a rate of 1.21 admissions/patient-year (pt-yr) versus 1.51 admissions/pt-yr for ICHD-CVC. This corresponded to a 24% lower rate of hospitalisation among USPD patients (adjusted incidence rate ratio 0.76, 95% confidence interval [CI] 0.65–0.88). Mortality rates were 0.08 and 0.11 deaths/pt-yr among USPD patients and ICHD-CVC patients, respectively (adjusted hazard ratio 0.84, 95% CI 0.62, 1.15). These findings suggest that more widespread adoption of USPD may be beneficial among patients with limited pre-dialysis planning.

Background: mRNA-based SARS-CoV-2 vaccines have been shown to be highly effective among dialysis patients. Because individual vaccines may be differentially available or acceptable to patients, it is important to understand comparative effectiveness of other vaccines, such those based on adeno-virus technologies. Methods: This retrospective study compared the clinical effectiveness of Ad26.COV2.S (Janssen/Johnson and Johnson) to BNT162b2 among dialysis patients. Patients initiating BNT162b2 (Pfizer/BioNTech) were matched 1:1 to Ad26.COV2.S recipients based on age, race, US state of residence, calendar week of first vaccine receipt, and history of COVID-19. The primary outcome was the comparative rate of COVID-19 considered over 3 follow-up intervals: weeks 1-3, 4-6, and ≥ 7 post-vaccination. In a subset of consented Ad26.COV2.S patients, blood samples were collected ≥28 days after vaccination and anti-SARS-Cov-2 immunoglobulin G antibodies were measured. Results: There were 2659 matched pairs of patients who received a first dose of each vaccine. During weeks 1-3, incidence rates were 1.13 vs 1.39 per 1000 patient-weeks (pt-wks) for BNT162b2 and Ad26.COV2.S recipients, respectively (incident rate difference [IRD]: 0.25; 95% CI: 0.90, 1.36). During weeks 4-6, incidence rates were 0.78 vs 0.39 per 1000 pt-wks for BNT162b2 and Ad26.COV2.S recipients, respectively (IRD: -0.39; 95% CI: -1.16, 0.38). After week 7, incidence rates were 1.29 vs 1.39 per 1000 pt-wks for BNT162b2 and Ad26.COV2.S recipients, respectively (IRD: 0.10; 95% CI: -0.35, 0.55). Results were similar when considering only patients without a history of COVID-19 and among matched pairs in which BNT162b2 recipients completed the 2-dose regimen. SARS-CoV-2 antibodies were detected in 59.4% (95% CI: 53.0%-65.5%) of Ad26.COV2.S patients. Conclusion: In a large real-world cohort of dialysis patients, no difference was detected in the clinical effectiveness of BNT162b2 and Ad26.COV2.S, despite an inconsistent antibody response to the latter. These data support the use of either agent in ongoing vaccination efforts in this population.