SARS-CoV-2 Vaccine Acceptability in Patients on Hemodialysis: A Nationwide Survey
Authors: Garcia Pablo , Montez-Rath Maria E. , Moore Heather , Flotte Johnie , Fults Chris , Block Martha S. , Han Jialin , Dittrich Mary , Parsonnet Julie , Chertow Glenn M. , Block Geoffrey A. , Anand Shuchi 
Published: April 2021

Significance Statement
High uptake of the SARS-COV-2 vaccine among patients on dialysis is critical to mitigating the devastating rates of COVID-19–related complications and deaths observed in the dialysis population. In a nationwide vaccine acceptability survey involving 150 dialysis facilities in the United States and broadly representative of this patient population, the authors found that, overall, one in five patients had vaccine hesitancy, as did one in four Black patients or patients aged 18–44 years. One in three responders identified dialysis staff as key sources of information about COVID-19 vaccines. Patients on hemodialysis who were vaccine hesitant were chiefly concerned about side effects. These findings highlight the opportunities available to dialysis networks in facilitating vaccine uptake among patients on dialysis and identify specific subgroups for which additional outreach is necessary.

Background
Patients on dialysis are at increased risk for COVID-19–related complications. However, a substantial fraction of patients on dialysis belong to groups more likely to be hesitant about vaccination.

Methods
With the goal of identifying strategies to increase COVID-19 vaccine uptake among patients on hemodialysis, we conducted a nationwide vaccine acceptability survey, partnering with a dialysis network to distribute an anonymized English and Spanish language online survey in 150 randomly selected facilities in the United States. We used logistic regression to evaluate characteristics of vaccine-hesitant persons.

Results
A total of 1515 (14% of eligible) patients responded; 20% of all responders, 29% of patients aged 18–44 years, and 29% of Black responders reported being hesitant to seek the COVID-19 vaccine, even if the vaccine was considered safe for the general population. Odds of vaccine hesitancy were higher among patients aged 18–44 years versus those 45–64 years (odds ratio [OR], 1.5; 95% confidence interval [95% CI], 1.0 to 2.3), Black patients versus non-Hispanic White patients (OR, 1.9; 95% CI, 1.3 to 2.7), Native Americans or Pacific Islanders versus non-Hispanic White patients (OR, 2.0; 95% CI, 1.1 to 3.7), and women versus men (OR, 1.6; 95% CI, 1.2 to 2.0). About half (53%) of patients who were vaccine hesitant expressed concerns about side effects. Responders’ main information sources about COVID-19 vaccines were television news and dialysis staff (68% and 38%, respectively).

Conclusions
A substantial proportion of patients receiving in-center hemodialysis in the United States are hesitant about seeking COVID-19 vaccination. Facilitating uptake requires outreach to younger patients, women, and Black, Native American, or Pacific Islander patients, and addressing concerns about side effects.

Podcast
This article contains a podcast at https://www.asn-online.org/media/podcast/JASN/2021_07_07_JASN2021010104.mp3