Reasons for COVID-19 vaccination hesitancy in hemodialysis patients
Authors: Sunil Bhandari
Journal: Kidney International (2021)

We read the excellent series of reports and editorial on the effectiveness of vaccination in patients on dialysis.1Ikizler T.A. Coates P.T. Rovin B.H. Ronco P. Immune response to SARS-CoV-2 infection and vaccination in patients receiving kidney replacement therapy.Kidney Int. 2021; 99: 1275-1279Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar We would concur that although vaccination is less effective in these high-risk patients it remains critical to ensure our at-risk population remains as protected as possible. We would draw attention to the other significant challenge in such a population, namely hesitancy toward vaccination in patients on maintenance dialysis. Vaccine hesitancy is defined by the World Health Organization as a delay in acceptance or refusal of safe vaccines despite availability of vaccine services. We have completed vaccination of our large cohort of patients on renal replacement therapy and have found that while a substantial portion agreed to vaccination, hesitancy still exists in approximately 3% (12 of 378) of our patients. Various reasons for declining the vaccination by these patients are detailed in Table 1. Because others have reported even higher rates of unvaccinated patients on dialysis (and between 8% and 41% may display vaccine hesitancy, depending on ethnicity, sex, age, and deprivation2Razai M. Chaudhry U.A.R. Doerholt K. et al.COVID-19 vaccination hesitancy.BMJ. 2021; 373: 283-285Google Scholar), this represents a significant risk to the remaining cohort of patients and staff as we approach considering booster vaccinations this winter to minimize further COVID-19 disease spikes. A mandatory vaccination is a potential solution for minimizing the risk but could be considered a controversial approach that may interfere with patients' autonomy and choice. The nephrology community needs to provide recommendations that involve a universal thoughtful process.Table 1Reasons given by patients on hemodialysis for not being vaccinated with any of the available COVID-19 vaccinesNo. of patientsReason2"Their choice"—no faith in the COVID-19 vaccines.1Noncompliant with all treatments and did not wish additional treatment.1Refused to give reason for not accepting a COVID-19 vaccine.1Verbally aggressive to staff when offered and not prepared to give reasons.1Believes COVID-19 is just flu and so will not have it—does not take flu vaccine.1Refused to consider COVID-19 vaccine and does not want to be approached. Again a patient who has general noncompliance.3We are young and we believe the media reports that it is all overhyped and we are not convinced of the benefit.1Recovery from a recent long-term illness but may consider it.1Stated they are allergic to vaccines, but this is not substantiated.COVID-19, coronavirus disease 2019. Open table in a new tab COVID-19, coronavirus disease 2019. Immune response to SARS-CoV-2 infection and vaccination in patients receiving kidney replacement therapyKidney InternationalVol. 99Issue 6PreviewIn this issue of Kidney International, the initial experience regarding the immunogenicity of prior coronavirus disease 2019 (COVID-19) infection and the response to the COVID-19 vaccines among patients on maintenance dialysis and kidney transplant recipients is summarized. Preliminary data suggest that there is durability of immune response after COVID-19 infection. Although immune response to the first dose of vaccine is less in infection-naïve patients than healthy individuals in both groups, after the second vaccine dose a significant portion of patients receiving maintenance dialysis develop robust antibody titers, whereas kidney transplant recipients show a less-strong immune response. Full-Text PDF