As vaccines roll out, the threat of COVID-19 continues to loom large over those with kidney disease, especially for the millions of Americans living with chronic kidney disease (CKD), end-stage renal disease (ESRD), and kidney transplants. The COVID-19 pandemic has forced all of us in the medical community to confront a disease where we have had incomplete knowledge of transmission, clinical course, and therapeutics. All the while, we have needed to provide for immediate needs and protect the vulnerable with the best knowledge we have.
The threat is, indeed, very real: data compiled by the Centers for Medicare & Medicaid Services show that 50% of Medicare beneficiaries who have been hospitalized with COVID-19 suffered from CKD. Other evidence has revealed that patients with CKD are more likely to die from COVID-19 in the hospital than COVID-19 patients with preserved renal function. Moreover, evidence shows that, relative to patients without pre-existing kidney diseases, individuals with ESRD who rely on dialysis care have a shorter time between the first onset of COVID-19 symptoms to admission to an ICU, as well as greater in-hospital mortality.
Without question, individuals with ESRD especially are at an increased risk of developing severe COVID-19 complications. Knowing this, it's imperative that the U.S. Department of Health and Human Services (HHS) specifically prioritize COVID-19 vaccinations for these individuals -- as well as their care providers -- during the highest group possible of Phase 1 distribution.
According to the CDC, as of September, the rate of COVID-19 infection among dialysis patients in particular was over four times higher than the general Medicare population. Because 90% of our patients must travel to in-center treatments during the pandemic, observation of strict quarantine measures are not possible for this group, leading to a tragically high infection rate. In other words, our patients not only contract the disease more often, but because of comorbidities, are more likely to be hospitalized and succumb to infection.
Fortunately, based on what we know from publicly available safety and efficacy data, there have been no ethnic, gender, or age-related groups identified that do not benefit from COVID-19 vaccination. So, once a vaccine does eventually roll out, we expect that it will be efficacious for individuals with kidney disease or who have had a transplant -- and especially vulnerable ESRD patients -- consequently saving countless lives of people in this high-risk group.
Prioritizing this vulnerable population, a large percentage of whom are African Americans and suffering from multiple comorbidities, is essential. Vaccinating both patients and health professionals will help stop the spread of COVID-19 in the dialysis population while reducing the likelihood they will be hospitalized or infect others.
So far, it appears that policymakers are on the right track. Both HHS and the CDC have announced plans to prioritize healthcare workers and high-risk patient groups. We applaud those healthcare workers who have made life-threatening sacrifices to provide care to patients with kidney disease. However, with more than 90 million American adults at "high risk" of developing severe COVID-19 complications, and a limited supply of vaccines in the early months, it's crucial that individuals on dialysis be given special consideration.
Even with their multiple comorbidities, elevated risk for infection, and disproportionate risk for developing deadly complications, the fact is that our patients simply cannot go without the dialysis services they need -- even during a highly contagious pandemic. Ensuring early vaccination of these patients, as well as the healthcare providers who serve them, is the best way to protect this vulnerable community and reduce the transmission of COVID-19.
There is light at the end of the tunnel, and the kidney community is hopeful that the various groups working toward equitable distribution of the vaccine keep in mind the subpopulations -- like those living with kidney disease -- who need it so desperately for their health and survival.
John P. Butler, is chair of Kidney Care Partners, as well as president and CEO of Akebia Therapeutics. Lori Hartwell is founder and president of the Renal Support Network. Charles (Ross) Betts, MD, is acting chief medical officer for American Renal Associates.