# Status of COVID-19 vaccination in patients undergoing dialysis in China: a national cross-sectional study (2022)

## TL;DR

This study examines low vaccination rates among dialysis patients in China and identifies barriers like institutional issues and vaccine hesitancy.

## Contribution

The study provides the first national assessment of COVID-19 vaccination in Chinese dialysis patients and identifies specific barriers and recommendations.

## Key findings

- Only 21.0% of dialysis patients received at least one vaccine dose, with inactivated vaccines being most common.
- Institutional barriers affected 53.5% of unvaccinated patients, despite 88.7% having no contraindications.
- Adenovirus vector vaccines had higher adverse reaction rates compared to other vaccine types.

## Abstract

Due to their comorbidities and frequent exposure to healthcare settings, patients undergoing dialysis are at a high risk of developing severe COVID - 19. However, there are no customized vaccination guidelines for this group in China. This study had two aims: to systematically evaluate the current status of COVID - 19 vaccination among Chinese dialysis patients and to offer a basis for policy - making and further research.

This study was conducted across all provinces in mainland China using the stratified randomization method. Electronic questionnaires were distributed to patients undergoing dialysis.

Conducted as a national cross - sectional study from May to July 2022, it involved 131,149 dialysis patients from 2,865 centers. The study examined vaccination coverage, the barriers to vaccination, and the safety of vaccines. Only 21.0% received ≥1 vaccine dose, predominantly inactivated vaccines (84.5%). Adverse reactions occurred in 19.0%, with higher rates for adenovirus vector vaccines (27.3%) than for recombinant protein (19.4%) and inactivated vaccines (18.5%, P < 0.001). Among unvaccinated patients, 53.5% faced institutional barriers (e.g., site refusal or lack of recommendations), while 88.7% had no contraindications. Older age (OR = 1.32, 95% CI 1.28–1.36), female gender (OR = 1.18, 1.14–1.22), and hemodialysis (OR = 1.12, 1.06–1.19) predicted non-vaccination.

In general, this study highlights critical barriers to COVID-19 vaccination in dialysis patients: guideline gaps, patient hesitation, and non-specific vaccination settings. Recommendations include updating guidelines to prioritize this population, training non-specialized staff, and launching dialysis center-based vaccination programs. Future research should investigate vaccine immunogenicity in dialysis patients to refine booster strategies.