Survival benefit of a third dose of the COVID-19 vaccine among hemodialysis patients: A prospective cohort study

Tz Heng Chen, Yang Ho, Hsin Ling Tai, Yuan Chia Chu, Yao Ping Lin, Chih Yu Yang, Wei Cheng Tseng, Shuo Ming Ou, Ming Tsun Tsai, Jinn Yang Chen, Tsai Hung Wu, Kuo Hua Lee, Fan Yu Chen, Szu Yuan Li, Chih Ching Lin, Der Cherng Tarng*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Hemodialysis (HD) patients are particularly vulnerable to severe coronavirus disease 2019 (COVID-19) due to their immunocompromised state and comorbid conditions. Timely vaccination could be the most effective strategy to reduce morbidity and mortality. However, data on the survival benefit of the COVID-19 vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and death among HD patients are limited, especially during the Omicron-dominant period. Methods: In this prospective hospital-based cohort study, we identified HD patients from July 1, 2021, to April 29, 2022. The patients were divided into fully vaccinated and partially vaccinated groups. We compared the humoral response, risk of developing SARS-CoV-2 infection, and all-cause mortality between the two groups. Results: Among the 440 HD patients included, 152 patients were fully vaccinated, and 288 patients were partially vaccinated. Patients in the fully vaccinated group exhibited higher anti-spike protein receptor-binding domain (S protein RBD) antibody levels and lower risks of all-cause mortality (adjusted hazard ratio, 0.35; 95% confidence interval, 0.17–0.73; p = 0.005) than the partially vaccinated group. However, the risk for SARS-CoV-2 infection did not significantly differ between the two groups. Irrespective of the number of vaccinations, the risk of all-cause mortality was lower in patients with anti-S protein RBD antibody levels in the higher tertile. Conclusion: A third dose of the COVID-19 vaccine was associated with a decreased risk of all-cause mortality among HD patients during the Omicron-dominant period. A higher post-vaccination anti-S protein RBD antibody level was also associated with a lower risk of mortality.

Original languageEnglish
JournalJournal of Microbiology, Immunology and Infection
StateAccepted/In press - 2023


  • Anti-spike protein receptor-binding domain antibody
  • Coronavirus disease 2019 (COVID-19)
  • COVID-19 vaccine
  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)


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