Factors associated with COVID-19 vaccine uptake in people with kidney disease: an OpenSAFELY cohort study

This research has not been peer-reviewed. It is a preliminary report that should not be regarded as conclusive, guide clinical practice or health-related behaviour, or be reported in news media as established information.


Kidney disease is a significant risk factor for COVID-19-related mortality. Achieving high COVID-19 vaccine coverage among people with kidney disease is therefore a public health priority.


With the approval of NHS England, we performed a retrospective cohort study using the OpenSAFELY-TPP platform. Individual-level routine clinical data from 24 million people in England were included. A cohort of individuals with stage 3-5 chronic kidney disease (CKD) or receiving renal replacement therapy (RRT) at the start of the COVID-19 vaccine roll-out was identified based on evidence of reduced estimated glomerular filtration rate or inclusion in the UK Renal Registry. Individual-level factors associated with vaccine uptake were explored via Cox proportional hazards models.


948,845 people with stage 3-5 CKD or receiving RRT were included. Cumulative vaccine coverage as of 11th May 2022 was 97.5%, 97.0%, and 93.5% for doses 1, 2, and 3, respectively, and 61.1% among individuals with one or more indications for receipt of a fourth dose. Delayed 3-dose vaccine uptake was associated with non-White ethnicity, social deprivation, and severe mental illness - associations that were consistent across CKD stages and in RRT recipients. Similar associations were observed for 4-dose uptake, which was also delayed among care home residents.


Although high primary and booster dose coverage has been achieved among people with kidney disease in England, key disparities in vaccine uptake remain across demographic groups. Identifying how to address these disparities remains a priority to reduce the risk of severe disease in this vulnerable patient group.

Author list



  1. London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
  2. Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
  3. TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
  4. The Francis Crick Institute, London, NW1 1AT, UK
  5. UCL Department of Renal Medicine, Royal Free Hospital, London, UK
  6. Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
  7. NIHR Bristol Biomedical Research Centre, Bristol, UK
  8. Kidney Care UK, Alton, UK
  9. Patient Council, UK Kidney Association, Bristol, UK
  10. UK Renal Registry, Bristol, UK
  11. Health Data Research UK South-West, Bristol, UK
  12. Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, Du Cane Road London, W12 0NN, UK
  13. Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK


The OpenSAFELY Collaborative: Edward PK Parker1, John Tazare1, William J Hulme2, Christopher Bates3, Rupert Beale4,5, Edward J Carr4, Jonathan Cockburn3, Helen J Curtis2, Louis Fisher2, Amelia CA Green2, Sam Harper3, Frank Hester3, Elsie MF Horne6,7, Fiona Loud8, Susan Lyon9, Viyaasan Mahalingasivam1, Amir Mehrkar2, Linda Nab2, John Parry3, Shalini Santhakumaran10, Retha Steenkamp10, Jonathan AC Sterne6,7,11, Alex J Walker2, Elizabeth J Williamson1, Michelle Willicombe12,13, Bang Zheng1, Ben Goldacre2, Dorothea Nitsch1,10, Laurie A Tomlinson1

Novel Coronavirus SARS-CoV-2