Introduction The effects of the coronavirus disease 19 (COVID-19) pandemic in particular affect those with chronic kidney disease (CKD), who commonly have defects in humoral and cellular immunity, and the efficacy of vaccinations against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is uncertain. Methods To inform public health and clinical practice, we synthesized published studies and preprints evaluating surrogate measures of immunity after SARS-CoV-2 vaccination in patients with CKD including those receiving dialysis or with a kidney transplant. Results We found 35 studies (28 published, 7 preprints), sample size from 23 to 1140 patients, and follow-up from one week to 1 month after vaccination. 17 of the 35 studies enrolled a control group. In the 22 studies of patients receiving dialysis, the development of antibodies was observed in 18 to 53% after one dose, and in 70 to 96% after two doses of mRNA vaccine. In the 14 studies of transplant recipients, 3% to 59% mounted detectable humoral or cellular responses after 2 doses of mRNA vaccine. After vaccination, there are a few reported cases of relapse or de novo glomerulonephritis, and acute transplant rejection suggesting ongoing surveillance is important. Conclusion Studies are needed to better evaluate the effectiveness of SARS-CoV-2 vaccination in these populations. Rigorous surveillance for long-term adverse effects in patients with autoimmune disease and transplant recipients is required. For transplant recipients and those with suboptimal immune responses, alternate vaccination platforms and strategies should be considered. As additional data arise, the NephJC COVID-19 page will be updated ( http://www.nephjc.com/news/covid-vaccine ).

Patients receiving dialysis may have a less robust antibody response to coronavirus disease 2019 (COVID-19) vaccination, yet have a 10-15-fold higher risk for COVID-19-associated mortality than the general population. 1,2 We previously raised concerns about diminished vaccine responses to the attenuated adenovirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine compared with mRNA vaccines among patients on dialysis, although the number of patients receiving the attenuated adenovirus vaccine was small. In this study, we report qualitative and semiquantitative receptor-binding domain (RBD) antibody responses by vaccine type and dialysis modality in 2367 patients receiving dialysis.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.