Comparison of long-term antibody response to mRNA SARS-CoV-2 vaccine among peritoneal dialysis and hemodialysis patients

Einbinder, Yael; Hornik-Lurie, Tzipi; Cohen-Hagai, Keren; Goldman, Shira; Tanasiychuk, Tatiana; Nacasch, Naomi; Erez, Daniel; Magen, Sophie; Zitman‐Gal, Tali; Wiener-Well, Yonit; Frajewicki, Victor; Benchetrit, Sydney; Shavit, Linda; Bnaya, Alon

doi:10.1093/ndt/gfab321

Cited by 7 publications

(9 citation statements)

References 8 publications

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“…The effect of dialysis modality on SARS-CoV-2-vaccine-induced antibody levels remains uncertain. In several studies, PD patients exhibited higher vaccine-induced antibody levels than HD patients [ 31 , 32 ]. However, in our cohort, we observed lower antibody titers in PD patients compared with HD patients, which could be explained by a lower serum albumin level, a well-known risk factor for reduced HMI for COVID-19 and other vaccines in the PD group [ 4 , 28 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Durability of Humoral and Cellular Immunity after an Extended Primary Series with Heterologous Inactivated SARS-CoV-2 Prime-Boost and ChAdOx1 nCoV-19 in Dialysis Patients (ICON3)

et al. 2022

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The durability of a three-dose extended primary series of COVID-9 vaccine in dialysis patients remains unknown. Here, we assessed dynamic changes in SARS-CoV-2-specific humoral and cell-mediated immunity at baseline, 3 months, and 6 months after the extended primary series in 29 hemodialyzed (HD), 28 peritoneal dialyzed (PD) patients, and 14 healthy controls. Participants received two doses of inactivated SARS-CoV-2 vaccine followed by a dose of ChAdOx1 nCoV-19 vaccine. At 6 months, median anti-RBD IgG titers (IQR) significantly declined from baseline in the HD (1741 (1136–3083) BAU/mL vs. 373 (188–607) BAU/mL) and PD (1093 (617–1911) BAU/mL vs. 180 (126–320) BAU/mL) groups, as did the mean percent inhibition of neutralizing antibodies (HD: 96% vs. 81%; PD: 95% vs. 73%) (all p < 0.01). Age and post-vaccination serological response intensity were predictors of early humoral seroprotection loss. In contrast, cell-mediated immunity remained unchanged. In conclusion, humoral immunity declined substantially in dialysis patients, while cell-mediated immunity remained stable 6 months after the extended heterologous primary series of two inactivated SARS-CoV-2/ChAdOx1 nCoV-19 vaccine. A booster dose could be considered in dialysis patients 3 months after this unique regimen, particularly in the elderly or those with a modest initial humoral response.

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Section: Discussionmentioning

confidence: 99%

Durability of Humoral and Cellular Immunity after an Extended Primary Series with Heterologous Inactivated SARS-CoV-2 Prime-Boost and ChAdOx1 nCoV-19 in Dialysis Patients (ICON3)

et al. 2022

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“…In a recent report, antibody levels remained high in both PD (85%) and HD (79%) patients in 3 months after BNT162Bb2 vaccine [ 10 ]. In another study again with BNT162Bb2 vaccine, seropositivity was around 80% after 6 months [ 11 ]. There has been an example of 3rd dose application 4 weeks after the 2nd dose [ 12 ], but the same report also highlighted greater increase in antibody titers when interval between 2nd and 3rd doses were longer.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Waning of SARS-CoV-2 Vaccine-Induced Immune Response over 6 Months in Peritoneal Dialysis Patients and the Role of a Booster Dose in Maintaining Seropositivity

Murt

Dinç

Altiparmak

et al. 2022

Nephron

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Introduction: Although lower than general population, newly developed SARS-CoV-2 vaccines generate immune responses in end-stage kidney disease patients. However, the persistence of immune responses in the long term is not known yet. This study aimed to evaluate humoral immune responses in peritoneal dialysis (PD) patients over 6 months and to analyze the effects of the booster dose. Methods: Humoral immune responses of PD patients were measured after initial SARS-CoV-2 vaccinations and after 6 months following initial vaccinations. Immune responses were compared between patients who received and did not receive booster doses. PD patients were compared with 41 hemodialysis (HD) patients and 61 healthy controls. Humoral immune responses were measured by a commercial test that detects antibodies toward the receptor-binding domain of the spike protein of SARS-CoV-2. Results: Twenty PD patients were evaluated over 6 months. The initial seropositivity rate was 90.9% with inactivated vaccine and 100% with mRNA vaccine. Seropositivity decreased to 44.4% after 6 months, and a booster dose helped in maintaining the 100% of seropositivity (p = 0.005). Magnitude of humoral response at the 6th month was also higher in patients who received the third dose (1,132.8 ± 769.6 AU/mL vs. 400.0 ± 294.6 AU/mL; p = 0.015). Among patients who did not receive the third dose, those who got mRNA vaccine could maintain higher seropositivity than others who got inactivated vaccine (75% vs. 40% for PD, 81.8% vs. 50% for HD). Seropositivity and antibody levels were similar for PD and HD patients after 6 months (p = 0.24 and 0.56) but lower than healthy controls (p = 0.0013). Conclusion: SARS-CoV-2 vaccine-induced antibody levels and seropositivity of PD patients significantly fall after 6 months. A booster dose after around 3 months following initial immunization might help in maintaining seropositivity.

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“…While most haemodialysis patients experience a durable immune response following a full COVID-19 vaccination schedule that is comparable to the general population, there is evidence to suggest that those with higher initial antibody titres exhibit a more prolonged response [ 80 , 81 , 82 , 83 ]. When reviewed after a second vaccination dose, reduced responses have been observed in haemodialysis patients as indicated by lower peak antibody levels compared to the general population [ 46 , 82 ]. A lower level of immunity is greatest amongst elderly individuals receiving haemodialysis [ 46 , 82 ].…”

Section: Prevention Strategies For Covid-19 In Elderly Haemodialysis ...mentioning

confidence: 99%

“…When reviewed after a second vaccination dose, reduced responses have been observed in haemodialysis patients as indicated by lower peak antibody levels compared to the general population [ 46 , 82 ]. A lower level of immunity is greatest amongst elderly individuals receiving haemodialysis [ 46 , 82 ]. However, a third COVID-19 vaccination dose has been demonstrated to have elicited increased and adequate peak antibody levels for this patient group [ 84 ].…”

Section: Prevention Strategies For Covid-19 In Elderly Haemodialysis ...mentioning

confidence: 99%

COVID-19 in Elderly Patients Receiving Haemodialysis: A Current Review

McDonnell

Kalra

et al. 2023

Biomedicines

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There is an increased incidence of elderly adults diagnosed with kidney failure as our global aging population continues to expand. Hence, the number of elderly adults indicated for kidney replacement therapy is also increasing simultaneously. Haemodialysis initiation is more commonly observed in comparison to kidney transplantation and peritoneal dialysis for the elderly. The onset of the coronavirus 2019 (COVID-19) pandemic brought new paradigms and insights for the care of this patient population. Elderly patients receiving haemodialysis have been identified as high-risk groups for poor COVID-19 outcomes. Age, immunosenescence, impaired response to COVID-19 vaccination, increased exposure to sources of COVID-19 infection and thrombotic risks during dialysis are key factors which demonstrated significant associations with COVID-19 incidence, severity and mortality for this patient group. Recent findings suggest that preventative measures such as regular screening and, if needed, isolation in COVID-19-positive cases, alongside the fulfillment of COVID-19 vaccination programs is an integral strategy to reduce the number of COVID-19 cases and consequential complications from COVID-19, particularly for high-risk groups such as elderly haemodialysis patients. The COVID-19 pandemic brought about the rapid development and repurposing of a number of medications to treat patients in the viral and inflammatory stages of their disease. However, elderly haemodialysis patients were grossly unrepresented in many of these trials. We review the evidence for contemporary treatments for COVID-19 in this population to provide clinicians with an up-to-date guide. We hope our article increases awareness on the associations and impact of COVID-19 for the elderly haemodialysis population, and encourage research efforts to address knowledge gaps in this topical area.

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Comparison of long-term antibody response to mRNA SARS-CoV-2 vaccine among peritoneal dialysis and hemodialysis patients

Cited by 7 publications

References 8 publications

Durability of Humoral and Cellular Immunity after an Extended Primary Series with Heterologous Inactivated SARS-CoV-2 Prime-Boost and ChAdOx1 nCoV-19 in Dialysis Patients (ICON3)

Durability of Humoral and Cellular Immunity after an Extended Primary Series with Heterologous Inactivated SARS-CoV-2 Prime-Boost and ChAdOx1 nCoV-19 in Dialysis Patients (ICON3)

Waning of SARS-CoV-2 Vaccine-Induced Immune Response over 6 Months in Peritoneal Dialysis Patients and the Role of a Booster Dose in Maintaining Seropositivity

COVID-19 in Elderly Patients Receiving Haemodialysis: A Current Review

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