Haemodialysis patients show a highly diminished antibody response after COVID-19 mRNA vaccination compared with healthy controls

Simon, Benedikt; Rubey, Harald; Treipl, Andreas; Gromann, Martin; Hemedi, Boris; Zehetmayer, Sonja; Kirsch, Bernhard

doi:10.1093/ndt/gfab179

Cited by 126 publications

(137 citation statements)

References 28 publications

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“…This observation is of interest given that antibody titres are described as significantly lower in HD patients after vaccination as compared with healthy subjects [ 5 , 8 , 14 , 15 ] and that a lower antibody response is associated with a lower ability to neutralize SARS-CoV-2 in vitro [ 14 ]. Additionally, a recent study demonstrated that a rapid decline of anti-SARS-CoV-2 antibodies occurs following natural immunization after COVID-19 in dialysis patients [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Humoral response to a third injection of BNT162b2 vaccine in patients on maintenance haemodialysis

Dekervel

Henry

Torreggiani

et al. 2021

Clinical Kidney Journal

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Background Humoral response against SARS-CoV-2 after two doses of BNT162b2 (Pfizer-BioNTech) has been proven less intense in maintenance dialysis patients as compared to healthy subjects, leading the French authorities to recommend a third injection in this population. Here, we investigated the response to the third injection in two cohorts of hemodialysis patients. Methods Data from two prospective observational cohorts were collected. In the first -“systematic”- cohort, patients from 2 hemodialysis centers (n = 66) received a 3rd injection of BNT162b2, regardless of the response after two injections. In the second -“conditional”- cohort, the injection was only prescribed to patients (n = 34) with no or low response to the previous two doses. In both cohorts, the 3rd dose was injected 1 to 2 months after the 2nd dose. Serology was performed after the 2nd and 3rd dose to assess anti-Spike IgG antibody titer. Results In the “systematic” cohort, anti-Spike IgG were found in 83.3% and 92.4% of patients after the 2nd and the 3rd dose of BNT162b2, respectively. In this cohort, 6/11 (54.5%) and 20/21 (95.2%) patients switched from non-responder to low-responder and from low-responder to high-responder, respectively. In low and high-responders to 2 doses, 50/55 (90.9%) at least doubled their anti-Spike IgG titer. Similar trends were observed in the “conditional” cohort. Conclusions In maintenance hemodialysis patients, humoral response against SARS-Cov-2 was boosted after a third dose of BNT162b2, allowing seroconversion in more than half of non-responders. These data may support an intensified vaccination protocol with a 3rd dose of BNT162b2 in dialysis patients.

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Section: Discussionmentioning

confidence: 99%

Humoral response to a third injection of BNT162b2 vaccine in patients on maintenance haemodialysis

Dekervel

Henry

Torreggiani

et al. 2021

Clinical Kidney Journal

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“…Currently, the strategy to eliminate COVID-19 is based on mass vaccination campaigns. Thus, a better awareness of the immune responses to SARS-CoV-2 infection in immunodepressed populations is also important to optimize vaccination strategies in such weak patients [44].…”

Section: Discussionmentioning

confidence: 99%

Persistence of Antibody Responses to the SARS-CoV-2 in Dialysis Patients and Renal Transplant Recipients Recovered from COVID-19

et al. 2021

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Nephropathic subjects with impaired immune responses show dramatically high infection rates of coronavirus disease 2019 (COVID-19). This work evaluated the ability to acquire and maintain protective antibodies over time in 26 hemodialysis patients and 21 kidney transplant recipients. The subjects were followed-up through quantitative determination of circulating SARS-CoV-2 S1/S2 IgG and neutralizing antibodies in the 6-month period after clinical and laboratory recovery. A group of 143 healthcare workers with no underlying chronic pathologies or renal diseases recovered from COVID was also evaluated. In both dialysis and transplanted patients, antibody titers reached a zenith around the 3rd month, and then a decline occurred on average between the 270th and 300th day. Immunocompromised patients who lost antibodies around the 6th month were more common than non-renal subjects, although the difference was not significant (38.5% vs 26.6%). Considering the decay of antibody levels below the positivity threshold (15 AU/mL) as “failure”, a progressive loss of immunisation was found in the overall population starting 6 months after recovery. A longer overall antibody persistence was observed in severe forms of COVID-19 (p = 0.0183), but within each group, given the small number of patients, the difference was not significant (dialysis: p = 0.0702; transplant: p = 0.1899). These data suggest that immunocompromised renal patients recovered from COVID-19 have weakened and heterogeneous humoral responses that tend to decay over time. Despite interindividual variability, an association emerged between antibody persistence and clinical severity, similar to the subjects with preserved immune function.

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“…Robust SARS-CoV-2 antibody responses ≥7 days after the second dose were detected (4). However, patients with KF have an impaired response to vaccination (5) and the earliest reports on COVID-19 vaccination suggest that mRNA vaccines are immunogenic but some patients on dialysis do not seroconvert (6)(7)(8). Patients on kidney replacement therapy were excluded from previous trials.…”

Section: Introductionmentioning

confidence: 99%

Immunogenicity of COVID-19 Tozinameran Vaccination in Patients on Chronic Dialysis

et al. 2021

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Patients with kidney failure have notoriously weak responses to common vaccines. Thus, immunogenicity of novel SARS-CoV-2 vaccines might be impaired in this group. To determine immunogenicity of SARS-CoV-2 vaccination in patients with chronic dialysis, we analyzed the humoral and T-cell response after two doses of mRNA vaccine Tozinameran (BNT162b2 BioNTech/Pfizer). This observational study included 43 patients on dialysis before vaccination with two doses of Tozinameran 21 days apart. Overall, 36 patients completed the observation period until three weeks after the second dose and 32 patients were further analyzed at week 10. Serum samples were analyzed by SARS-CoV-2 specific IgG and IgA antibodies ~1, ~3–4 and ~10 weeks after the second vaccination. In addition, SARS-CoV-2-specific T-cell responses were assessed at ~3–4 weeks by an interferon-gamma release assay (IGRA). Antibody and T cell outcomes at this timepoint were compared to a group of 44 elderly patients not on dialysis, after immunization with Tozinameran. Median age of patients on chronic dialysis was 74.0 years (IQR 66.0, 82.0). The proportion of males was higher (69.4%) than females. Only 20/36 patients (55.6%, 95%CI: 38.29–71.67) developed SARS-CoV-2-IgG antibodies at the first sampling, whereas 32/36 patients (88.9%, 95%CI: 73.00–96.38) demonstrated IgG detection at the second sampling. In a longitudinal follow-up at ~10 weeks after the second dose, the proportion of dialysis patients reactive for anti-SARS-CoV-2-IgG decreased to 27/32 (84.37%, 95%CI: 66.46–94.10) The proportion of anti-SARS-CoV-2 S1 IgA decreased from 33/36 (91.67%; 95%CI: 76.41–97.82) at weeks 3–4 down to 19/32 (59.38; 95%CI: 40.79–75.78). Compared to a cohort of vaccinees with similar age but not on chronic dialysis seroconversion rates and antibody titers were significantly lower. SARS-CoV-2-specific T-cell responses 3 weeks after second vaccination were detected in 21/31 vaccinated dialysis patients (67.7%, 95%CI: 48.53–82.68) compared to 42/44 (93.3%, 95%CI: 76.49–98.84) in controls of similar age. Patients on dialysis demonstrate a delayed, but robust immune response three to four weeks after the second dose, which indicates effective vaccination of this vulnerable group. However, the lower immunogenicity of Tozinameran in these patients needs further attention to develop potential countermeasures such as an additional booster vaccination.

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Haemodialysis patients show a highly diminished antibody response after COVID-19 mRNA vaccination compared with healthy controls

Cited by 126 publications

References 28 publications

Humoral response to a third injection of BNT162b2 vaccine in patients on maintenance haemodialysis

Humoral response to a third injection of BNT162b2 vaccine in patients on maintenance haemodialysis

Persistence of Antibody Responses to the SARS-CoV-2 in Dialysis Patients and Renal Transplant Recipients Recovered from COVID-19

Immunogenicity of COVID-19 Tozinameran Vaccination in Patients on Chronic Dialysis

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