Humoral Response Following Triple Dose of mRNA Vaccines Against SARS-CoV-2 in Hemodialysis Patients: Results After 1 Year of Follow-Up

Abstract

IntroductionCOVID-19 is associated with an increased mortality in hemodialysis patients. Therefore, achieving a long-lasting effective immune response to SARS-CoV-2 vaccines is essential. This study describes the humoral immune response in hemodialysis patients following three doses of mRNA vaccines against SARS-CoV-2, and explores the factors associated with a sustained immune response.Materials and MethodsWe analyzed the monthly serological evolution of SARS-CoV-2 anti-S(RBD) antibodies for 1 year in 178 chronic hemodialysis patients who received three doses of SARS-CoV-2 mRNA vaccines. The primary outcome was sustained effective humoral response defined as anti-S(RBD) levels > 1,000 AU/ml after 4 months from the third dose. Multivariate logistic regression analyses were used to identify features associated with a sustained humoral immune response.ResultsAfter the initial two SARS-CoV-2 mRNA vaccine doses, 77.8% of patients showed an immediate effective humoral response, decreasing to 52.5% after 4 months. Antibody levels were significantly higher in COVID-exposed patients and HBV vaccine responders. After the third dose, 97% of patients showed an effective humoral response, and remained in 91.7% after 4 months. The mean monthly rate of antibody titer decline decreased from 33 ± 14.5 to 25 ± 16.7%. Multivariate regression analysis showed that previous exposure to COVID-19 and response to HBV vaccines were associated with an effective sustained humoral immune response.ConclusionImmunization with SARS-CoV-2 mRNA vaccines elicits an effective immediate humoral immune response in hemodialysis patients, with a progressive waning in antibody levels. A third booster dose enhances the immune response with significantly higher antibody levels and more sustained humoral immune response. COVID-naïve patients and patients without previous response to HBV vaccines are likely to benefit from receiving more booster doses to maintain an effective immune response.

Two versus three doses of COVID-19 vaccine and post-vaccination COVID-19 infection in hemodialysis patients

“…They noted that this dose resulted in 97% seropositivity and 50 times enhancement on antibody levels. Similar conclusions were reported by other studies [ 19 , 21 , [23] , [24] , [25] , [26] , [27] ].…”

Cellular and Humoral Responses in Dialysis Patients after Vaccination with the BNT162b2 or mRNA-1273 Vaccines

“…Notably, this study reinforced previous observations stating that an extended dosing interval of at least 3 months takes full advantage of the booster vaccine’s properties [ 45 ], since following this extended-duration regimen, 76% of HDPs achieved a robust immune response, with anti-S1-RBD antibody titers exceeding 4.160 AU/mL. Regarding the effects of a third dose of the mRNA-1273 vaccine on the humoral response, Gallego-Valcarce et al [ 29 ] studied 178 HDPs, 138 of which received the mRNA-1273 vaccine, with the remaining 40 receiving the BNT162b2 vaccine. All patients initially received a two-dose regimen with an mRNA-based vaccine.…”

Early humoral response to COVID-19 vaccination in patients living with obesity and diabetes in France. The COVPOP OBEDIAB study with results from the ANRS0001S COV-POPART cohort

“…This finding warrants caution, as part of diabetes complications are known to increase the risk for lower vaccine response. Several studies have reported that patients with CKD have low seroconversion rates in response to mRNA vaccines and fail to develop sustained humoral response, especially those with kidney transplants [37] , [38] , [39] , suggesting a need for ongoing isolation measures and supplementary booster doses in these populations. In a recent systematic review including 16 studies, Boroumand et al extended our findings that patients with diabetes have lower antibody response after the second dose of vaccine compared to individuals without diabetes, irrespective of vaccine type.…”