Humoral Response to Pfizer BNT162b2 Vaccine Booster in Maintenance Hemodialysis Patients

Abstract

<b><i>Introduction:</i></b> Coronavirus disease is associated with increased morbidity and mortality in maintenance hemodialysis (MHD) patients. Recent breakthrough infection in vaccinated people has led some authorities to recommend a booster dose for patients fully vaccinated 5–8 months ago. We aimed to assess the humoral response of MHD patients following a booster dose with the BNT162b2 vaccine. <b><i>Methods:</i></b> The study included 102 MHD patients vaccinated with 2 doses of the BNT162b2 (Pfizer-BioNTech) vaccine. A third dose (booster) was recommended to all MHD patients in our center and was given to those who opted to receive it, resulting in a booster group and a control group that did not receive the booster. Previous exposure was excluded by testing for the presence of the anti-nucleocapsid antibody (SARS-CoV-2) or positive PCR. We assessed the humoral response before and after the booster dose. <b><i>Results:</i></b> Of 66 patients in the booster group, 65 patients (98.5%) developed a positive antibody response, from 472.7 ± 749.5 to 16,336.8 ± 15,397.3, as compared to a sustained decrease in the control group (695.7 ± 642.7 to 383.6 ± 298.6), <i>p</i> < 0.0001. No significant adverse effects were reported. Prior antibody titers were positively correlated to IgG levels following the booster dose. There was a significant association between malnutrition-inflammation markers and the humoral response. <b><i>Conclusions:</i></b> Almost all MHD patients developed a substantial humoral response following the booster dose, which was significantly higher than levels reported for MHD patients following administration of 2 doses alone. Further studies and observations are needed to determine the exact timing and dosing schedule.

Humoral Response and SARS-CoV-2 Infection Risk following the Third and Fourth Doses of the BNT162b2 Vaccine in Dialysis Patients

“…The degree of response was in line with previous response to the third dose. Correlation between the humoral response to the third dose and the response to previous doses, as well as an inverse correlation with age, has been previously reported by our group and others [3,4].…”

“…Dialysis patients elicit weaker early humoral responses to vaccinations, when compared to healthy controls, which also decline over time [6]. Similar to previous reports, the third vaccine dose led to a profound increase in antibody titers [3,7]. Nevertheless, the durability and efficacy of this immune response are still undefined in general, let alone in dialysis patients.…”

“…A third “booster” dose of the BNT162b2 (Pfizer-BioNTech) vaccine effectively overcame waning immunity over time and the emergence of the highly transmissible B.1.617.2 (Delta) variant and significantly reduced the rate of SARS-CoV-2 infections and illness severity in the general population [2]. The third dose also led to a significant humoral response in hemodialysis (HD) patients [3, 4].…”

Effect of Third and Fourth mRNA-Based Booster Vaccinations on SARS-CoV-2 Neutralizing Antibody Titer Formation, Risk Factors for Non-Response, and Outcome after SARS-CoV-2 Omicron Breakthrough Infections in Patients on Chronic Hemodialysis: A Prospective Multicenter Cohort Study

“…Furthermore, twelve former low-responders and two of three non-responders (after two doses) showed significant increases in their antibody levels after the third booster vaccination. Since then, further investigations on the efficacy of booster vaccinations in end-stage renal disease patients have been published [ 20 , 21 , 22 , 23 , 24 ]. These investigations evaluated IgG antibody titers in cohorts of 40 to over 2700 hemodialysis patients.…”

A third SARS-CoV-2 mRNA vaccine dose in people receiving hemodialysis overcomes B cell defects but elicits a skewed CD4+T cell profile

“…As cellular immune responses are comparatively less impacted by the third dose in CI than HD individuals, responses from both cohorts globally converged after the full vaccination course. Some studies have highlighted such convergence for anti-RBD IgG responses between HD and CI after three mRNA vaccine doses (El Karoui et al, 2022; Shashar et al, 2022; Verdier et al, 2022). We believe that the finding that low cellular immunity responsiveness in HD can be overcome by repeat dosing is a major positive conclusion of our study and provides an immunological basis for previous findings on the antibody responses elicited by a third dose in this vulnerable population.…”