Humoral Response to Third Dose of SARS-CoV-2 Vaccines in the CKD Spectrum

Quiroga, Borja; Soler, María José; Ortíz, Alberto; Orero, Esther; Tejedor, Sandra; Mantecón, Carlos Jesús Jarava; Pérez, Virginia Olinda Gómez; Franco, A; Sánchez, Christian Alfaro; Carretero, Marta; Rodríguez, Maria Teresa Jaldo; Riso, Manuel Antonio Carnerero Di; Martínez, Shaira; González, Carmen Calderón; Červienka, Michal; Carmona, Nicolás Macías; Arroyo, David; Valle, Katia M Pérez Del; Arriba, Gabriel de; Mazuecos, Auxiliadora; Cazorla, Juan Manuel; Pereira, Mónica; Parra, Emilio González; Márquez, Marı́a Gabriela; Novillo, Carolina Lancho; Ruiz, Carmen Toyos; Cervera, María Cinta Aguilar; Ramos, Patricia Muñoz; Horrillo, Ana Sánchez; Martín, Isabel Jimeno; Toapanta, Néstor; Guldris, Secundino Cigarrán; López, Montserrat Folgueiras; Cecilio, Rosalía Valero San; Linaza, Blanca Villacorta; Pesquera, Ignacio Minguela; Estupiñán, Raquel Santana; Zamora, Rocío; Soriano, Sagrario; Bustillo, Eduardo; Sánchez, María Soledad Pizarro; Puerto, Ana Isabel Martínez; Yugueros, Alejandra; Pacios, Laura Muñiz; Leyva, Alba; Rojas, José Antonio Muñoz; Gansevoort, Ron T.; Sequera, Patricia de

doi:10.2215/cjn.01770222

Cited by 27 publications

(19 citation statements)

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“…In line with previous reports 19-21 , we identified immunosuppressive agents as a predictor for lower neutralization capacity which were primarily prescribed to patients with a history of kidney transplantation. Patients on immunosuppressive medication had significantly lower neutralization capacity for Delta and, by trend, for Omicron.…”

Section: Discussionsupporting

confidence: 80%

See 1 more Smart Citation

Improved SARS-CoV-2 neutralization of Delta and Omicron variants of concern after fourth vaccination in hemodialysis patients

Cheng

Platen

Christa

et al. 2022

Preprint

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Background Hemodialysis patients are exposed to a markedly increased risk when infected with SARS-CoV-2. To date it is unclear if hemodialysis patients benefit from a fourth vaccination. Methods A total of 142 hemodialysis patients (median age 72.6 years, 33.8% female) received four COVID-19 vaccinations between December 2020 and March 2022. RDB binding antibody titers were determined in a competitive surrogate neutralization assay. Vero-E6 cells were infected with SARS-CoV-2 variants of concern (VoC) Delta (B.1.617.2) or Omicron (B.1.1.529, sub lineage BA.1) in a biosafety level 3 laboratory to determine serum infection neutralization capacity before and after vaccination. Results After the fourth vaccination serum infection neutralization capacity significantly increased from a 50% inhibitory concentration (IC50, serum dilution factor 1:x) of 247.0 (46.3-1560.8) to 2560.0 (1174.0-2560.0) for the Delta VoC, and from 37.5 (20.0-198.8) to 668.5 (182.2-2560.0) for the Omicron VoC (each p<0.001). A significant increase of the neutralization capacity was even observed for patients who had high antibody titers after three vaccinations (p<0.001). Univariate regression analysis indicated immunosuppressive medication (p=0.001) and hepatitis B vaccination non-response (p=0.046), and multivariate analysis immunosuppressive medication as the only factor associated with a reduced effect against Delta (p<0.001). Ten patients with SARS-CoV-2 breakthrough infection before the fourth vaccination had by trend lower prior neutralization capacity for Omicron (p=0.051). Conclusions Our findings suggest that hemodialysis patients benefit from a fourth vaccination in particular in the light of the highly infectious SARS-CoV-2 Omicron variant. A routinely applied four-time vaccination seems to broaden immunity against variants and would be recommended in hemodialysis patients.

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Section: Discussionsupporting

confidence: 80%

“…We found response rates of 57% for Omicron and 79% for Delta four months after the third vaccination. Methodological differences in the neutralization assays 5, 18 as well as time interval differences associated with reduced immune responses to vaccination 19 might explain these variations.…”

Section: Discussionmentioning

confidence: 99%

Improved SARS-CoV-2 neutralization of Delta and Omicron variants of concern after fourth vaccination in hemodialysis patients

Cheng

Platen

Christa

et al. 2022

Preprint

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“…Nonetheless, patients with CKD mounted a seroconversion rate that was comparable with the general population (Supplemental Table 1 ) and were prioritized for vaccination. It is noteworthy, however, that patients who did not receive a third dose of the vaccine had a significant decline in antibody titre after 3 to 6 months 35 .…”

Section: Challenges and Opportunities Of Covid-19mentioning

confidence: 93%

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

et al. 2022

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The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce.

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“…One study analyzed the humoral response after the third dose of the vaccine, showing a slight increase in the proportion of patients who achieve seroconversion, but with a very intense humoral response, reaching a 36-fold increase in median antibody titers after the booster dose ( 29 ), and another study showed that a third dose reduced the proportion of patients with no or weak response from 60.8 to 15% ( 30 ). An additional study determined that 6 months after the first immunization, 96% of patients who had received three vaccine doses had responded positively, compared to 64% when only two doses had been administered ( 31 ). The rate of immediate seroconversion observed in our study after the booster dose confirms the data described by these previous studies.…”

Section: Discussionmentioning

confidence: 99%

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

Gallego-Valcarce

Shabaka²,

Leon-Poo³

et al. 2022

Front. Med.

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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.

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Humoral Response to Third Dose of SARS-CoV-2 Vaccines in the CKD Spectrum

Abstract: A prospective observational study for justification, safety, and efficacy of a third dose of mRNA vaccine in patients receiving maintenance hemodialysis. Kidney Int 101: [390][391][392][393][394][395][396][397][398][399][400][401][402] 2022

Cited by 27 publications

References 5 publications

Improved SARS-CoV-2 neutralization of Delta and Omicron variants of concern after fourth vaccination in hemodialysis patients

Improved SARS-CoV-2 neutralization of Delta and Omicron variants of concern after fourth vaccination in hemodialysis patients

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

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

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