Immunogenicity of SARS-CoV-2 Vaccine in Dialysis

Weiner

Aweh³

et al. 2021

Preprint

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ImportanceVaccines against SARS-CoV-2 are highly effective in the general population; however, their efficacy may be diminished in maintenance dialysis patients, a population particularly vulnerable to COVID-19 infection and morbidity.ObjectiveWe assessed vaccine response in a national sample of maintenance dialysis patients and identified predictors of response.DesignRetrospective cohort studySetting130 Dialysis Clinic, Inc (DCI) facilitiesParticipantsMaintenance dialysis patients without known prior COVID-19 or a positive baseline antibody titerExposure(s)Vaccine type and clinical characteristicsMain Outcome(s)Using a semi-quantitative assay for antibodies against SARS-CoV-2 spike antigen, vaccine response was defined as at least one titer ≥1 U/L between 14 and 74 days after completion of a SARS-CoV-2 vaccine series. Regression analysis was used to identify characteristics associated with response.ResultsAmong 1528 patients, 437 received BNT162b2/Pfizer vaccine, 766 received mRNA-1273/Moderna, and 325 received Ad26.COV2.S/Janssen. Serologic response differed significantly by vaccine type: 381/437 (87%) among BNT162b2/Pfizer recipients, 736/766 (96%) among mRNA-1273/Moderna recipients, and 119/325 (37%) among Ad26.COV2.S/Janssen recipients. Vaccine type, older age, immune-modulating medication, history of transplantation, and lower serum albumin were associated with vaccine non-response.Conclusions and RelevanceSerologic response to mRNA vaccines is robust among maintenance dialysis patients. Future research should evaluate durability of this response, correlation between seroresponse and protection from COVID-19, and the role of the AD26.COV2.S/Janssen vaccine in this vulnerable population.

“…Accordingly, we retrospectively analyzed seroresponse to SARS-CoV-2 vaccines in maintenance dialysis patients, updating an earlier report. 9…”

Section: Introductionmentioning

confidence: 99%

Seroresponse to SARS-CoV-2 vaccines among maintenance dialysis patients

Weiner

Aweh³

et al. 2021

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“…22,23 We therefore conducted a retrospective multicenter study to assess the intermediate duration of vaccine-induced seroresponse among maintenance dialysis patients. Expanding on an earlier publication, 11 we report here the seroresponse trends over time.…”

Section: Introductionmentioning

confidence: 85%

Seroresponse to SARS-CoV-2 vaccines among maintenance dialysis patients over six months

Weiner

Manley³

et al. 2021

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Background and Objectives: While most maintenance dialysis patients exhibit initial seroresponse to vaccination, concerns remain regarding the durability of this antibody response. This study evaluated immunity over time. Design, setting, participants, and measurements: This retrospective cohort study included maintenance dialysis patients from a midsize national dialysis provider who received a complete SARS-CoV-2 vaccine series and had at least one antibody titer checked after full vaccination. Immunoglobulin G spike antibodies (SAb-IgG) titers were assessed monthly with routine labs beginning after full vaccination and followed over time; the semiquantitative SAb-IgG titer reported a range between 0 and ≥20 U/L. Descriptive analyses compared trends over time by prior history of COVID-19 and type of vaccine received. Time-to-event analyses were conducted for the outcome of loss of seroresponse (SAb-IgG < 1 U/L or development of COVID-19). Cox proportional hazards regression was used to adjust for additional clinical characteristics of interest. Results: Among 1898 maintenance dialysis patients, 1567 (84%) had no prior history of COVID-19. Patients without a history of COVID-19 had declining titers over time. Among 441 BNT162b2/Pfizer recipients, median [IQR] SAb-IgG titer declined from 20 [5.99-20] U/L in month 1 to 1.30 [0.15-3.59] U/L by month 6. Among 779 mRNA-1273/Moderna recipients, median [IQR] SAb-IgG titer declined from 20 [20-20] in month 1 to 6.20 [1.74-20] by month 6. The 347 Ad26.COV2.S/Janssen recipients had a lower titer response than mRNA vaccine recipients over all time periods. In time-to-event analyses, Ad26.COV2.S/Janssen and mRNA-1273/Moderna recipients had the shortest and longest time to loss of seroresponse, respectively. The maximum titer reached in the first two months after full vaccination was predictive of the durability of the SAb-IgG seroresponse; patients with SAb-IgG titer 1-19.99 U/L were more likely to have loss of seroresponse compared to patients with SAb-IgG titer ≥20 U/L (HR 23.9 [95% CI: 16.1-35.5]). Conclusions: Vaccine-induced seroresponse wanes over time among maintenance dialysis patients across vaccine types. Early titers after full vaccination predict the durability of seroresponse.

“…Antibody values range from 1 to 20 U/L, with minimum detectable level of ≥1 U/L per manufacturer, although the DCI Lab validated threshold of ≥2 U/L was used. 3,8 Statistical analyses were performed using SAS v9.4.…”

Section: Methodsmentioning

confidence: 99%

“…1,2 Studies show that 2 doses of the SARS-CoV-2 mRNA vaccines elicit a seroresponse in most (>90%) maintenance dialysis patients, albeit with lower levels than in the general population. [3][4][5][6] The impact of this lesser response as well as potentially more rapidly waning immunity on clinical outcomes is not known. Accordingly we describe the incidence of COVID-19 infection and COVID-19 related hospitalization among unvaccinated, partially vaccinated and fully vaccinated dialysis patients from a national dialysis provider within the US between February 1 and August 26, 2021, as well as available SARS-CoV-2 vaccine immunoglobulin G spike antibody (SAb-IgG) titers in fully vaccinated patients with breakthrough infections.…”

mentioning

confidence: 99%

SARS-CoV-2 vaccine effectiveness and breakthrough infections in maintenance dialysis patients

Manley¹,

Aweh²,

et al. 2021

Preprint

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Among patients receiving maintenance dialysis with a national US dialysis provider, fully vaccinated dialysis patients were significantly less likely to be diagnosed with COVID-19 or be hospitalized than unvaccinated patients. Ad26.COV2.S/Janssen vaccine had significantly worse outcomes, and mRNA-1273/Moderna the best. Among the 27 patients with breakthrough COVID-19 and anti-spike IgG antibodies measured, 23/27 (85%) breakthrough COVID-19 cases occurred at titers <2 U/L (lower limit of a positive response); 14 of these patients never developing Ab titers above 2 U/L. Only 3/27 were receiving immunosuppression. The potential use of antibody titers to guide vaccinations should be explored.