Immunosuppression in Glomerular Diseases: Implications for SARS-CoV-2 Vaccines and COVID-19

Yeaman, Michael R.

doi:10.1159/000519182

Cited by 4 publications

(3 citation statements)

References 92 publications

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“…Several potential risk factors for failed seroconversion have been suggested, immunosuppression and its intensity in the post-transplant period being the most important [44]. The number of vaccine doses received also influences the development of an immune response.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of COVID-19 Disease in Renal Transplant Recipients

Zimnickaitė,

Kucinaitė,

Zablockienė

et al. 2024

Medicina

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Background and Objectives: Kidney transplant recipients are at risk of developing more severe forms of COVID-19 infection. The aim of this study was to compare the clinical course of COVID-19 infection among kidney transplant patients and a control group. Materials and Methods: We examined 150 patients hospitalized with COVID-19 infection. Patients were divided into study (kidney transplant recipients, n = 53) and control (without a history of kidney transplantation, n = 97) groups. Demographics, clinical characteristics, treatment data, and clinical outcomes were assessed. Results: The median patient age was 56.0 (46.0–64.0) years, and seventy-seven patients (51.3%) were men. The median Charlson comorbidity index was higher in the study group (3.0 vs. 2.0, p < 0.001). There was a higher incidence of hypoxemia in the control group upon arrival (52.6% vs. 22.6%, p = 0.001) and a higher NEWS index median (2.0 vs. 1.0 points, p = 0.009) and incidence of pneumonia during hospitalization (88.7% vs. 73.6%, p = 0.023). In the study group, there were more cases of mild (26.4% vs. 11.3%, p = 0.023) and critically severe forms of COVID-19 infection (26.4% vs. 3.1%, p < 0.001), kidney failure was more prevalent (34.0% vs. 1.0%, p < 0.001), and a greater number of patients were transferred to the intensive care unit (22.6% vs. 3.1%, p < 0.001) and died (18.9% vs. 1.0%, p < 0.001). Multivariable analysis revealed that treatment in the intensive care unit correlated with a higher mortality rate than transplantation itself (HR = 20.71, 95% CI 2.01–213.33, p = 0.011). Conclusions: The course of the COVID-19 disease in kidney transplant recipients is heterogeneous and can be more severe than in the general population. Even though patients may be hospitalized with fewer symptoms, complications and death are more likely to occur.

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Section: Discussionmentioning

confidence: 99%

Characteristics of COVID-19 Disease in Renal Transplant Recipients

Zimnickaitė,

Kucinaitė,

Zablockienė

et al. 2024

Medicina

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“…Immunosuppressive treatment of rheumatic diseases is associated with reduced immunity to mRNA vaccines ( 5 , 6 ) and poor outcomes ( 7 ). Although there are several reports on seroconversion against SARS-CoV-2 vaccines in patients with kidney disease receiving immunosuppressive treatment ( 8 , 9 ), few studies have compared the degree of serial humoral immune responses among different treatment regimens. The objective of this study was to estimate the humoral immune response, as measured by the immunoglobulin G (IgG) levels, against the SARS-CoV-2 spike receptor-binding domain (RBD-IgG) following the third mRNA coronavirus disease 2019 (COVID-19) vaccination in patients with kidney disease who received immunosuppressive treatment.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Serial Humoral Immune Response according to the Immunosuppressive Treatment after SARS-CoV-2 mRNA Vaccination

Menjo,

Hasegawa,

Fujigaki

et al. 2023

Intern. Med.

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Objective The objective of this study was to estimate the humoral immune response evaluated by immunoglobulin G (IgG) against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike receptor-binding domain (RBD-IgG) following the third mRNA coronavirus disease 2019 (COVID-19) vaccination in patients with kidney disease who received immunosuppressive treatment. Methods The primary outcome was RBD-IgG levels after the third SARS-CoV-2 vaccination. The primary comparison was the RBD-IgG levels between patients with kidney disease who received immunosuppressive treatment (n=124) and those who did not (n=33). Results The RBD-IgG levels were significantly lower in the patients with kidney disease who received immunosuppressive treatment than in those who did not receive immunosuppressive treatment. The RBD-IgG levels were lower in patients treated with glucocorticoid monotherapy than in those who did not receive immunosuppressive treatment. Even in patients who received ≤5 mg prednisolone, the RBD-IgG levels were significantly lower. Nine of the 10 patients who received rituximab within one year before the first vaccination did not experience seroconversion after the third vaccination. Meanwhile, all nine patients who received rituximab only after the second vaccination experienced seroconversion, even if B cell recovery was insufficient. Patients treated with mycophenolate mofetil plus glucocorticoid plus belimumab had significantly lower RBD-IgG levels than those treated with mycophenolate mofetil plus glucocorticoid. Conclusion The RBD-IgG levels were lower in patients with kidney disease who received immunosuppressive treatment than in those who did not receive immunosuppressive treatment. Low-dose glucocorticoid monotherapy affected the humoral immune response following the third mRNA COVID-19 vaccination.

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“…During the ongoing COVID-19 pandemic, accrued data worldwide across the socio-geographic spectrum has convincingly shown that COVID-19 infection-related morbidity and mortality risks can be amplified in kidney disease and immunocompromised hosts [ 6 , 7 ]. Thus, leading expert opinion had empirically recommended COVID-19 vaccination for patients with immune-mediated kidney diseases [ 8 ], despite limited published data regarding vaccine efficacy in glomerulonephritides treated with immunosuppressants [ 9 ]. However, the lack of trial safety data in glomerulonephritides and reports of IgA nephropathy flares after vaccination that emerged in early 2021 [ 10 , 11 , 12 ] have led to calls for nephrologists to advocate COVID-19 vaccination but counsel patients regarding a small risk of relapsing disease for up to one month after the second dose and to monitor for symptoms suggestive of relapse [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

A Descriptive Evaluation of Health Literacy and Determinants of COVID-19 Vaccine Acceptance among Patients with IgA Nephropathy with High Vaccine Uptake

Lim

Mok²,

Leeu³

et al. 2022

Glomerular Dis

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Aims: Shared decision-making regarding COVID-19 vaccination in IgA nephropathy involves the ability to handle health information regarding potential benefits and risk of flare, but few studies have evaluated health literacy in the context of vaccination. We aimed to evaluate the health literacy and COVID-19 vaccination uptake and acceptance in IgA nephropathy. Methods: Single-center cross-sectional study of 126 consecutive patients with IgA nephropathy. Health literacy was assessed using the HLS-EU-47 questionnaire. Determinants of vaccine acceptance such as contextual influences, individual and group influences, and vaccine-specific issues were adapted from the World Health Organization framework. Results: Forty-eight patients (38.1%) with IgAN nephropathy completed the survey between June and August 2021. The participants’ median age was 40.5 (31.6, 52.8) years with median disease duration of 2.8 (1.3, 4.3) years. The median general health literacy index was 31.74 (29.88, 35.82) with significantly greater difficulty in the competency of appraising health information and in the domain of disease prevention (p<0.001). Forty-five patients (93.8%) received at least one dose of COVID-19 vaccine between January and August 2021. Among the 3 unvaccinated patients, 2 intended to receive the vaccination while and 1 did not intend to get vaccinated. There was a high level of trust and belief that their government and healthcare providers had their best interests at heart and that the healthcare providers were honest about the vaccine’s risk and benefits, although 31.2% did not understand how the vaccine works and 22.9% believed that there were other ways to prevent infection. Most thought there was adequate safety information, were confident in the system for tracking adverse events and had no issues with access to the vaccine. Conclusion: Participants with IgA nephropathy had high health literacy scores and low vaccine hesitancy. The determinants for vaccine acceptance can guide efforts to optimize vaccination coverage.

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Immunosuppression in Glomerular Diseases: Implications for SARS-CoV-2 Vaccines and COVID-19

Cited by 4 publications

References 92 publications

Characteristics of COVID-19 Disease in Renal Transplant Recipients

Characteristics of COVID-19 Disease in Renal Transplant Recipients

Comparison of the Serial Humoral Immune Response according to the Immunosuppressive Treatment after SARS-CoV-2 mRNA Vaccination

A Descriptive Evaluation of Health Literacy and Determinants of COVID-19 Vaccine Acceptance among Patients with IgA Nephropathy with High Vaccine Uptake

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