Response to and outcomes of the Pfizer BNT162B2 vaccine in hemodialysis patients—A prospective observational study

Abstract

Introduction: COVID-19 infection is associated with high mortality among hemodialysis patients. Standard vaccine response is generally lower among these patients. The adequate antibody titer response and the outcome of COVID-19 vaccine responders versus non-responders are unknown.Methods: Hemodialysis patients on maintenance hemodialysis who have received two doses of Pfizer BNT162B2 vaccine were studied. Antibody response was tested after 14 days of the second dose. LIAISON SARS-CoV2 S1/S2 IgG test by DiaSorin (Italy) was used to assess antibody response. Patients were followed between 3 and 7 months after vaccination for COVID-19 infection, hospitalization and death related to COVID-19.Findings: A total of 138 patients received two doses of Pfizer BNT162B2 vaccine. One hundred and twenty-seven patients had adequate response to the vaccine with IgG level ≥ 15 AU/ml versus 11 patients had poor response with IgG level ≤ 15 AU/ml. The response was 92% (127/138). Patient with history of prior COVID-19 infection had higher antibody titer mean of 339 AE 113 versus 157 AE 140 for patient with no prior history of COVID-19.Seven patients in both groups had COVID-19 infection post vaccine. Among the responders, five patients had COIVD-19 infection and two were hospitalized. These two patients had lower antibody titer of 23.9 and 75.2 AU/ml. In comparison, three patients who were not hospitalized had higher antibody titer 96.3, 118, and 319 AU/ml, respectively. In the non-responders one patient was hospitalized and one death occurred with rate of infection of 18%.Discussion: Seropositive patients with low antibody titer might be associated with worse outcome among responders. The ideal antibody titer level among dialysis patient is not known. Also, prior COVID-19 infection is associated with higher response to vaccine with higher antibody titer. All non-responders

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

“…In comparison, Al-Muhaiteeb et al. [ 16 ] found the rate of infection in 138 HD patients was only 5.1%. Also, Rodríguez-Espinosa et al.…”

18-month longitudinal SARS COV-2 neutralizing antibody dynamics in haemodialysis patients receiving heterologous 3-dose vaccination (AZD-1222- AZD-1222- BNT162b2) in a lower middle income setting

“…Seroconversion rates vary between study populations depending on the vaccine used. Rates of 73%-92%, 2-4 weeks following 2 doses of Pfizer-BioNTech (BNT162b2) in HD patients (lower than healthy controls) have been shown in multiple studies [21,38,[44][45][46][47]. The post 2nd dose seroconversion rate of HD patients, in our study (83.7% with MAB 450 IU/ml) was comparable with other work on similarly vaccinated HD cohorts (seroconversion 71.4% (MAB:345.1 BAU/ml) to 94.16% (MAB:1342 BAU/ml) [22,[48][49][50][51].…”

COVID-19 Vaccination Trends and Side Effects among Egyptian Hemodialysis Patients: A Multicenter Survey Study

“…In dialysis patients, the immune response after vaccination is comparable to that of controls [ 21 ]. So, COVID-19 vaccination is critical in this high-risk group in reducing mortality and hospitalization rates [ 22 ]. However, some individuals still have unwarranted fears about the vaccine [ 23 ], and this explains the percentage of 8.4% of our cohort who refrained from having the vaccination.…”