Safety and efficacy of coronavirus disease‐19 vaccines in chronic kidney disease patients under maintenance hemodialysis: A systematic review

Mehta, Neha; Shah, Sangam; Paudel, Kiran; Chamlagain, Rajan; Chhetri, Santosh

doi:10.1002/hsr2.700

Cited by 11 publications

(9 citation statements)

References 48 publications

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“…However, multiple adult studies have shown similar findings. Most of these studies reported a very good humoral immune response with robust anti‐spike protein antibody titers 26–28 …”

Section: Discussionmentioning

confidence: 99%

“…Most of these studies reported a very good humoral immune response with robust anti-spike protein antibody titers. [26][27][28] Our study is unique in comparing the seroconversion rate and anti-S protein titers across four different groups, including hemodialysis patients. We also were the first to show the robust humoral immune response of BNT 162b2 vaccine in hemodialysis patients.…”

Section: Dialysis (Hv) Transplant (Ktv) Transplant (Kth) Transplant (...mentioning

confidence: 99%

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The humoral immune response to the BNT 162B2 vaccine in pediatrics on renal replacement therapy

Alshami,

Bahbah,

Al Attas

et al. 2024

Pediatric Transplantation

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IntroductionSince the start of the COVID‐19 pandemic, data published on the immunogenicity of the SARS‐CoV‐2 BNT 162B2 vaccine in pediatric patients receiving renal replacement therapy are scant. Our primary objective is to study this population's humoral immune response to the COVID‐19 vaccine.MethodsPediatric kidney transplant recipients (PKTRs) and hemodialysis recipients (HR) at our center who received two doses of the SARS‐CoV‐2 BNT 162B2 vaccine were included. Transplant and HR who had PCR‐positive COVID‐19 infections during the study, regardless of their vaccine status, were also included. SARS‐CoV‐2 anti‐spike protein (S1/S2) IgG was measured after the second dose of the vaccine and after any PCR‐positive COVID‐19 infection as routine clinical practice. Data on demographics, induction, maintenance immunosuppressants, type of transplant, and posttransplant or dialysis duration were included.ResultsOf the 61 patients included, 19 were dialysis recipients who received two doses of vaccine without subsequent infection (HV), and 42 were kidney transplant recipients. All dialysis patients and 33 (78.6%) transplant recipients received two doses of the SARS‐CoV‐2 BNT 162b2 vaccine. A total of 33.3% (11/33) of the transplant recipients who received vaccination developed COVID‐19 infection (KTH) at a median time of 13 days after the second dose of vaccine. Nine transplant patients had pure COVID‐19 infection without vaccination (KTI). The seroconversion rate in the HV group was 94.7% (18/19) compared to 50% (11/22) in the kidney transplant vaccine recipients who did not develop subsequent COVID‐19 infection (KTV) (p < .001). The median S1/S2 IgG titers for the HV group were 400 AU/mL versus 15 AU/mL in the KTV group (p < .0001). There was no significant difference in the duration of the test from the second dose of the vaccine between HV and KTV (55 vs. 33.5 days, p = .095). The KTH had higher titers than KTV group (370 vs. 15 p < .0001). The median duration of the test after vaccination in the vaccine group and those with hybrid immunity was similar (35 vs. 33.5 days, p = .2).There were no clear predictors for seroconversion in the PKTRs. Natural infection alone was as good as the vaccine in eliciting humoral immune response.ConclusionThe humoral immune response to two doses of the SARS‐CoV‐2 BNT 162B2 vaccine in PKTRs without subsequent COVID‐19 infection is suboptimal compared to that in hemodialysis recipients and in PKTRs with hybrid immunity from both infection and vaccination.

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“…However, multiple adult studies have shown similar findings. Most of these studies reported a very good humoral immune response with robust anti‐spike protein antibody titers 26–28 …”

Section: Discussionmentioning

confidence: 99%

Section: Dialysis (Hv) Transplant (Ktv) Transplant (Kth) Transplant (...mentioning

confidence: 99%

The humoral immune response to the BNT 162B2 vaccine in pediatrics on renal replacement therapy

Alshami,

Bahbah,

Al Attas

et al. 2024

Pediatric Transplantation

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“…Patients requiring HD can generate anti-S antibody after SARS-CoV-2 infection, which confers protection from subsequent infection in survivors [32]. Nevertheless, after primary vaccination, quantitative humoral anti-S responses are typically lower than in controls [33][34][35][36]. This may be because HD patients, who often have a B cell lymphopenia, have a less diverse naïve B cell repertoire [37].…”

Section: Discussionmentioning

confidence: 99%

Different vaccine platforms result in distinct antibody responses to the same antigen in haemodialysis patients

Wall,

Lamerton,

Ashford

et al. 2024

Preprint

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Generalised immune dysfunction in chronic kidney disease, especially in patients requiring haemodialysis (HD), significantly enhances the risk of severe infections. Moreover, vaccine-induced immunity is typically reduced in HD populations, but the full mechanisms behind this remain unclear. The SARS-CoV-2 pandemic provided an opportunity to examine the magnitude and functionality of antibody responses in HD patients to a previously unencountered antigen, Spike (S)-glycoprotein, after vaccination with different vaccine platforms (viral vector (VV); mRNA (mRV)). Here, we compared total and functional anti-S antibody responses (cross-variant neutralisation and complement binding) in 187 HD patients and 43 healthy controls 21-28 days after serial immunisation. After 2 doses of the same vaccine, HD patients had anti-S antibody levels and complement binding capacity comparable to controls. However, 2 doses of mRV induced greater polyfunctional antibody responses than VV, yet previous SARS-CoV-2 infection or an mRV boost after 2 doses of VV significantly enhanced antibody functionality in HD patients. Therefore, HD patients can generate near-normal, functional antigen-specific antibody responses following serial vaccination to a novel antigen, suggesting largely intact B cell memory. Encouragingly, exploiting immunological memory by using mRNA vaccines and boosting may improve the success of vaccination strategies in this vulnerable patient population.

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“…The study concluded that primary administration of inactivated SARS-CoV-2 vaccination generates an effective antibody response and can be safely administered to individuals undergoing HD. Moreover, a systematic review ( 90 ) examining the safety and efficacy of COVID-19 vaccination in patients with CKD undergoing maintenance HD revealed that two doses of COVID-19 vaccines were effective: Seroconversion rates for humoral response were 81-97% and T cell responses were observed in 67-100% of cases. COVID-19 vaccinations demonstrated no significant adverse effects and can be considered safe.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of immune response to SARS‑CoV‑2 vaccine in patients with chronic kidney disease and dialysis: A systematic review and meta‑analysis

Li,

Xia,

et al. 2024

Biomed Rep

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The coronavirus disease 2019 (COVID-19) vaccination is the most effective way to prevent COVID-19. However, for chronic kidney disease patients on long-term dialysis, there is a lack of evidence regarding the efficacy and safety of the immune response to the vaccine. The present meta-analysis explores the efficacy and safety of COVID-19 vaccine in the immune response of patients with chronic kidney disease (CKD) undergoing dialysis. PubMed, Web of Science, Science Direct, and Cochrane Library databases were systematically searched from January 1, 2020, to December 31, 2022. Data analysis was performed using REVMAN 5.1s and Stata14 software. Baseline data and endpoint events were extracted, mainly including age, sex, dialysis vintage, body mass index (BMI), vaccine type and dose, history of COVID-19 infection, seropositivity rate, antibody titer, pain at injection site, headache and other safety events. The meta-analysis included 33 trials involving 81,348 patients. The immune efficacy of patients with CKD and dialysis was 80% (95 CI, 73-87%). The seropositivity rate of individuals without COVID-19 infection was 76.48% (3,824/5,000), while the seropositivity rate of individuals with COVID-19 infection was 80.82% (1,858/2,299). The standard mean difference of antibody titers in CKD and dialysis patients with or without COVID-19 infection was 27.73 (95% CI, -19.58-75.04). A total of nine studies reported the most common adverse events: Pain at the injection site, accounting for 18% (95 CI, 6-29%), followed by fatigue and headache, accounting for 8 (95 CI, 4-13%) and 6% (95 CI, 2-9%), respectively. COVID-19 vaccine benefitted patients with CKD undergoing dialysis with seropositivity rate ≥80%. Adverse events such as fatigue, headache, and pain at the injection site may occur after COVID-19 vaccination but the incidence is low.

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Safety and efficacy of coronavirus disease‐19 vaccines in chronic kidney disease patients under maintenance hemodialysis: A systematic review

Cited by 11 publications

References 48 publications

The humoral immune response to the BNT 162B2 vaccine in pediatrics on renal replacement therapy

The humoral immune response to the BNT 162B2 vaccine in pediatrics on renal replacement therapy

Different vaccine platforms result in distinct antibody responses to the same antigen in haemodialysis patients

Effectiveness and safety of immune response to SARS‑CoV‑2 vaccine in patients with chronic kidney disease and dialysis: A systematic review and meta‑analysis

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