Serological Response to SARS-CoV-2 Vaccine in Hemodialyzed Patients and the Association with Later COVID-19 Positivity

Abstract

Background: The effectiveness of the COVID-19 vaccine may differ in hemodialysis patients. The aim of this prospective multicenter study was to determine the degree of serological response to the SARS-CoV-2 vaccine in the population of dialysis patients and its association with later SARS-CoV-2 infections. Methods: A blood sample was taken for the determination of COVID-19 serological status (IgG antibodies) in 706 dialysis patients 16 weeks after vaccination with the second dose (Pfizer-BioNTech). Results: Only 314 (44.5%) hemodialyzed patients had a satisfactory response to the COVID-19 vaccine. Eighty-two patients (11.6%) had a borderline response, while 310 patients (43.9%) had an unsatisfactory (negative) post-vaccinal antibody titer. A longer dialysis vintage had an increased odds ratio (OR) of 1.01 for the occurrence of COVID-19 positivity after vaccination. In the group of subsequently positive patients, 28 patients (13.6%) died from complications of COVID-19. We have found differences in mean survival time between patients with and without appropriate responses to vaccination in favor of patients with a satisfactory serological response. Conclusions: The results showed that the dialysis population will not have the same serological response to the vaccine as the general population. The majority of dialysis patients did not develop a severe clinical picture or die at the time of positivity for COVID-19.

Immune Response after Anti-SARS-CoV-2 mRNA Vaccination in Relation to Cellular Immunity, Vitamin D and Comorbidities in Hemodialysis Patients

“…The mean of anti-SARS-CoV-2 IgG class antibodies titers three to four weeks after the second vaccine dose was more than twice lower in hemodialysis patients as compared to controls in our study. Similarly, in other studies, patients undergoing dialysis exhibited lower antibody titers than the general population [20,21,[31][32][33]. The results of the study from Israel were similar to ours.…”

“…[20] and Anand S. [37] also found similar correlations between immune response and serum albumin levels. Premuzic V. et al, as well as our study, did not find associations between hemoglobin, serum calcium, phosphates, creatinine levels and immune response [33].…”

“…In the multivariable analysis, immunosuppressive treatment and lower albumin levels retained statistical significance [43]. More studies have found that longer dialysis vintage was associated with a higher risk for absent or attenuated response [33,37]. In our study, the total amount of anti-SARS-CoV-2 antibodies was not related to the dialysis vintage (in months).…”

“…Thus, the duration of dialysis treatment is important for the developing cellular immunity. The results of previous stud-ies [32,33,45,46] showed that the amount of anti-SARS-CoV-2 antibodies decreased rapidly a few months after vaccination in patients with kidney diseases. Our results are in line with these studies.…”

Neutralizing Activity of SARS-CoV-2 Antibodies in Patients with COVID-19 and Vaccinated Individuals

“…Numerous studies have indicated that cohorts of people with chronic diseases and those receiving immunosuppressive medication have inadequate immune responses to COVID-19 [ 48 ]. The hemodialysis population does not show the same serological response to SARS-CoV-2 vaccination as immunocompetent people [ 49 ]. In addition, the serological response to SARS-CoV-2 vaccination is also diminished in the elderly.…”