The Efficacy of COVID-19 Vaccines in Chronic Kidney Disease and Kidney Transplantation Patients: A Narrative Review

Abstract

The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic has posed a huge threat to global health because of its rapid spread and various mutant variants. Critical illness occurs in the elderly and vulnerable individuals, such as those with chronic kidney disease. The severity of SARS-CoV-2 infection is associated with the severity of chronic kidney disease (CKD)and even kidney transplantation (KT) because of the chronic use of immunosuppressive agents. To develop adaptive immunity against SARS-CoV-2, vaccination against the spike protein is important. Current phase III trials of vaccines against SARS-CoV-2 have not focused on a specific group of individuals, such as patients with CKD or those undergoing dialysis or kidney transplantation. Chronic use of immunosuppressive agents might disturb the immune response to the SARS-CoV-2 spike protein. On the basis of limited evidence, the immune compromised status of CKD patients might decrease neutralizing antibody development after a single dose of a specific vaccine. Boosting dosage more than the protocol might increase the titer of the neutralizing antibody in CKD patients. Further evidence is needed to understand the factors disturbing the immunogenicity of the SARS-CoV-2 vaccine, and CKD patients should receive the recommended dose of the SARS-CoV-2 vaccine due to their relatively immune compromised status.

Safety and Effectiveness of COVID-19 SPUTNIK V Vaccine in Dialysis Patients

“…Hyporesponse to vaccines in general has been described in dialysis patients, in vaccination against hepatitis B, which shows a seroconversion of only 40-70% compared to more than 95% in healthy controls (20), attributing associated factors such as age, the presence of diabetes, nutritional status and altered innate and adaptive immune response (21). However, in our experience, the level of seroconversion with the two Sputnik V components was, on the contrary, much higher, and has already been described with other COVID-19 vaccines in dialysis patients (19,(21)(22)(23)(24)(25)(26), thus highlighting the importance of a complete vaccination in this patients (19,26). Besides, patients who presented COVID-19 after the first Sputnik V component had mild forms of the disease, as has been seen in the general population (27).…”

Predictors of Humoral Response to mRNA COVID19 Vaccines in Kidney Transplant Recipients: A Longitudinal Study—The COViNEPH Project

“…The results of our previous studies also showed a significant humoral post-vaccination response in the vast majority of dialyzed patients [5,6]. In contrast, kidney transplant recipients (KTR) demonstrated a markedly impaired seroconversion rate of 40-60% after two doses of mRNA vaccines [7][8][9]. Liver, heart, and lung transplant recipients exhibited a reduced response to mRNA-based vaccines as well [10][11][12].…”

The intestinal microbiota and improving the efficacy of COVID-19 vaccinations

“…However, a recent clinical trial reported that Astrazeneca is well tolerated in the older aged population and produced similar immunogenicity results ( Ramasamy et al, 2021 ). A systemic review showed that the older aged population were usually excluded in most clinical trials of COVID-19 vaccines, leading to insufficient data to analyse vaccine efficacy ( Hou et al, 2021 ). The involvement of gut dysbiosis in inefficacy of COVID-19 in the older age groups warrants extensive studies.…”

“…It may be necessary to distinguish mild and severe liver diseases on vaccine efficacy ( Cornberg and Eberhardt, 2021 ). A study reported that chronic kidney disease was associated with decreased vaccine efficacy ( Hou et al, 2021 ) due to the uremic milieu- vitamin D deficiency- and insufficient erythropoitin-caused antigen presenting cell dysfunction and reduced B cell numbers. Both a uremic milieu and vitamin D deficiency are known to cause gut dysbiosis ( Chaves et al, 2018 , Chen et al, 2021 ).…”