Vaccination in patients with kidney failure: lessons from COVID-19

Abstract

Infection is the second leading cause of death in patients with chronic kidney disease (CKD). Adequate humoral (antibody) and cellular (T cell-driven) immunity are required to minimize pathogen entry and promote pathogen clearance to enable infection control. Vaccination can generate cellular and humoral immunity against specific pathogens and is used to prevent many life-threatening infectious diseases. However, vaccination efficacy is diminished in patients with CKD. Premature ageing of the immune system and chronic systemic low-grade inflammation are the main causes of immune alteration in these patients. In the case of SARS-CoV-2 infection, COVID-19 can have considerable detrimental effects in patients with CKD, especially in those with kidney failure. COVID-19 prevention through successful vaccination is therefore paramount in this vulnerable population. Although patients receiving dialysis have seroconversion rates comparable to those of patients with normal kidney function, most kidney transplant recipients could not generate humoral immunity after two doses of the COVID-19 vaccine. Importantly, some patients who were not able to produce antibodies still had a detectable vaccine-specific T cell response, which might be sufficient to prevent severe COVID-19. Correlates of protection against SARS-CoV-2 have not been established for patients with kidney failure, but they are urgently needed to enable personalized vaccination regimens.

The third dose of mRNA SARS-CoV-2 vaccines enhances the spike-specific antibody and memory B cell response in myelofibrosis patients

“…The analysis of the antibody response following the first vaccination cycle in healthy and fragile subjects ( 21 , 24 – 26 ) indicates that factors such as age, sex, and comorbidities have shown impact on the level of spike-specific IgG levels and the rate at which they decline overtime ( 27 , 28 ). Age and comorbidities, which can induce physiological and premature immune senescence, respectively, as well as chronic systemic low-grade inflammation have been considered among the most impacting factors on immune responsiveness to vaccination ( 29 – 31 ). Applying a linear multivariate model to assess the impact of the age and sex as confounding factors on the antibody response in this study, no significant effect was observed (data not shown).…”

Trained immunity — basic concepts and contributions to immunopathology

“…Moreover, patients with CKD often have impaired immunity owing to the effects of uraemic toxicity, as well as treatment-associated immune alterations, especially in patients with kidney failure who require kidney replacement therapy (KRT) such as dialysis or kidney transplantation. These immune alterations associated with kidney disease and KRT include chronic inflammation and premature immune ageing, and patients with advanced CKD are more susceptible to infections, have a diminished response to vaccination and display profound innate immune system alteration compared with the general population 44 . Below, we discuss the molecular regulation of trained immunity in the context of pathological conditions that involve the kidney.…”

Immunogenicity of Bivalent Omicron BA.4/5–Adapted Vaccine in Hemodialysis Patients

“…Due to immune system alterations, patients with kidney failure are known to be at high risk for infections including severe COVID-19. Vaccination is of paramount importance in this vulnerable population for infections with effective vaccine 1 . Immune escape of SARS-CoV-2 and antibody fade led to the loss of protection against omicron VOC during the last months.…”