What has vaccination against COVID-19 in CKD patients taught us?

Abstract

Effective vaccination strategies are of crucial importance to protecting patients who are vulnerable to infections, such as patients with chronic kidney disease. This is because the decreased efficiency of the immune system in chronic kidney disease impairs vaccine-induced immunisation. COVID-19 has prompted investigation of the immune response to SARS-CoV-2 vaccines in chronic kidney disease and in kidney transplant recipients in an effort to improve efficacy. The seroconversion rate after two vaccine doses is reduced, especially in kidney transplant recipients. Furthermore, although the seroconversion rate in chronic kidney disease patients is as high as in healthy subjects, anti-spike antibody titres are lower than in healthy vaccinated individuals, and these titres decrease rapidly. Although the vaccine-induced anti-spike antibody titre correlates with neutralising antibody levels and with protection against COVID-19, the protective prognostic significance of their titre is decreased due to the emergence of SARS-CoV-2 variants other than the Wuhan index virus against which the original vaccines were produced. Cellular immunity is also relevant, and because of cross-reactivity to the spike protein, epitopes of different viral variants confer protection against newly emerging variants of SARS-CoV-2. A multi-dose vaccination strategy is the most effective way to obtain a sufficient serological response. In kidney transplant recipients, a 5-week discontinuation period from antimetabolite drugs in concomitance with vaccine administration may also increase the vaccine’s efficacy. The newly acquired knowledge obtained from COVID-19 vaccination is of general interest for the success of other vaccinations in chronic kidney disease 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

“…The COVID-19 pandemic has prompted research on the immune response to SARS-CoV-2 vaccines in patients with CKD and kidney transplant recipients with the aim of improving efficacy ( 64 ). In patients with CKD, the seroconversion rate is reduced after two doses of SARS-CoV-2 vaccine and anti-spike antibody titers are lower than those in healthy individuals ( 65 , 66 ). According to Babel et al ( 67 ) in patients with CKD, immunological aging and persistent inflammation decreases the efficacy of vaccination.…”

Five doses of the mRNA vaccination potentially suppress ancestral-strain stimulated SARS-CoV2-specific cellular immunity: a cohort study from the Fukushima vaccination community survey, Japan

“…These specific immune alterations might involve the Tregs expression or the emergence of exhausted T cells. Multiple doses of mRNA vaccines are recommended for high-risk groups ( 28 , 29 ). However, considering the potential for immune tolerance and exhaustion in cellular immunity after repeated mRNA vaccine administration (especially five or more doses), there might be an alternative strategy for SARS-CoV-2 immunization.…”

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

“…In this context, patients with chronic kidney disease, including those undergoing hemodialysis (HD),peritoneal dialysis or kidney transplant recipients constitute a particularly challenging group. This is mainly attributed to the impaired immune response in those patients [ 7 ]. So, many studies strongly recommended administration of a third COVID-19 vaccination dose 6 months after the second dose in HD patients [ 8 , 9 ].…”