Rationale & Objective Recent studies showed that antibody titers after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the dialysis population are diminished as compared to the general population, suggesting the possible value of a third booster dose. We aimed to characterize the humoral response after three doses of the BNT162b2 vaccine in patients treated with either maintenance hemodialysis (HD) or peritoneal dialysis (PD). Study Design Case series. Setting & Participants 69 French patients (38 HD and 31 PD) treated at a single center who received three doses of the BNT162b2 vaccine. Findings Humoral response was evaluated using plasma levels of anti-SARS-CoV-2 spike protein S1 immunoglobulin measured after the second dose and at least three weeks after the third dose of the BNT162b2 vaccine. Patients (median age 68 [IQR, 53-76] years, 65% men) had a median anti-S1 antibody level of 284 [IQR, 83-1190] AU/mL after the second dose, and 7554 [IQR, 2268-11736] AU/mL after the third dose. Three patients were non-responders (anti-S1 antibody level < 0.8 AU/mL) and 12 were weak responders (anti-S1 antibody level 0.8-50 AU/mL) after the second vaccine dose. After the third dose, one of the three initial non-responders produced anti-spike antibody and all the 12 initial weak responders increased their antibody levels. Patients with a greater increase in anti-S1 antibody levels after a third dose had lower antibody levels after the second dose, and a longer time interval between the second and the third dose. Adverse events did not seem to be more common or severe following a third vaccine dose. Limitations Observational study, small sample size. Relationship between antibody levels and clinical outcomes is not well understood. Conclusions A third dose of the BNT162b2 vaccine substantially increased antibody levels in patients receiving maintenance dialysis and appeared to be as well tolerated as a second dose.

The aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed.

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Introduction Les patients dialysés ont une réponse vaccinale plus faible, et sont exposés à une morbimortalité plus importante que la population générale en cas d’infection par le SARS-CoV-2. Cependant, l’efficacité de la réponse vaccinale anti-SARS-CoV-2 reste peu étudiée dans cette population. Description L’objectif de cette étude était d’évaluer la réponse humorale au vaccin BNT162b2, et les facteurs associés à la réponse vaccinale chez des patients traités par hémodialyse (HD) et par dialyse péritonéale (DP). Méthodes Cette étude rétrospective a inclus 85 patients ( n = 45 HD, n = 40 DP), ayant reçu deux doses du vaccin BNT162b2. La réponse vaccinale était évaluée par le titre d’anticorps anti-protéine spike, dosé au moins 10 jours après la deuxième dose vaccinale. Un titre d’anticorps anti-spike inférieur à 0,8 UI/mL correspondait à une non-réponse et un titre inférieur au 10 e percentile (< 10 UI/mL) était considéré comme une faible réponse vaccinale. Résultats L’âge médian était de 66 ans [intervalle interquartile : 54 ; 77] et 64,7 % étaient des hommes. Après un délai médian de 50 jours [29 ; 58], le titre médian d’anticorps anti-spike était de 250 UI/mL [87 ; 250]. Cinq (5,9 %) patients étaient non-répondeurs et 11 (12,9 %) étaient faiblement répondeurs. La réponse vaccinale n’était pas différente selon la modalité de dialyse (91,2 % en HD, 97,5 % en DP). En analyse multivariée, les facteurs associés à une plus faible réponse vaccinale étaient l’âge (β par année supplémentaire : −1,50 [IC95 % : −2,88 ; −0,13], p = 0,03), une immunosuppression (β : −52,71 [−99,59 ; −5,84], p = 0,03), le statut nutritionnel (β pour l’augmentation d’1 g/L de l’albuminémie : 3,89 [0,08 ; 7,70], p = 0,045). Conclusion La réponse vaccinale n’était pas différente selon la modalité de dialyse. L’âge, la présence d’une immunosuppression et une altération de l’état nutritionnel étaient indépendamment associés à une plus faible réponse vaccinale.