Diabetic kidney disease (DKD) is the most common cause of chronic kidney disease (CKD), and the major aetiology of end-stage renal disease (ESRD), contributing to renal replacement therapy worldwide. 1 The presence of DKD among diabetic patients is associated with higher morbidity and mortality, comparing to other vascular complications. 2 In diabetes mellitus (DM), substantial comorbid diseases such as hypertension and dyslipidaemia, which are the common illness that often found in the same patient, can enhance the deterioration of DKD. 3 Nevertheless, recent data demonstrate that although the incidence of DKD is stabilized, this is due to improved treatment on those comorbidities, not DKD. 4 The pathogenesis of DKD consists of two main mechanisms including haemodynamic and metabolic pathways. 3 Molecular studies demonstrated that each pathway involved numerous complicated vital substrates that are responsible for the development of DKD.Although many clinical studies using emerging therapies and possible beneficial strategies intended to reverse those pathological keys, none of those succeeded in stopping the disease progression. 4,5 It

Background: Vaccines that prevent SARS-CoV-2 infection are considered the most promising approach to modulating the pandemic. There is scarce evidence on the efficacy and safety of different vaccine prime-boost combinations in MHD patients since most clinical trials have used homologous mRNA vaccine regimens. Methods: This prospective observational study assessed the immunogenicity and safety of homologous CoronaVac® (SV-SV), ChAdOx1 nCoV-19 (AZD1222) (AZ-AZ), and the heterologous prime-boost of SV-AZ, among MHD patients. Results: A total of 130 MHD participants were recruited. On day 28, after the second dose, seroconversion results of the surrogate virus neutralization test were not different between vaccine regimens. The magnitude of the receptor-binding domain-specific IgG was highest among the SV-AZ. Different vaccine regimens had a distinct impact on seroconversion, for which the heterologous vaccine regimen demonstrated a higher probability of seroconversion (OR 10.12; p = 0.020, and OR 1.81; p = 0.437 for SV-AZ vs. SV-SV, and SV-AZ vs. AZ-AZ, respectively). There were no serious adverse events reported in any of the vaccine groups. Conclusions: Immunization with SV-SV, AZ-AZ, and SV-AZ could generate humoral immunity without any serious adverse events among MHD patients. Using the heterologous vaccine prime-boost seemed to be more efficacious in terms of inducing immunogenicity.