COVID-19 Vaccination Among Patients Receiving Maintenance Renal Replacement Therapy: Immune Response, Real-World Effectiveness, and Implications for the Future

Abstract

Chronic kidney disease affects more than 800 million people worldwide and often progresses to end-stage renal disease, which requires maintenance dialysis. Patients receiving dialysis are at higher risk for severe respiratory infections, including SARS-CoV-2 (the causative agent of COVID-19). In addition, many patients who receive dialysis also receive immunosuppressive treatments for conditions such as systemic vasculitis, systemic lupus erythematosus, or malignancies. Many studies have shown that while mRNA COVID-19 vaccines induce some level of immune response in patients receiving dialysis, the magnitude of response is often lower than that of healthy individuals, and responses rapidly wane. Importantly, the risk of COVID-19–related hospitalization and mortality for patients receiving dialysis is 4- to 8-fold higher compared with the general population. In this article, we summarize recent immunogenicity and real-world outcomes of COVID-19 mRNA vaccination among patients receiving dialysis, with a focus on the 3-dose extended primary series and additional (fourth) doses.

Immune Response after Anti-SARS-CoV-2 mRNA Vaccination in Relation to Cellular Immunity, Vitamin D and Comorbidities in Hemodialysis Patients

“…The mean of anti-SARS-CoV-2 IgG class antibodies titers three to four weeks after the second vaccine dose was more than twice lower in hemodialysis patients as compared to controls in our study. Similarly, in other studies, patients undergoing dialysis exhibited lower antibody titers than the general population [20,21,[31][32][33]. The results of the study from Israel were similar to ours.…”

“…Thus, the duration of dialysis treatment is important for the developing cellular immunity. The results of previous stud-ies [32,33,45,46] showed that the amount of anti-SARS-CoV-2 antibodies decreased rapidly a few months after vaccination in patients with kidney diseases. Our results are in line with these studies.…”

Serological responses and clinical outcomes following a three‐dose primary COVID‐19 vaccine schedule in kidney transplant recipients and people on dialysis

“…Recent studies have described antibody responses to fourth booster dose in people with CKD. 55 , 56 Understanding the serological and cellular responses in KTRs, dialysis and CKD population beyond the initial primary vaccine schedule (e.g. Doses 4 or more) is essential to inform schedule recommendations and clinical care.…”