Diminished Short- and Long-Term Antibody Response after SARS-CoV-2 Vaccination in Hemodialysis Patients

Abstract

Short-term studies have shown an attenuated immune response in hemodialysis patients after COVID-19-vaccination. The present study examines how antibody response is maintained after vaccination against SARS-CoV-2 in a large population of hemodialysis patients from six outpatient dialysis centers. We retrospectively assessed serum antibody levels against SARS-CoV-2 spike protein and nucleocapsid protein (electrochemiluminescence immunoassays, Roche Diagnostics) after COVID-19-vaccination in 298 hemodialysis and 103 non-dialysis patients (controls), comparing early and late antibody response. Compared to a non-dialysis cohort hemodialysis patients showed a favorable but profoundly lower early antibody response, which decreased substantially during follow-up measurement (median 6 months after vaccination). Significantly more hemodialysis patients had anti-SARS-CoV-2-S antibody titers below 100 U/mL (p < 0.001), which increased during follow-up from 23% to 45% but remained low in the control group (3% vs. 7%). In multivariate analysis, previous COVID-19 infections (p < 0.001) and female gender (p < 0.05) were significantly associated with higher early as well as late antibody vaccine response in hemodialysis patients, while there was a significant inverse correlation between patient age and systemic immunosuppression (p < 0.001). The early and late antibody responses were significantly higher in patients receiving vaccination after a SARS-CoV-2 infection compared to uninfected patients in both groups (p < 0.05). We also note that a higher titer after complete immunization positively affected late antibody response. The observation, that hemodialysis patients showed a significantly stronger decline of SARS-CoV-2 vaccination antibody titers within 6 months, compared to controls, supports the need for booster vaccinations to foster a stronger and more persistent antibody response.

18-month longitudinal SARS COV-2 neutralizing antibody dynamics in haemodialysis patients receiving heterologous 3-dose vaccination (AZD-1222- AZD-1222- BNT162b2) in a lower middle income setting

“…for patients with kidney disease given this 3-dose combination (compared to 2-dose), clinically corroborating our evidence [37]. Similar studies on HD patients that were older than the control group, had patient groups with mean age ranging from 52-86 years [38][39][40][41][42], showing our HD cohort (mean age 54.1 years) to be comparatively young, though of similar age and gender distribution to other CKD patient groups studied in Sri Lanka [43].…”

Longitudinal analysis of anti-SARS-CoV-2 S-RBD IgG antibodies before and after the third dose of the BNT162b2 vaccine

“…Fragile patients, such as patients with haematological malignancies and haemodialysis, show an overall reduced response to anti-SARS-CoV-2 vaccination than healthy individuals 26 , 27 . Additionally, some Authors reported that fragile patients have a significantly more substantial decline of anti-SARS-CoV-2 antibody titers within 6 months compared to healthy individuals 28 , 29 .…”

Humoral Response and Tolerance of Vaccination against SARS-CoV-2 in Adults Senegalese Patients Undergoing Hemodialysis: A Multicenter Prospective Study

“…Previously infected patients might have developed immunity but the magnitude and the durability of this protection are variable [23] [24]. Many data suggest that patients receiving vaccination after a previous SARS-CoV-2 infection present the best antibody response [25]. This is consistent with many studies that identified duration in dialysis as a risk factor associated with a faster immunity decline as well as the type of dialysis, male sex, type of vaccine, and use of immunosuppressive drugs [23] [26] [27].…”