Early Humoral Responses of Hemodialysis Patients after COVID-19 Vaccination with BNT162b2

Abstract

Background and objectives Patients receiving hemodialysis are at high risk for both SARS-CoV-2 infection and severe COVID-19 disease. A life-saving vaccine is available, but sensitivity to vaccines is generally lower in dialysis patients. Little is yet known about antibody responses after COVID-19 vaccination in this vulnerable group. Design, setting, participants, and measurements In this prospective single-center study, we included 22 dialysis patients and 46 healthy controls from Heidelberg University Hospital between December 2020 and February 2021. We measured anti-S1 IgG with a threshold index for detection >1, neutralizing antibodies with a threshold for viral neutralization of ≥30% and antibodies against different SARS-CoV-2 fragments 17-22 days after the first and 18-22 days after the second dose of the mRNA vaccine BNT162b2. Results After the first vaccine dose, 4/22 (18%) dialysis patients compared with 43/46 (93%) healthy controls developed positive anti-S1 IgG, with a median (IQR) anti-S1 IgG index of 0.2 (0.1-0.7) compared with 9 (4-16), respectively. SARS-CoV-2 neutralizing antibodies exceeded the threshold for neutralization in 4/22 (18%) dialysis patients compared with 43/46 (93%) in healthy controls, with a median (IQR) percent inhibition of 11 (3-24) compared with 65 (49-75), respectively. After the second dose, 14/17 (82%) of dialysis patients developed neutralizing antibodies exceeding the threshold for viral neutralization and antibodies against the receptor-binding S1-domain of the spike protein, compared to 46/46 (100%) of healthy controls, respectively. The median (IQR) percent inhibition was 51 (32-86) compared to 98 (97-98) in healthy controls. Conclusions Patients receiving long-term hemodialysis show a reduced antibody response to the first and second doses of the mRNA vaccine BNT162b2. The majority (82%) develop neutralizing antibodies after the second dose, but at lower levels than healthy controls.

Humoral and Cellular Responses to mRNA-1273 and BNT162b2 SARS-CoV-2 Vaccines Administered to Hemodialysis Patients

“…Moreover, to our knowledge ours is the largest hemodialysis cohort to have evaluated the immune response to the mRNA-1273 vaccine 22 . The strongest predictors of humoral vaccine response and antibody levels seen in our results are concordant with those reported across other publications such as age, immunosuppressive treatment, and previous SARS-CoV-2 infection 22,35,36 . A correlation between seroconversion, its intensity, and patient age was seen in our findings, as also observed in other previously reported results on SARS-CoV-2 mRNA vaccines 28,31,37 .…”

The Safety and Immunogenicity of the mRNA-BNT162b2 SARS-CoV-2 Vaccine in Hemodialysis Patients

“…Furthermore, Speer et al. recently found positive anti-S1 IgG antibodies in 18% of 22 German hemodialysis patients (4/22) three weeks after the first vaccination, and in 82% (14/17) three weeks after the second vaccination using the mRNA BNT162b2 vaccine ( 36 ). The same number of patients had SARS-CoV-2 neutralizing antibodies (18% after 1st vaccination, 82% after 2 nd vaccination), a finding which is in line with the assumption that IgG antibodies directed against the S1 spike protein and RBD correspond to virus neutralizing antibodies.…”

Immunogenicity of COVID-19 Tozinameran Vaccination in Patients on Chronic Dialysis

“…Robust SARS-CoV-2 antibody responses ≥7 days after the second dose were detected (4). However, patients with KF have an impaired response to vaccination (5) and the earliest reports on COVID-19 vaccination suggest that mRNA vaccines are immunogenic but some patients on dialysis do not seroconvert (6)(7)(8). Patients on kidney replacement therapy were excluded from previous trials.…”