Hemodialysis Patients Show a Highly Diminished Antibody Response after COVID-19 mRNA Vaccination Compared to Healthy Controls

Abstract

1. Abstract 1.1 Background and Objectives Hemodialysis patients are prone to infection with SARS-COV2 and show a high probability of a severe course of disease and high mortality when infected. In many countries hemodialysis patients are prioritised in vaccination programs to protect this vulnerable community. However, no hemodialysis patients were included in efficacy trials of SARS CoV-2 vaccines and therefore efficacy and safety data for this patient group are lacking. These data would be critical, since hemodialysis patients showed decreased responses against various other vaccines and this could mean decreased response to SARS CoV-2 vaccines. 1.2 Design, setting, participants, and measurements We conducted a prospective cohort study consisting of a group of 81 hemodialysis patients and 80 healthy controls who were vaccinated with mRNA vaccine BNT162b2 (BionTech/Pfizer, 2 doses with an interval of 21 days). Anti-SARS-COV-2 S antibody response in all participants was measured 21 days after the second dose. The groups were compared with univariate quantile regressions and a multiple analysis. Adverse events (AEs) of the vaccination were assessed with a standardized questionnaire. We also performed a correlation of HBs-Antibody response with the SARS-COV-2 antibody response in the hemodialysis patients. 1.3 Results Dialysis patients had significantly lower Anti-SARS-COV-2 S antibody titres than healthy control patients 21 days after vaccination with BNT162b2 (median dialysis Patients 171 U/ml versus median controls 2500 U/ml). Age also had a significant but less pronounced influence on antibody titres. Dialysis patients showed less AEs than the control group. No significant correlation was found for Hepatitis B vaccine antibody response and SARS CoV-2 vaccine antibody response. 1.4 Conclusions Hemodialysis patients exhibit highly diminished SARS-COV-2 S antibody titres compared to a cohort of controls. Therefore these patients could be much less protected by SARS CoV-2 mRNA vaccination than expected. Alternative vaccination schemes must be considered and preventive measures must be maintained after vaccination.

Cellular and humoral immunogenicity of a SARS-CoV-2 mRNA vaccine in patients on hemodialysis

“…Our study has several limitations. While we have a reasonable sample size (81 dialysis patients), which is similar or even larger compared to several other studies (12,13,25), our control group is not age-and gender-matched. In addition, we evaluated only one of the currently approved SARS-CoV-2 vaccines with samples from a single dialysis center and did not perform in-depth immune phenotyping or assessment of SARS-CoV-2 responsive T-cell frequencies.…”

“…Interestingly, we found no significant differences in vaccination-induced IgA levels in both saliva and plasma between our study groups. Although several studies reported lower protective IgG titers over time following hepatitis B, influenza A or SARS-CoV-2 vaccinations, IgA levels were not analyzed here (9)(10)(11)(12)(13)(14)(15)(16)(17). Interestingly, a monoclonal IgA antibody capable of recognizing both the SARS-CoV-1 and SARS-CoV-2 spike proteins and blocking ACE2 receptor interaction combined with an increased neutralization ability over its IgG equivalent has been described (28).…”

“…A recent study also suggested that seroreversion following natural SARS-CoV-2 infection is faster in dialysis patients compared to the general population further increasing the risk of re-infection (8). Other studies have also identified that vaccine efficacy is reduced in dialysis patients, as seen by the attenuation of antibody titers following vaccination with SARS-CoV-2 vaccines (9)(10)(11)(12)(13)(14). Additional data on the efficiency of SARS-CoV-2 vaccination is urgently needed not only for risk mitigation but also to assess whether additional protective measures during therapy must be put in place as seen by the impaired infection and vaccination-induced responses for influenza A and hepatitis B (15)(16)(17).…”

Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients With CKD

“…Several small studies investigating the role of COVID-19 vaccines in dialysis patients have been reported recently and are summarized in Table 2 [ 8 , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] ]. The development of anti-SARS-CoV-2 antibodies is variable and depends on several factors, including the time from vaccine administration to antibody measurement, and the type of antibody assay.…”

Immune response to SARS-CoV-2 infection and vaccination in patients receiving kidney replacement therapy

“…2 Although the nephrology community has called for ESKD patients to have priority for vaccination as a vulnerable population, there has been an underlying concern that these patients may not mount a good response to vaccination or even after a previous infection with SARS-CoV-2. In this issue of Kidney International, we present the initial experience of nephrologists from around the world regarding the immunogenicity of prior coronavirus disease 2019 (COVID- 19) infection and the response to the COVID-19 vaccines among patients with ESKD receiving kidney replacement therapy (Table 1 [3][4][5][6][7][8][9][10][11][12][13][14].…”