Humoral Response to mRNA-1273 SARS-CoV-2 Vaccine in Peritoneal Dialysis Patients: Is Boostering After Six Months Adequate?

Abstract

In dialysis patients the humoral response to anti-SARS-CoV-2 vaccines is attenuated and rapidly declines over time. However, data on the persistence of the immune response in peritoneal dialysis (PD) patients are scarce, particularly after a third (booster) dose with mRNA-1273 vaccine. In this prospective cohort study, we report anti-SARS-CoV-2 antibody levels in PD patients before and after the third dose of mRNA-1273 vaccine. Six months after the second dose, anti-SARS-CoV-2 antibodies were detected in all patients (n = 34). However, within this time period antibodies substantially declined in 31 of 34 patients (4.5-fold, median = 192 BAU/mL, p = 1.27 × 10–9) and increased in three patients. In accordance with government regulations, a third dose of mRNA-1273 vaccine (50 μg) was given to 27 PD patients 6 months after the second dose which induced a significant increase of anti-SARS-CoV-2 antibody titers (58.6-fold, median = 19405 BAU/mL, p = 1.24 × 10–29). A mixed model analysis showed that a lower Davies Comorbidity Score and a higher GFR were associated with higher antibody titers (p = 0.03 and p = 0.02). The most common adverse events after the third dose were pain at the injection site (77.8%) and fatigue (51.9%). No hospitalizations were reported. In conclusion, 6 months after the second dose of mRNA-1273 vaccine, anti-SARS-CoV-2 antibodies substantially decreased in PD patients, whereas a well-tolerated third dose induced a robust humoral response. Our data suggest that the administration of a booster dose within a shorter interval than 6 months should be considered in PD patients in order to maintain high anti-SARS-CoV-2 antibody levels and assure protection from severe COVID-19 disease.

Long-Term Dynamic Humoral Response to SARS-CoV-2 mRNA Vaccines in Patients on Peritoneal Dialysis

“…In this regard, a booster (or third) dose was considered early for these vulnerable patients. Although evidence on the effectivity of the third dose on patients in PD is scarce, some studies have suggested a robust humoral response rise [ 14 , 15 ]. More importantly, a booster dose has been demonstrated to seroconvert patients that had previously lost their humoral immunity against SARS-CoV-2 [ 16 , 17 ].…”

Durable Anti-SARS-CoV-2 Antibody Response after mRNA-1273 Booster in Peritoneal Dialysis Patients during the Omicron Wave

“…This study is a continuation of our previous published studies [22,28]. The vaccination timeline of included patients and SARS-CoV-2 waves in Austria are illustrated in Figure 1A.…”

“…Several studies in dialysis patients have shown that SARS-CoV-2 antibody levels declined after the two-dose vaccination scheme and that a third vaccine dose as a “booster” induced a strong humoral response in both hemodialysis (HD) and peritoneal dialysis (PD) patients [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Most of these studies were investigating HD patients vaccinated with BNT162b2, whereas few studies focused on PD patients using mRNA-1273 [ 22 , 23 , 24 , 25 ].…”

Vaccination and mortality from COVID-19: a comparative study between hemodialysis, peritoneal dialysis, and non-dialysis adult population in Panama

“…Dialysis patients had a high vaccination rate, probably because awareness was made after publication of mortality data of patients with a 26% for the period pre-vaccination in the 2020 for patients in hemodialysis in Panama, higher than the 2% mortality for general population for that period [ 16 ]. Some studies have addressed that dialysis patients’ immune response to vaccination is worse than in general population [ 17 ], but some studies have demonstrated a robust immune response after a third dose [ 18 ]. This study was able to assess the importance of vaccination in dialysis patients, as lethality decreased from 30 to 5% once vaccination was available.…”