Kinetics of Anti–SARS-CoV-2 IgG Antibodies in Hemodialysis Patients Six Months after Infection

Abstract

BackgroundThe humoral response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the hemodialysis population, including its dynamics over time, remains poorly understood.MethodsTo analyze initial and long-term humoral responses against SARS-CoV-2 in a hemodialysis population, we retrospectively evaluated findings from SARS-CoV-2 IgG serologic assays targeting the nucleocapsid antigen or spike antigen up to 6 months of follow-up in patients on hemodialysis in the Paris, France, region who had recovered from coronavirus disease 2019 (COVID-19).ResultsOur analysis included 83 patients (median age 65 years); 59 (71%) were male and 28 (34%) had presented with severe COVID-19. We observed positive initial SARS-CoV-2 IgG antinucleocapsid serology in 74 patients (89%) at a median of 67 days postdiagnosis. By multivariable analysis, immunocompromised status was the only factor significantly associated with lack of an IgG antinucleocapsid antibody response. Follow-up data were available at 6 months postdiagnosis for 60 of 74 patients (81%) with positive initial antinucleocapsid serology, and 15 (25%) of them had negative antinucleocapsid serology at month 6. In total, 14 of 15 sera were tested for antispike antibodies, 3 of 14 (21%) of which were also negative. Overall, 97% of antinucleocapsid-antibody–positive specimens were also antispike-antibody positive. Female sex, age >70 years, and nonsevere clinical presentation were independently associated with faster IgG antinucleocapsid titer decay in multivariable analysis. After adjustment for sex and age >70 years, nonsevere clinical presentation was the only factor associated with faster decay of IgG antispike antibodies.ConclusionsThis study characterizes evolution of the SARS-CoV-2 antibody response in patients on hemodialysis and identifies factors that are associated with lack of seroconversion and with IgG titer decay.

Twelve-month specific IgG response to SARS-CoV-2 receptor-binding domain among COVID-19 convalescent plasma donors in Wuhan

“…The titer of anti-SARS-COV-2 antibodies shows an overall decreasing trend over time, while several factors may accelerate the attenuation of anti-SARS-COV-2 antibodies. In a 6-month follow-up of COVID-19 patients in Paris, non-severe clinical presentation was found to be the only factor associated with the faster decay of IgG anti-spike antibodies 26 . However, the correlation between the titer change of neutralizing antibodies and clinical symptoms was not significant.…”

Persistence of humoral response upon SARS‐CoV‐2 infection

“… 2 A recent excellent systematic review on the immune response in Covid‐19 patients reported the earliest detectability of IgG to occur at a median of 12 days PSO or PCR‐confirmed diagnosis, to reach a peak at a median of 25 days and to start declining around 60 days. 23 Findings on IgG persistence are largely consistent across studies with positive IgG results being reported for all time points of serological testing, 12 , 15 , 17 , 20 , 21 , 25 , 26 , 27 , 28 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 up to 34–35 weeks PSO. 40 , 55 Whereas Hartley et al.…”

SARS-CoV-2 Antibody Response After a Third Dose of the BNT162b2 Vaccine in Patients Receiving Maintenance Hemodialysis or Peritoneal Dialysis

“…In terms of increase in antibody level, our results do not show a benefit of a third dose in patients who already have high anti-S1 antibodies. Nevertheless, the third dose could have a benefit if it extends the duration of vaccine efficacy in a population known to have a rapid antibody decline after vaccination 20 , 21 .…”

“…How long vaccine-induced protection lasts in the dialysis population is another important question. Sakhi et al showed that after infection, 25% of initially seropositive dialysis patients had undetectable antibodies at 6 months 20 . Clarke et al confirmed a significant decline of antibody titers at 6 months in dialysis patients 21 , but also showed that the majority of patients without antibody at 6 months still had SARS-CoV-2 antigen–specific T-cell responses.…”