Seroresponse to SARS-CoV-2 Vaccines Among Maintenance Dialysis Patients

Hsu, Caroline M.; Weiner, Daniel E.; Aweh, Gideon; Manley, Harold J.; Ladik, Vladimir; Frament, Jill; Miskulin, Dana C.; Argyropoulos, Christos; Abreo, Kenneth; Chin, Andrew I.; Gladish, Reginald; Salman, Loay; Johnson, Dianna A.; Lacson, Eduardo

doi:10.1053/j.ajkd.2021.10.002

Cited by 24 publications

(29 citation statements)

References 13 publications

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“…As previously described, beginning in January 2021, DCI physicians had the option of activating a SARS-CoV-2 vaccine protocol, in which anti-spike immunoglobulin G (anti-spike IgG) antibodies were drawn monthly with routine labwork. 4 This study includes all adult patients who received an additional SARS-CoV-2 vaccine dose after completion of an initial series, and who had at least one anti-spike IgG level checked both between the initial series and the additional dose, and at least 14 days after the additional dose. Demographic and clinical data, vaccination dates, history of COVID-19 diagnosis, and anti-spike IgG titer results were obtained from the DCI electronic health record.…”

Section: Methodsmentioning

confidence: 99%

Seroresponse to third doses of SARS-CoV-2 vaccine among patients receiving maintenance dialysis

Hsu

Lacson

Manley³

et al. 2022

Preprint

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Given the increased morbidity and mortality from COVID-19 among patients undergoing maintenance dialysis, we examined the seroresponse to an additional dose of SARS-CoV-2 mRNA vaccine, using a hypothesized protective anti-spike protein IgG antibody threshold of 7 based on prior work. Among 395 patients, 384 (97%) had seroresponse ≥7 following administration of the third dose. Among those with suboptimal (peak <7) and minimal (peak <1) seroresponse to an initial mRNA vaccine regimen, the rate of seroresponse ≥7 following a third dose was 97% (36 of 37) and 64% (14 of 22), respectively. Given ongoing high rates of COVID-19 and rapidly waning immunity after an initial vaccine series, we recommend a third mRNA vaccine dose be standard for all patients receiving maintenance dialysis.

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Section: Methodsmentioning

confidence: 99%

Seroresponse to third doses of SARS-CoV-2 vaccine among patients receiving maintenance dialysis

Hsu

Lacson

Manley³

et al. 2022

Preprint

Self Cite

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“…Data regarding viral vector-based vaccination in dialysis patients are scarce. Single-dose Ad26.COV2.S (Janssen-Cilag/Johnson & Johnson, Beerse, Belgium) vaccination resulted in a seroconversion rate of 37% among dialysis patients [31]. Seroconversion rates after two doses of AZD1222 in dialysis patients have not been reported yet; however, we established a seroconversion rate of 71.4%.…”

Section: Discussionmentioning

confidence: 59%

Immune Responses to SARS-CoV-2 Infection and Vaccination in Dialysis Patients and Kidney Transplant Recipients

et al. 2021

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Dialysis patients and kidney transplant (KTX) recipients suffer from an impaired immune system and show a decreased response to the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) vaccination. We performed a retrospective analysis of 1505 serological SARS-CoV-2 measurements obtained from 887 dialysis patients and 86 KTX recipients. The results were separated by patient subgroups (dialysis/KTX) as well as SARS-CoV-2 status. The latter criterion included SARS-CoV-2-naïve patients with or without COVID-19 vaccination and convalescent patients receiving a booster shot. Serologies of 27 vaccinated healthy individuals served as the reference group. Vaccine-induced cellular immune response was quantified by an interferon-γ release assay in 32 KTX recipients. We determined seroconversion rates of 92.6%, 93.4%, and 71.4% in dialysis patients vaccinated with either BNT162b2, mRNA-1273, or AZD1222, respectively. Vaccination-induced anti-SARS-CoV-2 antibody titers were lower in dialysis patients compared to healthy individuals, and vaccination with mRNA-1273 induced higher titers than BNT162b2. The initial seroconversion rate was 39.5% in KTX recipients vaccinated with BNT162b2. A linear regression model identified medication with mycophenolate-mofetil/mycophenolic acid as an independent risk factor for missing seroconversion. Within a cohort of 32 KTX recipients, cellular and humoral immune reactivity to SARS-CoV-2 was detectable in three patients only. Conclusively, vaccine-induced seroconversion rates were similar in dialysis patients compared to healthy individuals but were strongly impaired in KTX recipients. Anti-SARS-CoV-2 IgG titers elicited by double active immunization were significantly lower in both cohorts compared to healthy individuals, and immune responses to vaccination vanished quickly.

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“…Overall and during each time period evaluated, vaccine effectiveness for COVID-related hospitalization or death was highest with mRNA-1273/Moderna, then BNT162b2/Pfizer and finally Ad26.COV2.S/Janssen when compared to those unvaccinated. In our study population Ad26.COV2.S/Janssen vaccine was not only associated with lower antibody response, 5,8 but likely was associated with higher breakthrough and COVID-19 related hospitalization rates than the mRNA vaccines, particularly when compared to the mRNA-1273/Moderna vaccine.…”

Section: Discussionmentioning

confidence: 62%

“…There were 80 breakthrough infections (BNT162b2/Pfizer N=32, mRNA-1273/Moderna N=28, and Ad26.COV2.S/Janssen N=20) with the level most proximate to diagnosis measured a median (IQR) of 16 (8,27) IgG level was undetectable while an additional 4 hospitalizations and 12 total cases occurred at a level < 2, with the remaining hospitalizations occurring at antibody levels between 1 and 6. There were 8 patients with undetectable anti-spike IgG levels that experienced a COVID-19 related death following a hospitalization event (Figure 1).…”

Section: Anti-spike Igg Level and Breakthrough Covid-19mentioning

confidence: 99%

“…7 We previously reported that 10-15% of dialysis patients did not respond to two doses of an mRNA vaccine; additionally, among initial responders to vaccine, more than half experience waning immunity by 4-6 months, particularly those whose initial response was lesser. 5,8 The impact of lesser initial vaccine response and subsequent waning antibody levels on clinical outcomes among maintenance dialysis patients is not known. Additionally, the impact of the Delta variant on vaccine effectiveness in this population is unknown.…”

Section: Introductionmentioning

confidence: 99%

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SARS-CoV-2 vaccine effectiveness and breakthrough infections in maintenance dialysis patients

Manley¹,

Aweh²,

Hsu

et al. 2021

Preprint

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Background: SARS-CoV-2 vaccine effectiveness during the Delta period and immunogenicity threshold associated with protection against COVID-19 related hospitalization or death in the dialysis population is unknown. Methods: A retrospective, observational study assessed SARS-CoV-2 vaccine effectiveness and immunogenicity threshold in all adult maintenance dialysis patients without COVID-19 history treated between February 1 and October 2, 2021. All COVID-19 infections, composite of hospitalization or death following COVID-19 and available SARS-CoV-2 anti-spike immunoglobulin (Ig) G values were extracted from electronic medical record. COVID-19 cases per 10,000 days at risk and vaccine effectiveness during pre-Delta and Delta periods were determined. Results: Of 15,718 patients receiving dialysis during the study period, 11,191 (71%) were fully vaccinated, 733 (5%) were partially vaccinated and 3,794 (24%) were unvaccinated. 967 COVID-19 were cases identified: 511 (53%) occurred in unvaccinated patients and 579 (60%) occurred during the Delta period. COVID-19 related hospitalization or death was less likely among vaccinated versus unvaccinated patients for all vaccines (adjusted HR 0.19 [0.12, 0.30]) and for BNT162b2/Pfizer, mRNA-1273/Moderna, and Ad26.COV2.S/Janssen (adjusted HR=0.25 [0.16, 0.40], 0.14 [0.08, 0.22], and 0.34 [0.17, 0.68] respectively). Among those with anti-spike IgG levels, those with IgG level ≥ 7 had significantly lower risk of a COVID-19 diagnosis (HR=0.25 [0.15, 0.42]) and none experienced a COVID-related hospitalization or death. Conclusions: Among maintenance dialysis patients, SARS-CoV-2 vaccination was associated with a lower risk of COVID-19 diagnosis and associated hospitalization or death. Among vaccinated patients, low anti-spike IgG level is associated with worse COVID-19 related outcomes.

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Seroresponse to SARS-CoV-2 Vaccines Among Maintenance Dialysis Patients

Cited by 24 publications

References 13 publications

Seroresponse to third doses of SARS-CoV-2 vaccine among patients receiving maintenance dialysis

Seroresponse to third doses of SARS-CoV-2 vaccine among patients receiving maintenance dialysis

Immune Responses to SARS-CoV-2 Infection and Vaccination in Dialysis Patients and Kidney Transplant Recipients

SARS-CoV-2 vaccine effectiveness and breakthrough infections in maintenance dialysis patients

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