Vaccination against SARS-CoV-2 in Haemodialysis Patients: Spike’s Ab Response and the Influence of BMI and Age

Abstract

Patients with chronic kidney disease (CKD-5D) in dialysis have been associated with higher rates of SARS-CoV-2 infection. Objective: To identify the CKD-5D patients’ immune system behavior regarding the Pfizer-BioNTech (BNT162b2 mRNA) vaccine (Comirnaty©). This was a multicenter study carried out in 38 dialysis units in NephroCare Portugal. Eligible patients from two cohorts—one composed of completely vaccinated patients with Comirnaty© (vaccinated group) against a second cohort of patients who recovered from SARS-CoV-2 infection (control group)—were selected through representative sampling for each cohort. Humoral response was assessed at 3 (t0) and 6 months (t1) after complete vaccination and, in the control group, 6 months after COVID-19 recovery. In the vaccinated group, at t0, the median anti-Spike IgG level was 1120 AU/mL and, at t1, all participants’ antibody level decreased to a median of 455 AU/mL. In the control group, the median serum SARS-CoV-2 antibodies level was 1836 AU/mL. In the vaccinated group, at t0, patients < 70 years presented a significantly (p = 0.002) higher level of anti-Spike IgG titres. In contrast, older patients from the control group presented a significantly (p = 0.038) higher IgG. No correlation was found between age and anti-Spike IgG antibodies level in any of the studied groups. Patients with a higher body mass index showed a greater immune response in both the vaccinated and control group, although without significance. We concluded that, in the vaccinated group, elderly patients developed a lower immune response than younger patients and the levels of anti-Spike IgG antibodies declined faster between t0 and t1, while in the control group, the oldest and overweight patients developed the best humoral response.

Serological Response to SARS-CoV-2 Vaccine in Hemodialyzed Patients and the Association with Later COVID-19 Positivity

“…Patient antibody levels decreased at a monthly average adjusted rate of 31%, and at six months after vaccination, 40% of patients had either borderline or negative IgG antibodies [ 31 ]. In addition, a study from Portugal showed that elderly patients developed a lower immune response, and the levels of anti-spike IgG antibodies declined faster than in younger patients [ 32 ].…”

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

“…In agreement with our data, the previous humoral response is probably the better predictor of response to successive booster vaccine doses. Additionally, factors such as immunosuppressive drugs or conditions, obesity, older age, absence of previous or breakthrough COVID-19 or lower vaccine dose (number of doses or type of vaccine) can predict a suboptimal immunological response in CKD patients on RRT [ 6 , 8 , 9 , 10 , 27 ]. Thus, these factors should be considered when assessing the risks of not receiving early additional booster vaccine doses.…”