Humoral Response to the Pfizer BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis

Abstract

Background and objectives: Coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality in patients on maintenance hemodialysis. Patients on dialysis tend to have a reduced immune response to infection or vaccination. We aimed to assess, for the first time to the best of our knowledge, the humoral response following vaccination with the BNT162b2 vaccine in patients on maintenance hemodialysis and the factors associated with it.

Design, setting, participants, & measurements: The study included 56 patients on maintenance hemodialysis (dialysis group) and a control group composed of 95 health care workers. All participants had received two doses of the BNT162b2 (Pfizer-BioNTech) vaccine. The serology testing was done using Quant II IgG anti-Spike severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assay by Abbott a median of 30 days after receipt of the second dose of the vaccine.

Results: All subjects in the control group developed an antibody response compared with 96% (54 of 56) positive responders in the dialysis group. The IgG levels in the dialysis group (median, 2900; interquartile range, 1128-5651) were significantly lower than in the control group (median, 7401; interquartile range, 3687-15,471). A Mann-Whitney U test indicated that this difference was statistically significant (U=1238; P<0.001). There was a significant inverse correlation of age and IgG levels in both groups. The odds of being in the lower quartile were significantly higher for older individuals (odds ratio, 1.11 per year of age; 95% confidence interval, 1.08 to 1.20; P=0.004) and for the dialysis group compared with the control group (odds ratio, 2.7; 95% confidence interval, 1.13 to 7.51; P=0.05). Within the dialysis group, older age and lower lymphocyte count were associated with antibody response in the lower quartile (odds ratio, 1.22 per 1-year older; 95% confidence interval, 1.13 to 1.68; P=0.03 and odds ratio, 0.83 per 10-e³/µl-higher lymphocyte count; 95% confidence interval, 0.58 to 0.97; P=0.05).

Conclusions: Although most patients on maintenance hemodialysis developed a substantial humoral response following the BNT162b2 vaccine, it was significantly lower than controls. Age was an important factor in the humoral response, regardless of chronic medical conditions.

Keywords: BNT162 vaccine; COVID-19; hemodialysis; renal dialysis; vaccine.

Graphical abstract

Figure 1.

Patients on dialysis develop a lower IgG antisevere acute respiratory syndrome coronavirus 2 spike antibodies level compared with controls (P<0.001). Two patients from the dialysis group had undetectable antibody levels defined as <50 arbitrary units per milliliter (AU/ml).

Figure 2.

Mean antibody level in different age ranges was lower in dialysis compare to control group. Ends of the boxes are the upper and lower quartiles. The medians are marked by horizontal lines inside the boxes. Every dot represents one participant’s level of antibodies. Error bars represent the range between minimal and maximal points. The top eight whiskers in plot age <59 (all subjects from the control group) are beyond the range of the y axis (range, 23,177–40,000 AU/ml). It was done in order to provide a greater resolution to the age >70 group (P=0.003 for age <60, P=0.007 for age 60–70, and P=0.20 for age >70 for study group versus control group).