Antibody Response to COVID-19 vaccination in Patients Receiving Dialysis

Abstract

Background: Patients receiving dialysis may mount impaired responses to COVID19 vaccination.

Methods: We report antibody response to vaccination from 1140 patients without, and 493 patients with pre-vaccination SARS-CoV-2 RBD antibody. We used commercially available assays (Siemens) to test remainder plasma monthly in association with vaccination date and type, and assess prevalence of absent total receptor binding antibody, and absent or attenuated (index value < 10) semiquantitative receptor binding domain IgG index values. We used Poisson regression to evaluate risk factors for absent or attenuated response to vaccination.

Results: Among patients who were seronegative versus seropositive before vaccination, 62% and 56% were ≥65 years old, 20% and 24% were Hispanic, and 22% and 23% were Black. Median IgG index values rose steadily over time, and were higher among the seropositive than in the seronegative patients after completing vaccination (150 [25^th, 75^th percentile 23.2, 150.0] versus 41.6 [11.3, 150.0]). Among 610 patients who completed vaccination (assessed ≥14 days later, median 29 days later), the prevalence of absent total RBD response, and absent and attenuated semiquantitative IgG response was 4.4% (95% CI 3.1, 6.4%), 3.4% (2.4, 5.2%), and 14.3% (11.7, 17.3%) respectively. Risk factors for absent or attenuated response included longer vintage of end-stage kidney disease, and lower pre-vaccination serum albumin.

Conclusions: More than one in five patients receiving dialysis had evidence of an attenuated immune response to COVID19 vaccination.

Keywords: COVID-19; SARS-CoV-2; immune response; vaccination; vulnerable populations.

Figure 1.

Flow chart of study cohorts

Figure 2.

IgG responses following COVID19 vaccination among patients receiving dialysis Individual semiquantitative RBD IgG index values are graphed by time period since vaccination; the lines represent median with interquartile range. We defined early post vaccination as within 14 days of first dose, partially vaccinated as between 14 days after first dose to 14 days post second dose, and fully vaccinated as more than 14 days post second dose for Moderna and Pfizer. For Johnson and Johnson, we defined fully vaccinated as more than 14 days post first dose. In the seropositive prior to vaccination cohort, IgG index values closest to the dates before vaccination are graphed in the ‘before vaccination’ period; the seronegative cohort prior to vaccination was tested only with the total RBD Ig and all had negative results in the ‘before vaccination’ period. Although 1140 and 493 patients were included in the two cohorts (since they received at least one vaccine dose at the time of the study), all patients do not have values available for each time period, since these depend on the timing of the vaccination as well as on the timing of the routine monthly blood draw. For both cohorts, median IgG levels rose steadily after vaccination. Among the seronegative prior to vaccine cohort, median IgG index values post vaccination were 0.5 (25^th, 75^th percentile 0.5, 0.5), 3.2 (0.5, 27.8), and 41.6 (11.3, 150.0) in the early, partially and fully vaccinated periods respectively. Among the seropositive prior to vaccine cohorts, median IgG index values post vaccination were 0.5 (0.5, 7.6), 1.1 (0.5, 102.3), 15.3 (1.2, 150), and 150 (23.2, 150) in the prior to, early, partially and fully vaccinated periods respectively.