Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients With CKD

Abstract

The effects of the coronavirus disease-2019 (COVID-19) pandemic, particularly among those with chronic kidney disease (CKD), who commonly have defects in humoral and cellular immunity, and the efficacy of vaccinations against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are uncertain. To inform public health and clinical practice, we synthesized published studies and preprints evaluating surrogate measures of immunity after SARS-CoV-2 vaccination in patients with CKD, including those receiving dialysis or with a kidney transplant. We found 35 studies (28 published, 7 preprints), with sample sizes ranging from 23 to 1140 participants and follow-up ranging from 1 week to 1 month after vaccination. Seventeen of these studies enrolled a control group. In the 22 studies of patients receiving dialysis, the development of antibodies was observed in 18% to 53% after 1 dose and in 70% to 96% after 2 doses of mRNA vaccine. In the 14 studies of transplant recipients, 3% to 59% mounted detectable humoral or cellular responses after 2 doses of mRNA vaccine. After vaccination, there were a few reported cases of relapse or de novo glomerulonephritis, and acute transplant rejection, suggesting a need for ongoing surveillance. Studies are needed to better evaluate the effectiveness of SARS-CoV-2 vaccination in these populations. Rigorous surveillance is necessary for detection of long-term adverse effects in patients with autoimmune disease and transplant recipients. For transplant recipients and those with suboptimal immune responses, alternate vaccination platforms and strategies should be considered. As additional data arise, the NephJC COVID-19 page will continue to be updated (http://www.nephjc.com/news/covid-vaccine).

Keywords: COVID; COVID-19; coronavirus; dialysis; kidney disease; transplant; vaccine.

Graphical abstract

Figure 1

Graphical summary of antibody response over time from all studies. Percentage seroresponse as reported in published or preprinted studies in hemodialysis (a) or renal transplantation (b) patient groups. Data after 1 (open circles), 2 (filled circles), or 3 doses (filled diamond) are shown separately. The size of each point reflects the number of patients tested at that timepoint. Each point is labeled with its first author (full citations are in Tables 2 and 3). Studies used a variety of different measures of antibody responses and, where immunoglobulin isotypes were reported separately, we retained IgG data alone. Where baseline serology is known, we used seronaive vaccine recipient data. For Yi et al. and Rincon-Arevalo et al., there are both transplant and a smaller number of hemodialysis patients (both subgroups shown).