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. 2021 Nov;32(11):2735-2742.
doi: 10.1681/ASN.2021040432. Epub 2021 Aug 4.

Immunogenicity of SARS-CoV-2 Vaccine in Dialysis

Eduardo Lacson Jr  1   2 , Christos P Argyropoulos  3 , Harold J Manley  2 , Gideon Aweh  2 , Andrew I Chin  4 , Loay H Salman  5 , Caroline M Hsu  1 , Doug S Johnson  2 , Daniel E Weiner  1
Affiliations

Immunogenicity of SARS-CoV-2 Vaccine in Dialysis

Eduardo Lacson Jr et al. J Am Soc Nephrol. 2021 Nov.

Abstract

Background: Patients receiving maintenance dialysis represent a high-risk, immune-compromised population with 15%-25% COVID-19 mortality rate who were unrepresented in clinical trials of mRNA vaccines.

Methods: All patients receiving maintenance dialysis who received two doses of SARS-CoV-2 mRNA vaccines with antibody test results drawn ≥14 days after the second dose, as documented in the electronic health record through March 18, 2021, were included. Response was on the basis of levels of Ig-G against the receptor binding domain of the S1 subunit of SARS-CoV-2 spike-antigen (seropositive ≥2 U/L) using an FDA-approved semiquantitative chemiluminescent assay (ADVIA Centaur XP/XPT COV2G).

Results: Among 186 patients on dialysis from 30 clinics in eight states tested 23±8 days after receiving two vaccine doses, there were 165 (88.7%) responders with 70% at maximum titer. There was no significant difference between BNT162b2/Pfizer (148 out of 168, 88.1%) and mRNA-1273/Moderna (17 out of 18, 94.4%), P=0.42. All 38 patients with COVID-19 history were responders, with 97% at maximum titer. Among patients without COVID-19, 127 out of 148 (85.8%) were responders, comparable between BNT162b2/Pfizer (113 out of 133) and mRNA-1273/Moderna (14 out of 15) vaccines (85.0% versus 93.3%, P=0.38).

Conclusions: Most patients receiving maintenance dialysis responded after two doses of BNT162b2/Pfizer or mRNA-1273/Moderna vaccine, suggesting the short-term development of antispike antibody is good, giving hope that most of these patients who are vulnerable, once immunized, will be protected from COVID-19. Longer-term evaluation is needed to determine antibody titer durability and if booster dose(s) are warranted. Further research to evaluate the approach to patients without a serologic response is needed, including benefits of additional dose(s) or administration of alternate options.

Keywords: COVID-19; SARS-CoV-2; chronic kidney disease; clinical immunology; dialysis; end-stage kidney disease; immune deficiency; vaccine.

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Figures

Figure 1.
Figure 1.
Distribution of anti-spike protein IgG titers for patients who are SARS-CoV-2 mRNA vaccinated on maintenance dialysis drawn ≥14 days after the second dose. (A) All patients (n=186); (B) subset of patients without COVID-19 history (n=148).
See this image and copyright information in PMC

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