The Efficacy of COVID-19 Vaccines in Chronic Kidney Disease and Kidney Transplantation Patients: A Narrative Review

Abstract

The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic has posed a huge threat to global health because of its rapid spread and various mutant variants. Critical illness occurs in the elderly and vulnerable individuals, such as those with chronic kidney disease. The severity of SARS-CoV-2 infection is associated with the severity of chronic kidney disease (CKD)and even kidney transplantation (KT) because of the chronic use of immunosuppressive agents. To develop adaptive immunity against SARS-CoV-2, vaccination against the spike protein is important. Current phase III trials of vaccines against SARS-CoV-2 have not focused on a specific group of individuals, such as patients with CKD or those undergoing dialysis or kidney transplantation. Chronic use of immunosuppressive agents might disturb the immune response to the SARS-CoV-2 spike protein. On the basis of limited evidence, the immune compromised status of CKD patients might decrease neutralizing antibody development after a single dose of a specific vaccine. Boosting dosage more than the protocol might increase the titer of the neutralizing antibody in CKD patients. Further evidence is needed to understand the factors disturbing the immunogenicity of the SARS-CoV-2 vaccine, and CKD patients should receive the recommended dose of the SARS-CoV-2 vaccine due to their relatively immune compromised status.

Keywords: COVID-19; SARS-CoV-2; chronic kidney disease; dialysis; kidney transplantation; vaccine.

Figure 1

The mechanism of the impaired generation of neutralizing antibody after SARS-CoV-2 vaccine injection in CKD and KT patients. In CKD patients, the vitamin D deficiency, uremic toxin accumulation and erythropoietin deficiency could influence the antigen presenting ability of the antigen presenting cell (APC). In kidney transplantation (KT) patients, the corticosteroid, calcineurin inhibitor (tacrolimus or cyclosporin), mycopheloic acid (MPA) and mechanistic target of rapamycin (mTOR) inhibitor decrease the activity of T cells and the production of neutralizing antibody by B Cells in different aspects.IL2: interleukin 2; JAK-PI3K: Janus-activated kinase/phosphoinositide 3-kinase pathway; MHC: major histocompatibility complex.