Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 26;37(8):1400-1410.
doi: 10.1093/ndt/gfac052.

Perspective on COVID-19 vaccination in patients with immune-mediated kidney diseases: consensus statements from the ERA-IWG and EUVAS

Kate I Stevens  1 , Eleni Frangou  2 , Jae I L Shin  3 , Hans-Joachim Anders  4 , Annette Bruchfeld  5   6 , Ulf Schönermarck  4 , Thomas Hauser  7 , Kerstin Westman  8 , Gema M Fernandez-Juarez  9 , Jürgen Floege  10 , Dimitrios Goumenos  11 , Kultigin Turkmen  12 , Cees van Kooten  13 , Stephen P McAdoo  14   15 , Vladimir Tesar  16 , Mårten Segelmark  8 , Duvuru Geetha  17 , David R W Jayne  18 , Andreas Kronbichler  18 ; Immunonephrology Working Group (IWG) of the European Renal Association (ERA) and the European Vasculitis Society (EUVAS)
Affiliations

Perspective on COVID-19 vaccination in patients with immune-mediated kidney diseases: consensus statements from the ERA-IWG and EUVAS

Kate I Stevens et al. Nephrol Dial Transplant. .

Abstract

Patients with immune-mediated kidney diseases are at increased risk of severe coronavirus disease 2019 (COVID-19). The international rollout of COVID-19 vaccines has provided varying degrees of protection and enabled the understanding of vaccine efficacy and safety. The immune response to COVID-19 vaccines is lower in most patients with immune-mediated kidney diseases; either related to immunosuppression or comorbidities and complications caused by the underlying disease. Humoral vaccine response, measured by the presence of antibodies, is impaired or absent in patients receiving rituximab, mycophenolate mofetil (MMF), higher doses of glucocorticoids and likely other immunosuppressants, such as cyclophosphamide. The timing between the use of these agents and administration of vaccines is associated with the level of immune response: with rituximab, vaccine response can only be expected once B cells start to recover and patients with transient discontinuation of MMF mount a humoral response more frequently. The emergence of new COVID-19 variants and waning of vaccine-induced immunity highlight the value of a booster dose and the need to develop mutant-proof vaccines. COVID-19 vaccines are safe, exhibiting a very low risk of de novo or relapsing immune-mediated kidney disease. Population-based studies will determine whether this is causal or coincidental. Such cases respond to standard management, including the use of immunosuppression. The Immunonephrology Working Group and European Vasculitis Society recommend that patients with immune-mediated kidney diseases follow national guidance on vaccination. Booster doses based on antibody measurements could be considered.

Keywords: IgA nephropathy; immunology; immunosuppression; rituximab; vasculitis.

PubMed Disclaimer

Conflict of interest statement

The authors have no financial or non-financial potential conflicts of interest to declare related to this project. K.I.S. has received honoraria from Bayer Pharmaceuticals. H.J.A. received honoraria or lecture fees from AstraZeneca, Bayer, Eleva, GlaxoSmithKline, Kezar, Eli Lilly, Novartis, Otsuka, Previpharma and Vifor. A.B. has received honoraria or consulting fees from AstraZeneca, Bayer, ChemoCentryx, Merck/MSD and Vifor. U.S. received honoraria or consulting fees from Ablynx/Sanofi, Alexion Pharma, Allena Pharmaceuticals and Chemocentryx/Vifor. S.P.M. has received honoraria and/or consultancy fees from GlaxoSmithKline, Vifor, Travere and Celltrion. D. Geetha received consulting fees from ChemoCentryx and Aurinia. D.R.W.J. received honoraria or consulting fees from Amgen, Astra-Zeneca, Aurinia, Bristol-Myers Squibb, Boehringer Ingelheim, Chemocentryx, GlaxoSmithKline, National Institute for Health and Care Excellence, Novartis, Otsuka, Roche/Genentech, Takeda, UCB and Vifor. A.K. received honoraria for consulting from Alexion, Otsuka, Catalyst Biosciences, UriSalt, Vifor Pharma and Delta 4 and speaking fees from Vifor Pharma and TerumoBCT. All others report no conflicts of interest related to COVID-19 vaccines.

References

    1. Kronbichler A, Anders HJ, Fernandez-Juárez GMet al. Recommendations for the use of COVID-19 vaccines in patients with immune-mediated kidney diseases. Nephrol Dial Transplant 2021; 36: 1160–1168 - PMC - PubMed
    1. Strangfeld A, Schäfer M, Gianfrancesco MAet al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2021; 80: 930–942 - PMC - PubMed
    1. Sattui SE, Conway R, Putman MSet al. Outcomes of COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica from the COVID-19 Global Rheumatology Alliance physician registry: a retrospective cohort study. Lancet Rheumatol 2021; 3: e855–e864 - PMC - PubMed
    1. Shin YH, Shin JI, Moon SYet al. Autoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study. Lancet Rheumatol 2021; 3: e698–e706 - PMC - PubMed
    1. Pang NY, Pang AS, Chow VTet al. Understanding neutralising antibodies against SARS-CoV-2 and their implications in clinical practice. Mil Med Res 2021; 8: 47. - PMC - PubMed

Publication types

MeSH terms