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. 2022 Mar 11;10(3):433.
doi: 10.3390/vaccines10030433.

Waning Humoral Response after COVID-19 mRNA Vaccination in Maintenance Dialysis Patients and Recovery after a Complementary Third Dose

Bogdan Biedunkiewicz  1 , Leszek Tylicki  1 , Waldemar Ślizień  2 , Monika Lichodziejewska-Niemierko  1 , Małgorzata Dąbrowska  3 , Alicja Kubanek  4 , Sylwia Rodak  2 , Karolina Polewska  1 , Piotr Tylicki  1 , Marcin Renke  4 , Alicja Dębska-Ślizień  1
Affiliations

Waning Humoral Response after COVID-19 mRNA Vaccination in Maintenance Dialysis Patients and Recovery after a Complementary Third Dose

Bogdan Biedunkiewicz et al. Vaccines (Basel). .

Abstract

The aim of this study was to analyze the waning of anti-spike (S) antibodies after mRNA vaccination against COVID-19 in maintenance dialysis patients, and to assess the safety and effectiveness of the complementary third dose. This was a prospective, longitudinal study in which we analyzed the kinetics of antibodies up to six months after a two-dose vaccination (first protocol) in infection-naïve dialysis patients (IN-Ds), previously infected dialysis patients (PI-Ds) and subjects without chronic kidney disease (the controls), as well as their humoral response to the third dose of the same mRNA vaccine (second protocol). The respective reduction in antibody titer after 3 and 6 months by 82.9% and 93.03% in IN-Ds (n = 109), 73.4% and 93.36% in PI-Ds (n = 32) and 75.5% and 88.8% in the controls (n = 20) was demonstrated. Consequently, a protective antibody titer above 141 BAU/mL was found in only 47.7% and 23.8% of IN-Ds after 3 and 6 months, respectively. After the third vaccine dose, a significant increase in antibody titer was observed in all groups, with increases by a factor of ×51.6 in IN-Ds, ×30.1 in the controls and ×8.4 in PI-Ds. The median antibody titer after the third dose differed significantly between groups, and was the highest in PI-Ds: PI-Ds, 9090 (3300−15,000) BAU/mL; the controls, 6945 (2130−11,800); IN-Ds, 3715 (1470−7325) (p < 0.001). In conclusion, we observed similar degrees of antibody waning in all patients. After 3 months, over half of the infection-naïve dialysis patients had a very low antibody titer, and almost twenty percent of them had no antibodies at all. The humoral response to the third dose was very good, raising their titer of antibodies to a higher level than those in the general population who have received the primary two-dose scheme. The results support the administration of a complementary third dose of the mRNA vaccine for dialysis patients as soon as possible.

Keywords: COVID-19; SARS-CoV-2; humoral immunity; mRNA vaccines; maintenance dialysis patients; seroconversion.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Anti-S IgG titer decline over time after second dose of vaccination.
Figure 2
Figure 2
Anti-S antibody titer after the second and third dose of mRNA vaccine. * Kruskal-Wallis test: (IN-Ds vs. the controls vs. PI-Ds). Multiple range test for paired comparisons: after second dose, (IN-Ds vs. the controls: p = 0.002) and (IN-Ds vs. PI-Ds: p < 0.001); after third dose, (IN-Ds vs. PI-Ds: p = 0.001). Additional secondary analyses: ** p < 0.001 (IN-Ds’ second vs. IN-Ds’ third dose; controls’ second vs. controls’ third dose). *** p = 0.026 (IN-Ds’ third dose vs. controls’ second dose).
Figure 3
Figure 3
Association between anti-S antibody titer after second and third dose in IN-D patients.
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