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. 2023;147(3-4):185-192.
doi: 10.1159/000525519. Epub 2022 Jul 27.

Humoral Response to the Third Dose of BNT162b2 COVID-19 Vaccine among Hemodialysis Patients

Timna Agur  1   2 , Boris Zingerman  1   2 , Naomi Ben-Dor  1   2 , Weaam Alkeesh  2   3 , Tali Steinmetz  1   2 , Ruth Rachamimov  1   2 , Asher Korzets  1   2 , Benaya Rozen-Zvi  1   2 , Michal Herman-Edelstein  1   2
Affiliations

Humoral Response to the Third Dose of BNT162b2 COVID-19 Vaccine among Hemodialysis Patients

Timna Agur et al. Nephron. 2023.

Abstract

Background: Hemodialysis patients are at high risk for severe COVID-19 disease. Despite a high early seropositivity rate, dialysis patients mount a dampened immune response following two doses of an mRNA vaccine. This study aimed to evaluate the serologic response to a booster dose of BNT162b2 vaccine, 6 months after the second dose, among hemodialysis patients.

Methods: This prospective study included 80 hemodialysis patients and 56 healthcare workers serving as controls. Serologic samples were evaluated before and ∼3 weeks after the third vaccine dose. The primary outcomes were the seropositivity rate and the log-transformed anti-SARS-COV-2 S1 (RBD) IgG as a continuous variable after the third dose. Secondary outcomes were the proportion of participants with "high response," defined as antibody levels >1,000 AU/mL, and "robust response," defined as antibody levels >4,160 AU/mL, according to prespecified cutoff values associated with neutralizing antibodies. Univariate and multivariate analyses were conducted to identify predictors of antibody response.

Results: Among 80 hemodialysis patients, seropositivity rates improved from 78% (62/80) before the third dose, up to 96% (77/80) after the booster dose. The S1-RBD log-transformed antibody level increased significantly following the third dose from 2.15 ± 0.75 to 3.99 ± 0.83 compared with 2.65 ± 0.4 to 4.31 ± 0.42 in the control group. Among the hemodialysis patients, 88% (70/80) became "high responders" (>1,000 AU/mL), and of these, 79% (63/80) mounted a "robust response" (>4,160 AU/mL). Baseline antibody level, dialysis therapy, and hypoalbuminemia were independent predictors of impaired antibody response.

Conclusions: A third dose of BNT162b2 COVID-19 vaccine, 6 months after the standard two-dose vaccination regimen, substantially improved humoral response in hemodialysis patients.

Keywords: Antibody response; COVID-19 vaccine; Hemodialysis patients; Third dose.

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Conflict of interest statement

The authors of this manuscript have no conflicts of interest to disclose. The results presented in this article have not been published previously in whole or part.

Figures

Fig. 1
Fig. 1
Flowchart of the study.
Fig. 2
Fig. 2
Antibody response before and after a third dose of BNT162b2 vaccine. The anti-S1-RBD IgG level before and after a third vaccine dose in HDP and healthy control. Results refer to the HDP group (n= 80) and HCW group (n= 56).
See this image and copyright information in PMC

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