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. 2022 Oct;33(10):1832-1839.
doi: 10.1681/ASN.2022040504. Epub 2022 Aug 16.

SARS-CoV-2 Infection during the Omicron Surge among Patients Receiving Dialysis: The Role of Circulating Receptor-Binding Domain Antibodies and Vaccine Doses

Maria E Montez-Rath  1 , Pablo Garcia  1 , Jialin Han  1 , LinaCel Cadden  2 , Patti Hunsader  2 , Curt Morgan  2 , Russell Kerschmann  2 , Paul Beyer  2 , Mary Dittrich  3 , Geoffrey A Block  3 , Julie Parsonnet  4   5 , Glenn M Chertow  1   5 , Shuchi Anand  1
Affiliations

SARS-CoV-2 Infection during the Omicron Surge among Patients Receiving Dialysis: The Role of Circulating Receptor-Binding Domain Antibodies and Vaccine Doses

Maria E Montez-Rath et al. J Am Soc Nephrol. 2022 Oct.

Abstract

Background: It is unclear whether circulating antibody levels conferred protection against SARS-CoV-2 infection among patients receiving dialysis during the Omicron-dominant period.

Methods: We followed monthly semiquantitative SARS-CoV-2 RBD IgG index values in a randomly selected nationwide cohort of patients receiving dialysis and ascertained SARS-CoV-2 infection during the Omicron-dominant period of December 25, 2021 to January 31, 2022 using electronic health records. We estimated the relative risk for documented SARS-CoV-2 infection by vaccination status and by circulating RBD IgG using a log-binomial model accounting for age, sex, and prior COVID-19.

Results: Among 3576 patients receiving dialysis, 901 (25%) received a third mRNA vaccine dose as of December 24, 2021. Early antibody responses to third doses were robust (median peak index IgG value at assay limit of 150). During the Omicron-dominant period, SARS-CoV-2 infection was documented in 340 (7%) patients. Risk for infection was higher among patients without vaccination and with one to two doses (RR, 2.1; 95% CI, 1.6 to 2.8, and RR, 1.3; 95% CI, 1.0 to 1.8 versus three doses, respectively). Irrespective of the number of vaccine doses, risk for infection was higher among patients with circulating RBD IgG <23 (506 BAU/ml) (RR range, 2.1 to 3.2, 95% CI, 1.3 to 3.4 and 95% CI, 2.2 to 4.5, respectively) compared with RBD IgG ≥23.

Conclusions: Among patients receiving dialysis, a third mRNA vaccine dose enhanced protection against SARS-CoV-2 infection during the Omicron-dominant period, but a low circulating RBD antibody response was associated with risk for infection independent of the number of vaccine doses. Measuring circulating antibody levels in this high-risk group could inform optimal timing of vaccination and other measures to reduce risk of SARS-CoV-2 infection.

Keywords: COVID-19; ESKD; SARS-CoV-2; chronic dialysis; clinical epidemiology; immunology.

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Figures

Figure 1.
Figure 1.
Flow chart of main analysis cohort.
Figure 2.
Figure 2.
Age- and sex-adjusted median RBD IgG index values between February 1 and December 24, 2021 among patients who received mRNA vaccines. (A) mRNA1273. (B) BNT162b2. The figure depicts median antibody index values plotted by days since first dose of vaccine—excluding persons with documented SARS-CoV-2 (n=419)—using 30-day windows consistent with monthly laboratory draws among patients on dialysis. We assigned vaccine type by the type of first vaccine dose.
See this image and copyright information in PMC

Update of

References

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