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Observational Study
. 2025 Jun 23;26(1):290.
doi: 10.1186/s12882-025-04264-3.

Chronic heart failure and hypoalbuminemia are risk factors of poorer mRNA SARS-CoV-2 vaccine response in maintenance Hemodialysis patients (the COVaccinDia study)

Pierre Laurent  1 , Marianne Renou  1 , Najeh El Esper  1 , Gabriel Choukroun  1   2 , Pierre Pommerolle  1 , Sébastien Laburthe  3 , Pauline Caillard  4   5
Affiliations
Observational Study

Chronic heart failure and hypoalbuminemia are risk factors of poorer mRNA SARS-CoV-2 vaccine response in maintenance Hemodialysis patients (the COVaccinDia study)

Pierre Laurent et al. BMC Nephrol. .

Abstract

Background: Chronic kidney disease represents an immunocompromising condition and a cause of a lower vaccine efficacy, even in patients undergoing maintenance dialysis. Recent SARS-CoV-2 outbreaks have prompted clinicians to better understand the underlying mechanisms and establish more suitable vaccination schedules.

Methods: In a single-center, retrospective, observational study of patients undergoing maintenance dialysis in France, we studied the factors associated with the intensity of the humoral response to a SARS-CoV-2 vaccine in this population, including specific dialysis-related variables.

Results: After having received three doses of SARS-CoV-2 mRNA vaccine, a cohort of 80 patients was divided into low-responders (28 patients with an anti-SARS-CoV-2 antibody level of 50-1830 AU/mL) and responders (52 patients with an antibody level > 1830 AU/mL). We found that chronic heart failure (p < 0.00001), higher performance status (p = 0.004), hypoalbuminemia (p < 0.001), lymphopenia (p = 0.003), Rhesus status positivity (p = 0.02), and absence of response to a hepatitis B virus vaccine (p = 0.02) were associated with a poor response to a third dose of SARS-CoV-2 vaccine. In contrast, none of the dialysis-related variables were associated with the vaccine response. In multivariate logistic regression, chronic heart failure (p < 0.0001) and hypoalbuminemia (p = 0.0004) remained associated with a lower humoral response to SARS-CoV-2 vaccine.

Conclusions: Our results showed that chronic heart failure and hypoalbuminemia were factors associated with a poor humoral response after three doses of SARS-CoV-2 vaccine. However, we found no association between specific dialysis-related variables and the anti-SARS-CoV-2 antibody titer.

Keywords: COVID-19; Hemodialysis; Humoral response; SARS-CoV-2; Vaccines.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the institutional review board at Amiens University Medical Center (Amiens, France; reference: PI2022_843_0072) on June 5th, 2022). Informed consent was obtained from all patients involved in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
mRNA SARS-CoV-2 vaccination scheme in 80 dialysis patients. Patients were all triple-vaccinated. Sampling and vaccination schedules are given in months as indicated
Fig. 2
Fig. 2
The study flow-chart
Fig. 3
Fig. 3
Changes in the SARS-CoV-2 antibody level after a fourth dose of vaccine. Data are expressed as the median [interquartile range] ( n  = 10/18/15/37 for 50<Ac<1830 D3, 50<Ac<1830 D4, Ac>1830 D3, and Ac>1830 D4, respectively, at S1, and n  = 7/17/9/31 in 50<Ac<1830 D3, 50<Ac<1830 D4, Ac>1830 D3, and Ac>1830 D4, respectively, at S2). $ p  < 0.05. Abbreviations. Ac: serum antibody level; S1: first serology test; S2: second serology test; D3: three doses of vaccine; D4, four doses of vaccine
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