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Observational Study
. 2023 Mar 31;38(4):969-981.
doi: 10.1093/ndt/gfac307.

Humoral response after the fourth dose of the SARS-CoV-2 vaccine in the CKD spectrum: a prespecified analysis of the SENCOVAC study

Borja Quiroga  1 , María José Soler  2   3 , Alberto Ortiz  3   4 , Carlos Jesús Jarava Mantecón  5 , Virginia Olinda Gomes Pérez  5 , Antoni Bordils  6 , José Lacueva  6 , Antonio José Marin Franco  7 , Pablo Delgado Conde  8 , Patricia Muñoz Ramos  9 , Carmen Calderón González  10 , Juan Manuel Cazorla López  11 , Jinny Sanchez-Rodriguez  4 , Ana Sánchez Horrillo  1 , Tania Raquel Monzón Vázquez  12 , Alba Leyva  13 , José Rojas  13 , Ron T Gansevoort  14 , Patricia de Sequera  3   9 ; SENCOVAC collaborative network
Collaborators, Affiliations
Observational Study

Humoral response after the fourth dose of the SARS-CoV-2 vaccine in the CKD spectrum: a prespecified analysis of the SENCOVAC study

Borja Quiroga et al. Nephrol Dial Transplant. .

Abstract

Background: There is scarce evidence on the fourth dose of severe acute respiratory syndrome coronavirus 2 vaccines in chronic kidney disease (CKD) patients. We evaluated the humoral response and effectivity of the fourth dose in the CKD spectrum: non-dialysis CKD (ND-CKD), haemodialysis (HD), peritoneal dialysis (PD) and kidney transplant (KT) recipients.

Methods: This is a prespecified analysis of the prospective, observational, multicentric SENCOVAC study. In patients with CKD who had received a complete initial vaccination and one or two boosters and had anti-Spike antibody determinations 6 and 12 months after the initial vaccination, we analysed factors associated with persistent negative humoral response and higher anti-Spike antibody titres as well as the efficacy of vaccination on coronavirus disease 2019 (COVID-19) severity.

Results: Of 2186 patients (18% KT, 8% PD, 69% HD and 5% ND-CKD), 30% had received a fourth dose. The fourth dose increased anti-Spike antibody titres in HD (P = .001) and ND-CKD (P = .014) patients and seroconverted 72% of previously negative patients. Higher anti-Spike antibody titres at 12 months were independently associated with repeated exposure to antigen (fourth dose, previous breakthrough infections), previous anti-Spike antibody titres and not being a KT recipient. Breakthrough COVID-19 was registered in 137 (6%) patients, 5% of whom required admission. Admitted patients had prior titres <620 UI/ml and median values were lower (P = .020) than in non-admitted patients.

Conclusions: A fourth vaccine dose increased anti-Spike antibody titres or seroconverted many CKD patients, but those with the highest need for a vaccine booster (i.e. those with lower pre-booster antibody titres or KT recipients) derived the least benefit in terms of antibody titres. Admission for breakthrough COVID-19 was associated with low anti-Spike antibody titres.

Keywords: CKD; COVID-19; SARS-CoV-2; dialysis; kidney transplant; vaccines.

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