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Immunogenicity of SARS-CoV-2 Vaccine in Dialysis
Eduardo Lacson1,2, Christos P Argyropoulos3, Harold J Manley2
1Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
Background:
Patients receiving maintenance dialysis represent a high-risk, immune-compromised population with 15%-25% COVID-19 mortality rate who were unrepresented in clinical trials of mRNA vaccines.
Methods:
All patients receiving maintenance dialysis who received two doses of SARS-CoV-2 mRNA vaccines with antibody test results drawn ≥14 days after the second dose, as documented in the electronic health record through March 18, 2021, were included. Response was on the basis of levels of Ig-G against the receptor binding domain of the S1 subunit of SARS-CoV-2 spike-antigen (seropositive ≥2 U/L) using an FDA-approved semiquantitative chemiluminescent assay (ADVIA Centaur XP/XPT COV2G).
Results:
Among 186 patients on dialysis from 30 clinics in eight states tested 23±8 days after receiving two vaccine doses, there were 165 (88.7%) responders with 70% at maximum titer. There was no significant difference between BNT162b2/Pfizer (148 out of 168, 88.1%) and mRNA-1273/Moderna (17 out of 18, 94.4%), P=0.42. All 38 patients with COVID-19 history were responders, with 97% at maximum titer. Among patients without COVID-19, 127 out of 148 (85.8%) were responders, comparable between BNT162b2/Pfizer (113 out of 133) and mRNA-1273/Moderna (14 out of 15) vaccines (85.0% versus 93.3%, P=0.38).
Conclusions:
Most patients receiving maintenance dialysis responded after two doses of BNT162b2/Pfizer or mRNA-1273/Moderna vaccine, suggesting the short-term development of antispike antibody is good, giving hope that most of these patients who are vulnerable, once immunized, will be protected from COVID-19. Longer-term evaluation is needed to determine antibody titer durability and if booster dose(s) are warranted. Further research to evaluate the approach to patients without a serologic response is needed, including benefits of additional dose(s) or administration of alternate options.
Insights
Patients on maintenance dialysis showed strong antibody responses after two doses of mRNA COVID-19 vaccines. This indicates good short-term protection for this high-risk group, though long-term durability requires further study.
Area of Science:
- Immunology
- Vaccinology
- Nephrology
Background:
- Patients on maintenance dialysis are a vulnerable, immune-compromised population.
- This group faces a high mortality rate from COVID-19 (15-25%).
- Dialysis patients were excluded from initial mRNA vaccine clinical trials.
Purpose of the Study:
- To assess the immunogenicity of SARS-CoV-2 mRNA vaccines in patients on maintenance dialysis.
- To evaluate antibody response after two doses of BNT162b2/Pfizer or mRNA-1273/Moderna vaccines.
Main Methods:
- Study included 186 patients on maintenance dialysis receiving two mRNA vaccine doses.
- Antibody levels (IgG against SARS-CoV-2 spike antigen) were measured ≥14 days post-vaccination.
- An FDA-approved chemiluminescent assay was used to determine seropositivity (≥2 U/L).
Main Results:
- 88.7% of patients (165/186) were responders, with 70% reaching maximum antibody titer.
- No significant difference in response rates between Pfizer (88.1%) and Moderna (94.4%) vaccines.
- All patients with prior COVID-19 (38/38) responded, compared to 85.8% of those without prior infection.
Conclusions:
- Two doses of mRNA COVID-19 vaccines induce a robust short-term antispike antibody response in most dialysis patients.
- This suggests potential short-term protection against COVID-19 for this vulnerable population.
- Longer-term antibody durability and the need for boosters require further investigation; non-responders need additional research.
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