Related Experiment Video
Updated: Oct 10, 2025
Detection of SARS-CoV-2 Neutralizing Antibodies using High-Throughput Fluorescent Imaging of Pseudovirus Infection
Published on: June 5, 2021
SARS-CoV-2 Vaccine Antibody Response and Breakthrough Infection in Patients Receiving Dialysis
Shuchi Anand1, Maria E Montez-Rath1, Jialin Han1
1Department of Medicine (Nephrology), Stanford University, Palo Alto, California (S.A., M.E.M., J.H., P.G.).
Background:
Whether breakthrough SARS-CoV-2 infections after vaccination are related to the level of postvaccine circulating antibody is unclear.
Objective:
To determine longitudinal antibody-based response and risk for breakthrough infection after SARS-CoV-2 vaccination.
Design:
Prospective study.
Setting:
Nationwide sample from dialysis facilities.
Patients:
4791 patients receiving dialysis.
Measurements:
Remainder plasma from a laboratory processing routine monthly tests was used to measure qualitative and semiquantitative antibodies to the receptor-binding domain (RBD) of SARS-CoV-2. To evaluate whether peak or prebreakthrough RBD values were associated with breakthrough infection, a nested case-control analysis matched each breakthrough case patient to 5 control patients by age, sex, and vaccination month and adjusted for diabetes status and region of residence.
Results:
Of the 4791 patients followed with monthly RBD assays, 2563 were vaccinated as of 14 September 2021. Among the vaccinated patients, the estimated proportion with an undetectable RBD response increased from 6.6% (95% CI, 5.5% to 7.8%) 14 to 30 days after vaccination to 20.2% (CI, 17.0% to 23.3%) 5 to 6 months after vaccination. Estimated median index values decreased from 91.9 (CI, 78.6 to 105.2) 14 to 30 days after vaccination to 8.4 (CI, 7.6 to 9.3) 5 to 6 months after vaccination. Breakthrough infections occurred in 56 patients, with samples collected a median of 21 days before breakthrough infection. Compared with prebreakthrough index RBD values of 23 or higher (equivalent to ≥506 binding antibody units per milliliter), prebreakthrough RBD values less than 10 and values from 10 to less than 23 were associated with higher odds for breakthrough infection (rate ratios, 11.6 [CI, 3.4 to 39.5] and 6.0 [CI, 1.5 to 23.6], respectively).
Limitations:
Single measure of vaccine response; ascertainment of COVID-19 diagnosis from electronic health records.
Conclusion:
The antibody response to SARS-CoV-2 vaccination wanes rapidly in persons receiving dialysis. In this population, the circulating antibody response is associated with risk for breakthrough infection.
Primary Funding Source:
Ascend Clinical Laboratory.
More Related Videos
Related Concept Videos
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:24Hemodialysis II: Procedure and Complications
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:30Continuous Renal Replacement Therapy