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Interplay of kidney function and anti-SARS-CoV-2 antibodies in COVID-19 mortality: a prospective cohort study

Sylvia Mink1,2, Heinz Drexel3,4,5, Andreas Leiherer6,4

  • 1Central Medical Laboratories, Carinagasse 41 3495, 6800, Feldkirch, AT, Austria. smink@mzl.at.

Scientific Reports
|July 10, 2025
PubMed

Insights

Chronic kidney disease (CKD) patients with low anti-SARS-CoV-2 antibody levels face higher COVID-19 mortality. Maintaining antibody levels above 1200 BAU/ml is crucial for survival in CKD patients, suggesting a need for personalized vaccination strategies.

Area of Science:

  • Nephrology
  • Immunology
  • Infectious Diseases

Background:

  • Chronic kidney disease (CKD) is a significant risk factor for severe COVID-19 outcomes.
  • Humoral immune responses, including antibody levels, vary and decline with age, impacting vaccine effectiveness.
  • Optimal protection for CKD patients necessitates personalized vaccination strategies due to variable and diminishing antibody responses.

Purpose of the Study:

  • To investigate the combined impact of reduced kidney function and anti-SARS-CoV-2 antibody levels on COVID-19 mortality.
  • To identify critical antibody level thresholds associated with survival in hospitalized COVID-19 patients with CKD.
  • To inform personalized vaccination and booster recommendations for CKD patients.

Main Methods:

  • Prospective, multicenter cohort study of 1112 hospitalized COVID-19 patients.
  • Measurement of estimated glomerular filtration rate (eGFR) and anti-SARS-CoV-2 spike antibodies on admission.
  • Statistical analysis to determine the association between eGFR, antibody levels, and all-cause in-hospital mortality, adjusting for confounders.

Main Results:

  • Reduced kidney function and low anti-SARS-CoV-2 antibody levels synergistically predicted higher COVID-19 mortality.
  • Patients with eGFR < 60 ml/min and antibody levels below 182 BAU/ml had significantly increased odds of in-hospital death (aORs ranging from 4.5 to 8.5).
  • No significant difference in mortality by renal function was observed in CKD patients with antibody levels > 1200 BAU/ml.

Conclusions:

  • Sufficiently high anti-SARS-CoV-2 antibody levels are strongly associated with survival in CKD patients.
  • CKD patients with antibody levels below 1200 BAU/ml may benefit from additional booster vaccinations.
  • Personalized monitoring and vaccination strategies are essential for managing COVID-19 risk in CKD populations.

Keywords:
Anti-SARS-CoV-2 spike antibodiesCKDCOVID-19Correlate of protectionKidney functionSARS-CoV-2Vaccination

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