Six months follow up of hemodialysis patients after SARS-CoV-2 vaccinations: Effects of the booster dose and vaccine t

Abstract

Background: As hemodialysis patients are among the vulnerable groups for severe COVID-19, proper vaccination of these patients is quite important. However vaccine responsiveness is generally reduced in hemodialysis patients and strategies should be developed to maintain protection in the long term. Objectives: This study aimed to analyse the changes in antibody levels of SARS-CoV-2 vaccinated hemodialysis patients after six months and to compare the effectiveness of inactivated and mRNA vaccines. Methods: Eighty-five hemodialysis patients were followed up for six months after their initial vaccinations for SARS-CoV-2. Persistence of humoral responses were compared between patients who got inactivated or mRNA vaccines and also between patients who received a booster dose and those who didn’t. SARS-CoV-2 antibody titers were measured by a commercial test that measures IgG antibodies toward the receptor-binding domain of spike protein. Results: Seropositivity that was achieved by initial vaccination dropped abruptly by 6 months. Patients who received a booster dose had significantly higher antibody levels than those who didn’t (1120,8 ± 983,3 AU/mL vs 313,3 ± 435,3 AU/mL respectively; p<0,001) and higher seropositivity as well (88% vs 65%). Seropositivity with mRNA vaccine at the end of 6th month was 81,8% while this decreased to 50% for inactivated vaccine. Patients who received mRNA vaccine initially or as the third dose could maintain 88,4% of seropositivtiy and this was higher than other patients who have just got inactivated vaccine (p=0,013). Conclusion: Humoral immune response by SARS-CoV-2 vaccines is not very stable in hemodialysis patients and planning the booster doses should not be delayed. mRNA vaccines have better immunogenicity than inactivated vaccines.

Keywords

• SARS-CoV-2
• immunization
• vaccines
• hemodialysis
• protection

References

1. 1.Wakasugi M, Kawamura K, Yamamoto S, KazamaJJ, Narita I. High Mortality Rate of Infectious Diseases in Dialysis Patients: A Comparison With the GeneralPopulation in Japan. Ther Apher Dial. 2012; 16(3):226-31.
2. 2.Valeri AM, Robbins-Juarez SY, Stevens JS, et al.Presentation and outcomes of patients with ESKDand COVID-19. J Am Soc Nephrol. 2020;31(7):1409–15.
3. 3.Yilmaz Z, Yilmaz S. COVID-19 in HemodialysisPatients. Dicle Med J. 2021; 48: 140-144
4. 4.Litjens NHR, Huisman M, van den Dorpel M, BetjesMGH. Impaired Immune Responses and Antigen-Specific Memory CD4+ T Cells in HemodialysisPatients. J Am Soc Nephrol. Aug 2008; 19 (8): 1483-90.
5. 5.Hasmann S, Paal M, Füeβl L, Fischereder M,Schönermarck U. Humoral immunity to SARS-CoV-2vaccination in haemodialysis patients. The LancetReg Health Eur. 2021 Nov; 10: 100237.
6. 6.Strengert M, Becker M, Ramos GM, et al. Cellularand humoral immunogenicity of a SARS-CoV-2mRNA vaccine in patients on haemodialysis.EBioMedicine. 2021; 70: 103524. DOI:10.1016/j.ebiom.2021.103524
7. 7.Murt A, Altiparmak MR, Yadigar S, et al. Antibodyresponses to the SARS-CoV-2 vaccines inhemodialysis patients: Is inactivated vaccineeffective? Ther Apher Dial. 2021; 1-6. Doi:10.1111/1744-9987.13752
8. 8.Bachelet T, Bourdenx JP, Martinez C, et al.Humoral response after SARS-CoV-2 mRNA vaccines in dialysis patients: Integrating anti-SARS-CoV-2 Spike-Protein-RBD antibody monitoring to manage dialysis centers in pandemic times. PLoS One. 2021; 16(10): e0257646. Doi:10.1371/journal.pone.0257646.

9. 9.Campo F, Venuti A, Pimpinelli F, et al. AntibodyPersistence 6 months post-vaccination withBNT162b2 among Health Care Workers. Vaccines(Basel). 2021 Oct 3; 9 (10): 1125. Doi:10.3390/vaccines9101125.
10. 10.Shrotri M, Navaratnam AMD, Nguyen V, et al.Spike-antibody waning after second dose ofBNT162b2 or ChAdOx1. Lancet. 2021 Jul 31; 398:385-387. Doi: 10.1016/S0140-6736(21)01642-1.
11. 11.Coliier AY, Yu J, McMahan K, et al. DifferentialKinetics of Immune Responses Elicited by COVID-19Vaccines. N Eng J Med. 2021 Nov 18; 385 (21):2010-2.
12. 12.Levin EG, Lustig Y, Cohen C, et al. WaningImmune Humoral Response to BNT162b2 COVID-19Vaccine over 6 Months. N Eng J Med. 2021 Dec 9; 385 (24): e84.
13. 13.Pahl MV, Gollapudi S, Sepassi L, et al. Effect ofend-stage renal disease on B-lymphocytesubpopulations, IL-7, BAFF and BAFF receptorexpression. Nephrol Dial Transplant. 2010 Jan;25(1): 205-12.
14. 14.Weigert A, Bergman M-L, Gonçalves LA, et al.Longitudinal Analysis of Antibody Responses to themRNA BNT162b2 Vaccine in Patients UndergoingMaintenance Hemodialysis: A 6-Month Follow-Up.Front. Med (Lausanne). 2021 Dec 24; 8:796676. DOI: 10.3389/fmed.2021.796676
15. 15.Eliakim-Raz N, Leibovici-Weisman Y, Stemmer A, et al. Antibody Titers Before and After a Third Doseof the SARS-CoV-2 BNT162b2 Vaccine in AdultsAged ≥ 60 years. JAMA. 2021 Dec 7;326(21):2203-4
16. 16.Dekervel M, Henry N, Torreggiani M, et al.Humoral response to a third injection of BNT162b2vaccine in patients on maintenance haemodialysis.Clin Kidney J. 2021 Aug 13; 14(11): 2349-55.