Humoral response after the fourth dose of the SARS-CoV-2 vaccine in the CKD spectrum: a prespecified analysis of the SENCOVAC study
Authors: Quiroga Borja , Soler María José , Ortiz Alberto , Jarava Mantecón Carlos Jesús , Gomes Pérez Virginia Olinda , Bordils Antoni , Lacueva José , Marin Franco Antonio José , Delgado Conde Pablo , Muñoz Ramos Patricia , Calderón González Carmen , Cazorla López Juan Manuel , Sanchez-Rodriguez Jinny , Sánchez Horrillo Ana , Monzón Vázquez Tania Raquel , Leyva Alba , Rojas José , Gansevoort Ron T , de Sequera Patricia ,   SENCOVAC collaborative network, Rodríguez María Teresa Jaldo , Valverde Rafael Lucena , Carretero Marta Puerta , Díaz Mayra Ortega , Tocora Daniel Gaitán , Suárez Esther Rodriguez , Santolaya Alfredo José Sáenz , Cobo Patricia Arribas , Talavan Tamar , Calero Raquel Cerrajero , Gracia-Iguacel Carolina , González-Parra Emilio , Pereira Mónica , Martin-Cleary Catalina , Ramos-Verde Ana , Giorgi Martín , Sánchez Carmen , Giraldo Yohana Gil , Horrillo Ana Sánchez , Suárez Pablo Ruano , Perpén Antonio Fernández , Ramos Andrés Fernández , Villanueva Laura Salanova , Cortiñas Alejandra , Arias Pablo A Díez , Cárdenas Alicia Cabrera , de Santos Antonio , Núñez Almudena , Cuadrado Guillermina Barril , de Gante Loreto Mariscal , Repollet Raquel , Polo Concepción Redondo , Moreso Francesc , Azancot María Antonieta , Ramos Natalia , Toapanta Oriol Bestard Nestor , Cidraque Ignacio , Bermejo Sheila , Agraz Irene , Prat Oreto , Medina Carlota , Pardo Emma , Prat Oreto , Saiz Alejandro , Vila Maria Antònia Munar , Guldris Secundino Cigarrán , Granados Nicolás Menéndez , Cabo María Jesús Corton , Alarcón Walter López , Sánchez Soledad Pizarro , Alexandru Simona , Suarez Laura García Puente , Saico Saul Pampa , Tapia Marisol Poma , Zamora Rocío , Hernández Rosa Sánchez , Osorio Laura Rodríguez , García-Fernández Nuria , Moreno Paloma Leticia Martin , González Noelia Ania , Ortiz Ana Sabalza , Iñarrea María Nieves Bastida , Cabrera Sagrario Soriano , López Raquel Ojeda , Peregrí Cayetana Moyano , Morales Maria Luisa Agüera , Cabello Maria Dolores Navarro , Mazuecos Auxiliadora , García Teresa , Narváez Carlos , Orellana Cristhian , Márquez María Gabriela Sánchez , Novillo Carolina Lancho , Ganga Pedro Luis Quirós , Carrión Fernando Vallejo , Herrera Antonio Luis García , Castro Natalia Blanco , Cendrero Rosa María Ruiz-Calero , Hidalgo-Barquero María Victoria Martín , Gallego Román Hernández , Alvarez Álvaro , Leo Eva Vázquez , León José Luis Pizarro , García Manuel Antonio Martínez , Jiménez Benaldina García , Pérez Virginia Olinda Gómez , Moya Juan de Dios Ramiro , Espinosa Diana López , Herrador Alejandro Jiménez , Zurita Manuel Navarro , Díaz Álvarez Leonardo , Martínez ÁlvaroGonzález , Arroyo Sandra Báez , Fernández Raquel Reina , Vargas Marlyn Janella Suárez , Casero Rocío Calurano , Useche Gustavo , García Amparo Bernat , Díaz Ana Beatriz Muñoz , de Miguel Carmen Santamaría , Palacios Ángel , Henningsmeyer Brenda , Calve Esther Orero , Moya José Lacueva , Sato Yurika , Marín Marta Serra , Tejedor Sandra , Vaquera Shaida Martínez , Carnerero di Riso Manuel , Torres Irene , Alfaro Georgina , Halauko Olga , El Rifai Fouad , Martínez Ana Dolores , Justo Ávila Pablo , Sánchez Christian Alfaro , Sainz Marta Sanz , Martín José María Baltar , del Río García Laura , Canga José Luis Pérez , Ochoa Paola Milena Villabón , Pacios Laura Muñiz , Machado Lina León , Morales Augusto Quiroz , Cavalotti Ignacio Manzur , Zorita Itziar Navarro , López Sol Otero , González Sara Outon , Montañez Carlos Soto , Rubio Auxiliadora Bajo , Gilsanz Gloria Del Peso , Gonzalez Marta Ossorio , Villanueva Rafael Sánchez , Oliva Maria Ovidia Lopez , Varela Jesús Calviño , Enríquez Alba García , Casas Carmen Cobelo , Alonso Pablo Otero , Tabares Lourdes González , Barreiro José María Lamas , Solla Luisa Palomares , Gándara Arginino , Nájera de la Garza Walfred , Fleming Francisco Fernández , Goyanes María Gloria Rodríguez , Feijoo Cintia Caramés , Plaza María Mercedes Moreiras , Juan Cristina Bayón , de Arriba de la Fuente Gabriel , Pérez del Valle Katia , Contreras Francisco Javier Pérez , Lara Noelia Balibrea , Ferri Dioné González , Llorente Eduardo Muñoz de Bustillo , Rodríguez Enriqueta González , Perez Virginia Lopez De La Manzanara , Arevalo Marta Calvo , Calvo Jose Antonio Herrero , Carratalá María Rosario Llópez , Rodríguez Leyre María Martin , Salazar Marisa Serrano , Prieto Begoña Bravo , Pérez José María Portolés , Paraíso Antonio Gil , Huarte Emma , Lanau M , Campos Rodrigo Avellaneda , Ubé José Manuel , Godoy Isabel Berdud , Aguilera Esther Torres , Alea Rolando Tello , Saldaña Margie Soledad Del Rosario , Salgueira Mercedes , Aresté Nuria , de los Ángeles Rodríguez María , Collantes Rocío , Martínez Ana Isabel , Moyano María Jesús , Víbora Elena Jiménez , Gash Sandra Castellano , Martínez Lara Ruíz , Cervera María Cinta Aguilar , De Tomas María Teresa Rodrigo , Prieto Beatriz Azcue , Toyos Carmen , Del Rio José Molina , Acosta Adriana Restrepo , Zamacona Amagoia Celayeta , Martin Mª Isabel Jimeno , Ortega Saioa Bilbao , Ruiz Mª Isabel Gallardo , Rubio Ainhoa Hernando , Ledesma Paula Garcia , Alvarez Alvaro Goyoaga , Poch Esteban , Cucchiari David , Monzo José Broseta , Cabrera Beatriz Escamilla , Hernández Aurelio Pastor Rodríguez , Rebollo María Sagrario García , Hernández Juana Margarita Rufino , González Alejandra Yugueros , Alonso Juan Carlos , Más Amparo Martínez , Calvé Manuel , Cardona Marina Garces , Balaguer Vanesa Canto , Pesquera José Ignacio Minguela , Cotilla de la Rosa Eva , Santarelli David Rodríguez , Garcia Alba Santos , Martin-Caro Antonio Cabezas , Santamaria Inmaculada Martinez , Cervienka Michal , Urraca de la Pisa Ana María , Monzon Lidia Sendino , Anachuri Karina Ampuero , Garcia Esther Hernández , Gomez Victoria Oviedo , Estupiñán Raquel Santana , Amado Francisco Valga , Borges Patricia Pérez , Beloso Marta Durán , Alonso Fernanda Arroyo , Felpete Noemí Pérez , Ameneiro Ana Meizoso , Mera Mónica Cunha , Casares Beatriz Gil , Larrondo Sofía Zarraga , Kareaga Naroa Maruki , Salvador del Valle Ainhoa Inza San , García Ana Rosa Muñoz , Linaza Blanca Villacorta , del Toro Espinosa Nuria , Perico Paola Estupiñan , Oliva José Manuel Sánchez , Manrique Joaquín , Castaño Itziar , Purroi Carolina , Gómez Nerea , Mansilla Cristina , Utzurrum Ane , Serna Manuel Ramírez de Arellano , Perich Luis Guirado , Rincón María Muñiz , Perez Virginia Lopez De La Manzanara , Arevalo Marta Calvo , Calvo Jose Antonio Herrero , Villoria Jesús Grande , De Salinas Alfonso Pobes Martínez 
Published: November 2022

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 &lt;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.