Humoral response after 3 doses of the BNT162b2 mRNA COVID-19 vaccine in patients on hemodialysis
Authors: Didier Ducloux, Mathilde Colladant, Melchior Chabannes, Maria Yannaraki, Cécile Courivaud
Journal: Kidney International (2021)

Dialysis patients are at increased risk of severe coronavirus disease 2019 (COVID-19) infections.1Hsu C.M. Weiner D.E. COVID-19 in dialysis patients: outlasting and outsmarting a pandemic.Kidney Int. 2020; 98: 1402-1404Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar Therefore, they are considered as being a priority population for COVID-19 vaccination. Because immune responses against vaccines are considerably reduced in this population,2Litjens N.H. Huisman M. van den Dorpel M. Betjes M.G. Impaired immune responses and antigen-specific memory CD4+ T cells in hemodialysis patients.J Am Soc Nephrol. 2008; 19: 1483-1490Crossref PubMed Scopus (133) Google Scholar a vaccination strategy including 3 doses of vaccine has been recommended for dialysis patients. However, few data exist concerning humoral response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination with 3 doses of BNT162b2 (Pfizer–BioNTech) in patients on hemodialysis (HD). Moreover, about 90% of HD patients exhibit antibody positivity after 2 injections of vaccine,3Jahn M. Korth J. Dorsch O. et al.Humoral response to SARS-CoV-2-vaccination with BNT162b2 (Pfizer-BioNTech) in patients on hemodialysis.Vaccines (Basel). 2021; 9: 360Crossref PubMed Scopus (77) Google Scholar, 4Frantzen L, Cavaille G, Thibeaut S, El-Haik Y. Efficacy of the BNT162b2 mRNA COVID-19 vaccine in a hemodialysis cohort [e-pub ahead of print]. Nephrol Dial Transplant. https://doi.org/10.1093/ndt/gfab165. Accessed July 13, 2021.Google Scholar, 5Lacson E, Argyropoulos CP, Manley HJ, et al. Immunogenicity of SARS-CoV-2 vaccine in dialysis [preprint]. medRxiv. https://doi.org/10.1101/2021.04.08.21254779. Accessed July 13, 2021.Google Scholar, 6Korth J. Jahn M. Dorsch O. et al.Impaired humoral response in renal transplant recipients to SARS-CoV-2 vaccination with BNT162b2 (Pfizer-BioNTech).Viruses. 2021; 13: 756Crossref PubMed Scopus (120) Google Scholar and the relevance of a third dose is questionable. Nevertheless, only 75% exhibit robust responses after 2 doses, and a vaccine booster may be useful.7Ducloux D. Colladant M. Chabannes M. et al.Humoral response after BNT162b2 mRNA COVID-19 vaccination in patients on hemodialysis depends on immune status.Clin Kidney J. 2021; 100: 466-468Google Scholar We studied vaccine response in 50 HD patients who were COVID-19–naïve (no clinical history, negative serology) having received the BNT162b2 mRNA COVID-19 vaccine and 15 HD patients with a history of COVID-19 infections. Three doses of vaccine were proposed for naïve patients, and 2 were proposed for those previously exposed to COVID-19. Forty-five naïve patients received 3 doses, whereas 5 received only 2 doses (refusal of patients). Humoral response was studied using the SARS-CoV-2 immunoassay, Abbott designed to detect IgG antibodies to the receptor-binding domain of the S1 subunit of the spike protein of SARS-CoV-2. As a relevant threshold cannot be determined, we used that provided by the manufacturer. Among 45 naïve patients having received the 3 doses of vaccine, 40 (89%) had an antibody titer >50 arbitrary units [AU]/ml after 2 doses and 42 (93%) after 3 doses. Among the 5 nonresponders after 2 doses (antibody titer, <50 AU/ml), 2 had a robust response after the third dose (568 vs. 17 AU/ml and 923 vs. 35 AU/ml, respectively). Values of antibody titers were not normally distributed. Median values of antibody titers were 672 AU/ml (interquartile range [IQR]: 213–2528 AU/ml) and 6435 AU/ml (IQR: 2790–17,014 AU/ml) 1 month after the second and the third dose, respectively (Figure 1). After 3 doses, 92% of patients had antibody titers above the median antibody titer observed after 2 doses. Five patients denied a third dose of vaccine. There was no variation in antibody titers in 3 and a significant decline in 2. Median increase in antibody titers after the third dose was 580%. Explosive response (increase in titer >580%) was inversely related to antibody titer 1 month after the second dose (R2 = 0.373; P < 0.001). Those with an antibody titer <531 AU/ml after the second dose had better improvement in response (receiver operating curve characteristics, area under the curve, 0.77 [0.62–0.88]; P < 0.001; Figure 2). Antibody responses after 3 doses of vaccine in those not previously infected were similar to those after prior infection and 2 vaccine doses (5156 AU/ml [1502–21,569 AU/ml]). We report in a single-center study that 90% of dialysis patients have a vaccine response after 2 doses of BNT162b2 mRNA COVID-19 vaccine. A third dose enhances humoral response in almost all patients (Figure 3), but especially in those with lower antibody titers after 2 doses. Moreover, a fraction of nonresponders after 2 doses develops a strong response after the third dose. Dialysis patients with low humoral response may benefit from a third dose of BNT162b2 mRNA COVID-19 vaccine. COVID-19 in dialysis patients: outlasting and outsmarting a pandemicKidney InternationalVol. 98Issue 6PreviewCoronavirus disease 2019 (COVID-19) has affected the care and outcomes of patients treated with dialysis worldwide. In this issue of Kidney International, 3 reports highlight the disproportionately severe impact of COVID-19 on patients on dialysis, noting its high prevalence, particularly among patients receiving in-center dialysis. This likely reflects patients' limited ability to physically distance as well as community exposures, including residence in areas with high rates of infection. Patients on dialysis are at extremely high risk should they develop COVID-19, with short-term mortality of 20% or higher. Full-Text PDF Should vaccination against COVID-19 be mandated in patients on the transplant waiting list?Kidney InternationalVol. 100Issue 4PreviewConcordant studies report a very high mortality rate during coronavirus disease 2019 (COVID-19) infection in kidney transplant recipients (KTRs). The 30-day cumulative incidence of death is 18% in a French national cohort.1 Another study reported a mortality incidence of 32% among KTRs hospitalized for COVID-19 infection.2 Just as misfortunes never come one at a time, these patients, along with having vulnerability to infection, experienced a low rate of immunization after complete vaccination.3,4 Moreover, cases of severe COVID-19 occurring after complete vaccination have been reported in KTRs. Full-Text PDF