Antibody response to the BNT162b2 vaccine in maintenance hemodialysis patients
Authors: Philippe Attias, Hamza Sakhi, Philippe Rieu, Arvish Soorkia, David Assayag, Sabrina Bouhroum, Patrice Nizard, Khalil El Karoui
Journal: Kidney International (2021)

Patients receiving maintenance hemodialysis (MHD) may have altered vaccine responses.1Kato S. Chmielewski M. Honda H. et al.Aspects of immune dysfunction in end-stage renal disease.Clin J Am Soc Nephrol. 2008; 3: 1526-1533Crossref PubMed Scopus (791) Google Scholar Although mRNA vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have demonstrated dramatic efficacy in preventing symptomatic forms of coronavirus disease 2019 (COVID-19) in the nondialysis population,2Dagan N. Barda N. Kepten E. et al.BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting.N Engl J Med. 2021; 384: 1412-1423Crossref PubMed Scopus (1762) Google Scholar the characterization of vaccine response in patients receiving MHD remains a major unmet need. We studied the humoral response after the BNT162b2 mRNA vaccine using anti–spike(S)1 IgG antibody (Beckman Coulter Access; reference range for antibody positivity signal-to-cutoff >1; gray zone, 0.8–1) in a single-center cohort of 69 patients receiving MHD. Three hundred seventy-eight samples were analyzed (Figure 1). Thirteen patients (19%) had a history of previous COVID-19 or positive baseline serology. Samples until week 6 to 7 were available for 64 patients. Overall seropositivity rate at last follow-up was 55 of 64 (86%) (Supplementary Table S1). Patients aged >70 years were less likely to reach seropositivity at last follow-up (28 of 37 [75%]; P = 0.01; Supplementary Table S1). Conversely, immunocompromised status did not influence the seroconversion rate (7 of 8 [87%] seropositive among immunocompromised patients). The rate of early seropositivity was associated with a history of COVID-19 (Supplementary Table S2). Since week 2, the mean anti-S1 levels of these patients were significantly higher than those of infection-naïve individuals, even after both injections (Supplementary Table S3; Figure 1a). No difference in patient characteristics was observed between both groups (Supplementary Table S3). Among infection-naïve patients, anti–S1 IgG levels progressively increased among time (Figure 1b). The seropositivity rate was 10 of 56 (18%) before the second injection and 43 of 52 (82%) at last follow-up (Supplementary Tables S3–S5). Older age was associated with a reduced late seropositivity rate (Supplementary Table S5). Interestingly, 2 infection-naïve patients developed paucisymptomatic SARS-CoV-2 infection 5 and 6 weeks after first vaccine dose. Anti-S1 titers were 0.5 and 1.4, respectively, in these patients. In this analysis of postvaccine humoral response, patients receiving MHD have an overall anti-S1 seropositivity rate >80% after 2 doses of the BNT162b2 mRNA vaccine, but only 18% after a single injection. Moreover, patients receiving MHD with a previous SARS-CoV-2 infection have a higher rate of positive anti–S1 IgG (as expected) and higher anti–S1 IgG levels, compared with infection-naïve individuals. Older age is associated with a lower seropositivity rate in our cohort. These data are probably close to those observed in patients not receiving dialysis (as for long-term humoral response post–COVID-193Sakhi H. Dahmane D. Attias P. et al.Kinetics of anti-SARS-CoV-2 IgG antibodies in hemodialysis patients six months after infection [e-pub ahead of print]. J Am Soc Nephrol.https://doi.org/10.1681/ASN.2020111618Google Scholar), although seropositivity rates appear to be lower in patients receiving MHD.4Prendecki M. Clarke C. Brown J. et al.Effect of previous SARS-CoV-2 infection on humoral and T-cell responses to single-dose BNT162b2 vaccine.Lancet. 2021; 397: 1178-1181Abstract Full Text Full Text PDF PubMed Scopus (222) Google Scholar Although anti–S1 IgG titer is reported to correlate with in vitro virus neutralization,4Prendecki M. Clarke C. Brown J. et al.Effect of previous SARS-CoV-2 infection on humoral and T-cell responses to single-dose BNT162b2 vaccine.Lancet. 2021; 397: 1178-1181Abstract Full Text Full Text PDF PubMed Scopus (222) Google Scholar postvaccine immunity longevity (including cellular immunity not studied in this work) and protection from symptomatic infection remain to be studied in patients receiving MHD. Overall, this study suggests that most patients receiving MHD given both doses of the BNT162b2 mRNA vaccine are expected to develop an anti–S1 IgG response that may be protective. We thank all the patients involved in this study. Download .pdf (.06 MB) Help with pdf files Supplementary File (PDF) Immune response to SARS-CoV-2 infection and vaccination in patients receiving kidney replacement therapyKidney InternationalVol. 99Issue 6PreviewIn this issue of Kidney International, the initial experience regarding the immunogenicity of prior coronavirus disease 2019 (COVID-19) infection and the response to the COVID-19 vaccines among patients on maintenance dialysis and kidney transplant recipients is summarized. Preliminary data suggest that there is durability of immune response after COVID-19 infection. Although immune response to the first dose of vaccine is less in infection-naïve patients than healthy individuals in both groups, after the second vaccine dose a significant portion of patients receiving maintenance dialysis develop robust antibody titers, whereas kidney transplant recipients show a less-strong immune response. Full-Text PDF Anti–SARS-CoV-2 spike protein S1 receptor-binding domain antibody after vaccination with inactivated whole-virus SARS-CoV-2 in end-stage kidney disease patients: an initial reportKidney InternationalVol. 100Issue 5PreviewPatients with end-stage kidney disease (ESKD) are at greater risk for morbidity and mortality following coronavirus disease 2019 (COVID-19) than the general population.1 Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for this vulnerable population is the main priority to prevent COVID-19 and mitigate unfavorable or severe complications. However, the immune responses to vaccination in patients with ESKD may be altered by accumulation of uremic toxins and comorbidities. Full-Text PDF