Abstract
Background and objectives: Patients receiving hemodialysis are at high risk for both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe coronavirus disease 2019. A lifesaving vaccine is available, but sensitivity to vaccines is generally lower in patients on dialysis. Little is yet known about antibody responses after coronavirus disease 2019 (COVID-19) vaccination in this vulnerable group.
Design, setting, participants, and measurements: In this prospective single-center study, we included 22 patients on dialysis and 46 healthy controls from Heidelberg University Hospital between December 2020 and February 2021. We measured anti-S1 IgG with a threshold index for detection greater than one, neutralizing antibodies with a threshold for viral neutralization of ≥30%, and antibodies against different SARS-CoV2 fragments 17-22 days after the first dose and 18-22 days after the second dose of the mRNA vaccine BNT162b2.
Results: After the first vaccine dose, four of 22 (18%) patients on dialysis compared with 43 of 46 (93%) healthy controls developed positive anti-S1 IgG, with a median anti-S1 IgG index of 0.2 (interquartile range, 0.1-0.7) compared with nine (interquartile range, 4-16), respectively. SARS-CoV2 neutralizing antibodies exceeded the threshold for neutralization in four of 22 (18%) patients on dialysis compared with 43 of 46 (93%) healthy controls, with a median percent inhibition of 11 (interquartile range, 3-24) compared with 65 (interquartile range, 49-75), respectively. After the second dose, 14 of 17 (82%) patients on dialysis developed neutralizing antibodies exceeding the threshold for viral neutralization and antibodies against the receptor binding S1 domain of the spike protein, compared with 46 of 46 (100%) healthy controls, respectively. The median percent inhibition was 51 (interquartile range, 32-86) compared with 98 (interquartile range, 97-98) in healthy controls.
Conclusions: Patients receiving long-term hemodialysis show a reduced antibody response to the first and second doses of the mRNA vaccine BNT162b2. The majority (82%) develop neutralizing antibodies after the second dose but at lower levels than healthy controls.
Keywords: COVID-19; SARS-CoV-2; dialysis; hemodialysis; humoral response; vaccination.
【저자키워드】 COVID-19, SARS-CoV-2, vaccination, dialysis, Hemodialysis, Humoral response, 【초록키워드】 coronavirus disease, neutralizing antibody, IgG, Coronavirus disease 2019, Vaccine, coronavirus, SARS-CoV2, vaccination, Neutralizing antibodies, antibody, mRNA vaccine, neutralization, Antibody Response, Infection, Spike protein, dialysis, vaccine dose, BNT162b2, sensitivity, Antibody responses, Hemodialysis, Viral, Humoral response, Patient, viral neutralization, respiratory, threshold, university, Receptor binding, humoral, high risk, interquartile range, acute respiratory syndrome, Participants, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, severe coronavirus disease, second dose, healthy control, first dose, healthy controls, single-center study, positive, S1 domain, greater, develop, nine, receiving, reduced, median, majority, the spike protein, exceeded, 【제목키워드】 response,