Humoral Response Following Triple Dose of mRNA Vaccines Against SARS-CoV-2 in Hemodialysis Patients: Results After 1 Year of Follow-Up

Eduardo Gallego-Valcarce; Amir Shabaka; Mariana Leon-Poo; Enrique Gruss; Juan Manuel Acedo-Sanz; Alfredo Cordón; Clara Cases-Corona; Gema Fernandez-Juarez

doi:10.3389/fmed.2022.927546

Humoral Response Following Triple Dose of mRNA Vaccines Against SARS-CoV-2 in Hemodialysis Patients: Results After 1 Year of Follow-Up

Front Med (Lausanne). 2022 Jul 12:9:927546. doi: 10.3389/fmed.2022.927546. eCollection 2022.

Authors

Eduardo Gallego-Valcarce¹, Amir Shabaka¹, Mariana Leon-Poo¹, Enrique Gruss¹, Juan Manuel Acedo-Sanz², Alfredo Cordón³, Clara Cases-Corona¹, Gema Fernandez-Juarez¹

Affiliations

¹ Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain.
² Department of Clinical Analysis, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain.
³ Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo, Móstoles, Spain.

Abstract

Introduction: COVID-19 is associated with an increased mortality in hemodialysis patients. Therefore, achieving a long-lasting effective immune response to SARS-CoV-2 vaccines is essential. This study describes the humoral immune response in hemodialysis patients following three doses of mRNA vaccines against SARS-CoV-2, and explores the factors associated with a sustained immune response.

Materials and methods: We analyzed the monthly serological evolution of SARS-CoV-2 anti-S(RBD) antibodies for 1 year in 178 chronic hemodialysis patients who received three doses of SARS-CoV-2 mRNA vaccines. The primary outcome was sustained effective humoral response defined as anti-S(RBD) levels > 1,000 AU/ml after 4 months from the third dose. Multivariate logistic regression analyses were used to identify features associated with a sustained humoral immune response.

Results: After the initial two SARS-CoV-2 mRNA vaccine doses, 77.8% of patients showed an immediate effective humoral response, decreasing to 52.5% after 4 months. Antibody levels were significantly higher in COVID-exposed patients and HBV vaccine responders. After the third dose, 97% of patients showed an effective humoral response, and remained in 91.7% after 4 months. The mean monthly rate of antibody titer decline decreased from 33 ± 14.5 to 25 ± 16.7%. Multivariate regression analysis showed that previous exposure to COVID-19 and response to HBV vaccines were associated with an effective sustained humoral immune response.

Conclusion: Immunization with SARS-CoV-2 mRNA vaccines elicits an effective immediate humoral immune response in hemodialysis patients, with a progressive waning in antibody levels. A third booster dose enhances the immune response with significantly higher antibody levels and more sustained humoral immune response. COVID-naïve patients and patients without previous response to HBV vaccines are likely to benefit from receiving more booster doses to maintain an effective immune response.

Keywords: COVID-19; chronic kidney disease; immunology; prevention; vaccine.