Investigation for the efficacy of COVID-19 vaccine in Japanese CKD patients treated with hemodialysis

Ayumi Yoshifuji; Masataro Toda; Munekazu Ryuzaki; Kan Kikuchi; Toru Kawai; Ken Sakai; Emi Oyama; Masayoshi Koinuma; Kazuhiko Katayama; Yuki Uehara; Norio Ohmagari; Yoshihiko Kanno; Hirofumi Kon; Toshio Shinoda; Yaoko Takano; Junko Tanaka; Kazuhiko Hora; Yasushi Nakazawa; Naoki Hasegawa; Norio Hanafusa; Fumihiko Hinoshita; Keita Morikane; Shu Wakino; Hidetomo Nakamoto; Yoshiaki Takemoto

doi:10.1186/s41100-022-00427-2

Investigation for the efficacy of COVID-19 vaccine in Japanese CKD patients treated with hemodialysis

Ren Replace Ther. 2022;8(1):39. doi: 10.1186/s41100-022-00427-2. Epub 2022 Aug 19.

Authors

Ayumi Yoshifuji^#^{1

2}, Masataro Toda^#², Munekazu Ryuzaki^{1

2}, Kan Kikuchi¹, Toru Kawai¹, Ken Sakai¹, Emi Oyama¹, Masayoshi Koinuma³, Kazuhiko Katayama⁴, Yuki Uehara¹, Norio Ohmagari¹, Yoshihiko Kanno¹, Hirofumi Kon¹, Toshio Shinoda¹, Yaoko Takano¹, Junko Tanaka¹, Kazuhiko Hora¹, Yasushi Nakazawa¹, Naoki Hasegawa¹, Norio Hanafusa¹, Fumihiko Hinoshita¹, Keita Morikane¹, Shu Wakino¹, Hidetomo Nakamoto¹, Yoshiaki Takemoto¹

Affiliations

¹ Infection Control Committee, The Japanese Society for Dialysis Therapy, Tokyo, Japan.
² Division of Nephrology, Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
³ Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan.
⁴ Laboratory of Viral Infection Control, Ōmura Satoshi Memorial Institute, Graduate School of Infection Control Sciences, Kitasato University, Tokyo, Japan.

^# Contributed equally.

Abstract

Background: Dialysis patients are predisposed to severe disease and have a high mortality rate in coronavirus disease 2019 (COVID-19) due to their comorbidities and immunocompromised conditions. Therefore, dialysis patients should be prioritized for vaccination. This study aimed to examine how long the effects of the vaccine are maintained and what factors affect antibody titers.

Methods: Hemodialysis patients (HD group) and age- and sex-matched non-dialysis individuals (Control group), receiving two doses of BNT162b2 vaccine, were recruited through the Japanese Society for Dialysis Therapy (JSDT) Web site in July 2021. Anti-SARS-CoV-2 immunoglobulin (IgG) (SARS-CoV-2 IgG titers) was measured before vaccination, 3 weeks after the first vaccination, 2 weeks after the second vaccination, and 3 months after the second vaccination, and was compared between Control group and HD group. Factors affecting SARS-CoV-2 IgG titers were also examined using multivariable regression analysis and stepwise regression analysis (least AIC). In addition, we compared adverse reactions in Control and HD groups and examined the relationship between adverse reactions and SARS-CoV-2 IgG titers.

Results: Our study enrolled 123 participants in the Control group (62.6% men, median age 67.0 years) and 206 patients in the HD group (64.1% men, median age 66.4 years). HD group had significantly lower SARS-CoV-2 IgG titers at 3 weeks after the first vaccination (p < 0.0001), 2 weeks after second vaccination (p = 0.0002), and 3 months after the second vaccination (p = 0.045) than Control group. However, the reduction rate of SARS-CoV-2 IgG titers between 2 weeks and 3 months after the second vaccination was significantly smaller in HD group than in Control (p = 0.048). Stepwise regression analysis revealed that dialysis time was identified as the significant independent factors for SARS-CoV-2 IgG titers at 2 weeks after the second vaccination in HD group (p = 0.002) and longer dialysis time resulted in higher maximum antibody titers. The incidences of fever and nausea after the second vaccination were significantly higher in the HD group (p = 0.039 and p = 0.020). Antibody titers in those with fever were significantly higher than those without fever in both groups (HD: p = 0.0383, Control: p = 0.0096).

Conclusion: HD patients had significantly lower antibody titers than age- and sex-matched non-dialysis individuals over 3 months after vaccination. Dialysis time was identified as a factor affecting SARS-CoV-2 IgG titers in HD group, with longer dialysis time resulting in higher maximum SARS-CoV-2 IgG titers.

Keywords: Adverse reactions; COVID-19; Hemodialysis; Vaccination.