Antibody response to mRNA SARS-CoV-2 vaccines in haemodialysis patients

Michael Paal; Florian M Arend; Tobias Lau; Sandra Hasmann; Daniela Soreth-Rieke; Johanna Sorodoc-Otto; Wilke Beuthien; Julia Krappe; Marcell Toepfer; Gero von Gersdorff; Norbert Thaller; Simon Rau; Bernd Northoff; Daniel Teupser; Mathias Bruegel; Michael Fischereder; Ulf Schönermarck

doi:10.1093/ckj/sfab127

Antibody response to mRNA SARS-CoV-2 vaccines in haemodialysis patients

Clin Kidney J. 2021 Jul 6;14(10):2234-2238. doi: 10.1093/ckj/sfab127. eCollection 2021 Oct.

Authors

Michael Paal¹, Florian M Arend¹, Tobias Lau², Sandra Hasmann³, Daniela Soreth-Rieke⁴, Johanna Sorodoc-Otto⁵, Wilke Beuthien⁵, Julia Krappe³, Marcell Toepfer⁶, Gero von Gersdorff⁷, Norbert Thaller⁴, Simon Rau², Bernd Northoff¹, Daniel Teupser¹, Mathias Bruegel¹, Michael Fischereder³, Ulf Schönermarck³

Affiliations

¹ Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany.
² Dialysezentrum Bad Tölz und Wolfratshausen, Bad Tölz, Germany.
³ Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany.
⁴ KfH-Nierenzentrum Miesbach, Miesbach, Germany.
⁵ KfH-Nierenzentrum Germering, Germering, Germany.
⁶ Dialysezentrum Garmisch-Partenkirchen-Murnau-Weilheim, Murnau am Staffelsee, Germany.
⁷ Programm "Qualität in der Nephrologie" (QiN), KfH-Kuratorium für Dialyse und Nierentransplantation, Neu-Isenburg, Germany.

Abstract

Background: Some studies have shown an attenuated immune response in haemodialysis patients after vaccination. The present study examines the humoral response after mRNA vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a large population of haemodialysis patients from different outpatient dialysis centres.

Methods: We retrospectively assessed antibodies against SARS-CoV-2 spike protein and nucleocapsid protein (chemiluminescence immunoassays, Roche diagnostics) 3-6 weeks after the second mRNA vaccine dose in 179 maintenance haemodialysis and 70 non-dialysis patients (control cohort). Differences in anti-SARS-CoV-2 spike protein titers were statistically analysed with respect to patient-relevant factors, including age, gender, previous coronavirus disease 2019 (COVID-19) infection, systemic immunosuppressive therapy and time on dialysis.

Results: We found a favourable, but profoundly lower SARS-CoV-2 spike protein antibody response in comparison with a non-dialysis cohort (median 253.5 versus 1756 U/mL, P < 0.001). In multivariate analysis, previous COVID-19 infection (P < 0.001) and female gender were associated with a significantly higher vaccine response (P = 0.006) in haemodialysis patients, while there was a significant inverse correlation with increasing patient age and systemic immunosuppression (P < 0.001). There was no statistically significant correlation between the antibody titer and time on dialysis. Immune response in haemodialysis patients with a previous COVID-19 infection led to substantially higher antibody titers that were equal to those of vaccinated non-dialysis individuals with previous infection.

Conclusion: We strongly argue in favour of regular antibody testing after COVID-19 vaccination in haemodialysis patients. Further studies should elucidate the utility of booster vaccinations to foster a stronger and persistent antibody response.

Keywords: SARS-CoV-2; antibody response; haemodialysis; immunosuppression; vaccination.