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Bnaya A, Nacasch N, Einbinder Y, Shavit L, Erez D, Shashar M, Grupper A, Benchetrit S, Wand O, Cohen-Hagai K. Dialysis modality, humoral response to vaccine, and SARS-CoV-2 infection risk: Comparative prospective evaluation. Semin Dial 2023; 36:382-389. [PMID: 37042666 DOI: 10.1111/sdi.13155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND COVID-19 vaccinations have a central role in decreasing severe SARS-CoV-2 disease complications. This study investigated the long-term humoral immune response to BNT162b2 vaccine among hemodialysis (HD) versus peritoneal dialysis (PD) patients, and their relative risk for COVID-19 infection. METHODS This prospective, observational study included maintenance HD and PD patients who had received at least two BNT162b2 vaccine doses. Levels of antibodies targeting SARS-CoV-2 spike protein were measured 6 and 12 months after the first vaccine dose, and 2-3 weeks after the third and fourth vaccine doses. Patients were divided according to dialysis modality (HD or PD). Humoral response was evaluated at different time points among different vaccine regimens (two vs. three vs. four doses of vaccine). An adjusted multivariate model was used to assess cumulative risk for SARS-CoV-2 infection. RESULTS Eighty-seven HD and 36 PD patients were included. Among them, 106 (86%) received at least three vaccine doses. Both HD and PD patients demonstrated marked increases in humoral response 2-3 weeks after the third dose (mean anti-S antibody increased from 452 ± 501 AU/mL to 19,556 ± 14,949 AU/mL, p < 0.001). By 6 months after the third dose, antibody titers had declined significantly (mean anti-S antibody 9841 ± 10,493 AU/mL, p < 0.001). HD patients had higher risk for SARS-CoV-2 infection than PD patients (OR 4.4 [95% CI 1.4-13.6], p = 0.006). In multivariate analysis, the most important predictor for SARS-CoV-2 infection was dialysis modality. CONCLUSION This study found a high antibody response rate after the third and fourth doses of BNT162b2 vaccine among dialysis patients. Hemodialysis as dialysis modality is an important predictor of COVID-19 infection, despite similar humoral responses to vaccine in peritoneal dialysis.
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Affiliation(s)
- Alon Bnaya
- Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Shavit
- Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daniel Erez
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
| | - Ayelet Grupper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Wand
- Pulmonary Division, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Humoral Response to Hepatitis B and COVID-19 Vaccine among Maintenance Hemodialysis Patients. Vaccines (Basel) 2022; 10:vaccines10101670. [PMID: 36298535 PMCID: PMC9610516 DOI: 10.3390/vaccines10101670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
Maintenance hemodialysis (MHD) patients have impaired immunological responses to pathogens and vaccines. In this study, we compared the humoral response to HBV and COVID-19 vaccines in a cohort of MHD patients. Demographic and clinical characteristics of vaccine responders and non-responders were also compared, and the association between the humoral responses to both vaccines was evaluated. The cohort included 94 MHD patients who were vaccinated at least once for HBV and twice for COVID-19. Among the 94 patients, 28 (29.8%) did not develop protective titers to HBV. Hypertension, coronary heart disease, and heart failure were more common in non-responders. Among MHD patients, 85% had positive IgG anti-spike SARS-CoV-2 levels 6 months after two doses of BNT162b2 (Pfizer/Biotech) vaccine. Age and immunosuppressive therapy were the main predictors of humoral response to COVID-19 vaccine. We did not find any association between non-responders to HBV and non-responders to COVID-19 vaccine. There was no difference in IgG anti-spike titers between HBV responders and non-responders (505 ± 644 vs. 504 ± 781, p = 0.9) Our results suggest that reduced humoral response to hepatitis B is not associated with reduced response to COVID-19 vaccine. Different risk-factors were associated with poor immune response to HBV and to COVID-19 vaccines.
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Koh T, Ooi XY, Vasoo S, Yeo SC. Impact of Variant of Concern and Vaccination Status on COVID-19 Infection Virological Dynamics in End Stage Kidney Disease Patients Receiving Haemodialysis. Nephrology (Carlton) 2022; 27:804-809. [PMID: 35904135 PMCID: PMC9353295 DOI: 10.1111/nep.14084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/28/2022] [Accepted: 07/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is unclear if variant of concern and vaccination status impact COVID-19 infection virological dynamics in haemodialysis patients and affect de-isolation protocol for dialysis centres. METHOD We performed a retrospective observational cohort study between February 2020 to September 2021, to examine the virological kinetics of vaccinated and unvaccinated haemodialysis patients with polymerase chain reaction (PCR)-confirmed COVID-19 infection of the delta and pre-delta variants. RESULTS Of the 38 subjects with PCR-confirmed COVID-19 infection, we found that individuals infected during the delta-variant period had higher viral load at presentation and required longer duration to achieve a negative PCR swab, compared to those infected in the pre-delta variant period. Time to achieve negative PCR swab was longest in unvaccinated individuals infected during delta-variant period. However, vaccinated and unvaccinated individuals achieved high PCR cycle threshold value of ≥25 and ≥30 at similar timing. CONCLUSION Our study suggests that patients infected during delta-variant period of COVID-19 illness, have higher viral load at presentation and prolonged viral shedding, especially in the unvaccinated cohort. However, prolonged time to negative PCR is likely due to inactive virus shedding, and that conversion to negative PCR may not be a necessary pre-requisite for de-isolation.
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Affiliation(s)
- Timothy Koh
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore
| | - Xi Yan Ooi
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - See Cheng Yeo
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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El Karoui K, De Vriese AS. COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment. Kidney Int 2022; 101:883-894. [PMID: 35176326 PMCID: PMC8842412 DOI: 10.1016/j.kint.2022.01.022] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/01/2022] [Accepted: 01/20/2022] [Indexed: 01/07/2023]
Abstract
The COVID-19 pandemic has profound adverse effects on the population on dialysis. Patients requiring dialysis are at an increased risk of SARS-CoV-2 infection and mortality, and many have experienced psychological distress as well as delayed or suboptimal care. COVID-19 survivors have prolonged viral shedding, but generally develop a robust and long-lasting humoral immune response that correlates with initial disease severity. However, protection against reinfection is incomplete. A growing body of evidence reveals delayed and blunted immune responses to SARS-CoV-2 vaccination. Administration of a third dose within 1 to 2 months of prime-boost vaccination significantly increases antibody levels, in particular in patients with poor initial responses. Patients on dialysis have inferior immune responses to adenoviral vector vaccines than to mRNA vaccines. The immunogenicity of the mRNA-1273 vaccine is markedly better than that of the BNT162b2 vaccine, most likely by virtue of its higher mRNA content. Despite suboptimal immune responses in patients on dialysis, preliminary data suggest that vaccination partially protects against infection and severe disease requiring hospitalization. However, progressive waning of immunity and emergence of SARS-CoV-2 variants with a high potential of immune escape call for a booster dose in all patients on dialysis 4 to 6 months after prime-boost vaccination. Patients with persistent poor vaccine responses may be candidates for primary prophylaxis strategies. In the absence of specific data in patients on dialysis, therapeutic strategies in the event of established COVID-19 must be extrapolated from evidence obtained in the population not on dialysis. Neutralizing monoclonal antibodies may be an attractive option after a high-risk exposure or during the early course of infection.
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Affiliation(s)
- Khalil El Karoui
- Department of Nephrology and Transplantation, Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire TRUE, Université Paris Est, Créteil, France
| | - An S De Vriese
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium.
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Chen CY, Ye JJ, Huang TS, Lee CC, Chen YT, Hsu CK, Hsu HJ, Sun CY, Pan HC, Chen KS, Kao HH, Ko CC, She YH, Wu CY, Lai CC, Hwang SJ, Wu IW. Effective Preventive Strategies to Prevent Secondary Transmission of COVID-19 in Hemodialysis Unit: The First Month of Community Outbreak in Taiwan. Healthcare (Basel) 2021; 9:healthcare9091173. [PMID: 34574947 PMCID: PMC8467394 DOI: 10.3390/healthcare9091173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Dialyzed patients are vulnerable to coronavirus infection disease 2019 (COVID-19). The incidence and outcome of COVID-19 in hemodialysis (HD) patients in Taiwan remain unclear. A series of preventive measures were executed to combat COVID-19 transmission among HD patients. Methods: We carried out a series of forward-looking and practical preventive strategies of COVID-19 control in our HD center. Incidences of COVID-19 of our HD unit were compared with those of national and local estimates from a community outbreak from 15 May to 30 June 2021. Prognostic factors associated with mortality were analyzed. Results: The national incidence of COVID-19 was 0.062%; being highest in Taipei City (0.173%), followed by New Taipei City (0.161%) and Keelung (0.083%). The overall incidence in Keelung HD patients was 0.666%. One patient of our HD center contracted COVID-19 from the household; however, we have contained secondary transmission in our HD center by implementing strict preventive measures. The mortality rate of HD patients in Keelung was 66.6%. The median Ct value of HD patients was 17.53 (11.75–27.90) upon diagnosis. The deceased patients had a higher cardiac/thoracic ratio than alive (0.61 vs. 0.55, p = 0.036). Conclusions: Taking aggressive and proactive infection preventive measures impedes the secondary transmission of COVID-19 in HD facilities. COVID-19-associated mortality was high in HD patients, being the high cardiac-thoracic ratio, an important prognostic factor for clinical outcome of infected HD patients.
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Affiliation(s)
- Chun-Yu Chen
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Jung-Jr Ye
- Department of Infectious Diseases, Chang Gung Memorial Hospital, Keelung 204, Taiwan;
| | - Ting-Shuo Huang
- Community Medicine Research Center, Department of General Surgery, Chang Gung Memorial Hospital, Keelung 204, Taiwan;
- Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chin-Chan Lee
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Yih-Ting Chen
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Cheng-Kai Hsu
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Heng-Jung Hsu
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chiao-Yin Sun
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Heng-Chih Pan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Kuo-Su Chen
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Hao-Hsi Kao
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chia-Chun Ko
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Yun-Hsuan She
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chun-Ying Wu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Keelung 204, Taiwan;
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Shang-Jyh Hwang
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - I-Wen Wu
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Correspondence: ; Tel.: +886-2-24313131-6211
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