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Premuzic V, Stevanovic R, Vilibic-Cavlek T, Sirovica M, Stalman S, Bogdanic M, Zilic D, Nakic D, Santini Dusevic D, Vojkovic M, Barbic J, Durlen I, Grdan Z, Pavlovic D, Kudumija B, Sefer S, Griparic D, Rogic D, Bubas M, Capak K, Jelakovic B. Serological Response to SARS-CoV-2 Vaccine in Hemodialyzed Patients and the Association with Later COVID-19 Positivity. Antibodies (Basel) 2023; 12:37. [PMID: 37366653 DOI: 10.3390/antib12020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/13/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The effectiveness of the COVID-19 vaccine may differ in hemodialysis patients. The aim of this prospective multicenter study was to determine the degree of serological response to the SARS-CoV-2 vaccine in the population of dialysis patients and its association with later SARS-CoV-2 infections. METHODS A blood sample was taken for the determination of COVID-19 serological status (IgG antibodies) in 706 dialysis patients 16 weeks after vaccination with the second dose (Pfizer-BioNTech). RESULTS Only 314 (44.5%) hemodialyzed patients had a satisfactory response to the COVID-19 vaccine. Eighty-two patients (11.6%) had a borderline response, while 310 patients (43.9%) had an unsatisfactory (negative) post-vaccinal antibody titer. A longer dialysis vintage had an increased odds ratio (OR) of 1.01 for the occurrence of COVID-19 positivity after vaccination. In the group of subsequently positive patients, 28 patients (13.6%) died from complications of COVID-19. We have found differences in mean survival time between patients with and without appropriate responses to vaccination in favor of patients with a satisfactory serological response. CONCLUSIONS The results showed that the dialysis population will not have the same serological response to the vaccine as the general population. The majority of dialysis patients did not develop a severe clinical picture or die at the time of positivity for COVID-19.
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Affiliation(s)
- Vedran Premuzic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Tatjana Vilibic-Cavlek
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Croatian Institute of Public Health, 10000 Zagreb, Croatia
| | - Maja Sirovica
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Sara Stalman
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Maja Bogdanic
- Croatian Institute of Public Health, 10000 Zagreb, Croatia
| | | | - Dario Nakic
- Department of Nephrology and Dialysis, General Hospital Zadar, 23000 Zadar, Croatia
| | | | - Marina Vojkovic
- Department of Nephrology and Dialysis, General Hospital Zadar, 23000 Zadar, Croatia
| | - Jerko Barbic
- Department of Nephrology, Dialysis and Transplantation, Clinical Hospital Center Osijek, 31000 Osijek, Croatia
| | - Ivan Durlen
- Department of Nephrology and Dialysis, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Zeljka Grdan
- Department of Nephrology, Clinical Hospital Varazdin, 42000 Varazdin, Croatia
| | - Drasko Pavlovic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Policlinic for Internal Medicine and Dialysis B. Braun Avitum, 10000 Zagreb, Croatia
| | - Boris Kudumija
- Policlinic for Internal Medicine and Dialysis B. Braun Avitum, 10000 Zagreb, Croatia
| | - Sinisa Sefer
- Department of Nephrology and Dialysis, University Clinical Hospital Centre "Sestre Milosrdnice", 10000 Zagreb, Croatia
| | - Davor Griparic
- Policlinic for Dialysis Fresenius Sveti Duh 2, 10000 Zagreb, Croatia
| | - Dunja Rogic
- Clinical Institute for Laboratory Diagnostics, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Marija Bubas
- Croatian Institute of Public Health, 10000 Zagreb, Croatia
| | | | - Bojan Jelakovic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Long-Term Dynamic Humoral Response to SARS-CoV-2 mRNA Vaccines in Patients on Peritoneal Dialysis. Vaccines (Basel) 2022; 10:vaccines10101738. [PMID: 36298603 PMCID: PMC9609237 DOI: 10.3390/vaccines10101738] [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: 09/12/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Patients on peritoneal dialysis (PD) present an impaired humoral response against SARS-CoV-2, at least after the initial vaccination and booster dose. Until now, the effect of a fourth dose has not been established. The aim of the present study is to evaluate the long-term dynamics of the humoral response of PD patients to multiple doses of SARS-CoV-2 vaccines, focusing on the effect of the fourth dose. Methods. This is an analysis of the prospective and multicentric SENCOVAC study. We included patients on PD without additional immunosuppression that had received at least 3 SARS-CoV-2 mRNA vaccine doses. We evaluated anti-spike antibody titers after the initial vaccination, third and fourth doses, using prespecified fixed assessments (i.e., baseline, 28 days, 3, 6, and 12 months after completing the initial vaccine schedule). Breakthrough infections were also collected. Results. We included 164 patients on PD (69% males, 62 ± 13 years old). In patients who had received only two doses, the rates of positive humoral response progressively decreased from 96% at 28 days to 80% at 6 months, as did with anti-spike antibody titers. At 6 months, 102 (62%) patients had received the third vaccine dose. Patients with the third dose had higher rates of positive humoral response (p = 0.01) and higher anti-spike antibody titers (p < 0.001) at 6 months than those with only 2 doses. At 12 months, the whole cohort had received 3 vaccine doses, and 44 (27%) patients had an additional fourth dose. The fourth dose was not associated to higher rates of positive humoral response (100 vs. 97%, p = 0.466) or to statistically significant differences in anti-spike antibody titers as compared to three doses (p = 0.371) at 12 months. Prior antibody titers were the only predictor for subsequent higher anti-spike antibody titer (B 0.53 [95%CI 0.27−0.78], p < 0.001). The 2 (1.2%) patients that developed COVID-19 during follow-up had mild disease. Conclusions. PD presents an acceptable humoral response with three doses of SARS-CoV-2 vaccines that improve the progressive loss of anti-spike antibody titers following two vaccine doses.
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