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Santos AC, Costa VDD, Silva LLD, Miguel JC, Jardim R, Dávila AMR, Paula VSD, Melgaço JG, Lago BVD, Villar LM. SARS-CoV-2 and dialysis: humoral response, clinical and laboratory impacts before vaccination. Braz J Infect Dis 2024; 28:103735. [PMID: 38467386 DOI: 10.1016/j.bjid.2024.103735] [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: 10/06/2023] [Revised: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Patients with kidney disease on Hemodialysis (HD) are susceptible to Coronavirus Disease (COVID-19) due to multiple risk factors. AIM This study aims to report the prevalence of antibodies against SARS-CoV-2 among patients on hemodialysis before vaccination in Brazil and to compare with clinical, demographic, and laboratory data. METHODS Blood samples from 398 Chronic Kidney Disease (CKD) patients treated in three different private institutions in Rio de Janeiro State, Brazil were submitted to the total anti-SARS-CoV-2 testing. Kidney, liver, and hematological markers were also determined. Respiratory samples were tested by real-time PCR for SARS-CoV-2 RNA and positive samples were subjected to high-throughput sequencing on the MinION device. RESULTS Overall, anti-SARS-CoV-2 prevalence was 54.5 % (217/398) and two individuals had SARS-CoV-2 RNA with variant B.1.1. High anti-SARS-CoV-2 seroprevalence was found in male gender and those with hospital admission in the last 3-months before the inclusion in the study. Lower red blood cell count was observed in the anti-SARS-CoV-2 seropositive group. High levels of anti-SARS-CoV-2 were found in those who reported symptoms, had low levels of eosinophils and low hematocrit, and who practiced physical activity. CONCLUSION High prevalence of anti-SARS-CoV-2 was found in CKD patients before the universal immunization in Brazil suggesting that dialysis patients were highly exposed to SARS-CoV-2.
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Affiliation(s)
- Alanna Calheiros Santos
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório Brasileiro de Referência em Hepatites Virais, Rio de Janeiro, RJ, Brazil
| | - Vanessa Duarte da Costa
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório Brasileiro de Referência em Hepatites Virais, Rio de Janeiro, RJ, Brazil
| | - Lucas Lima da Silva
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório Brasileiro de Referência em Hepatites Virais, Rio de Janeiro, RJ, Brazil
| | - Juliana Custódio Miguel
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório Brasileiro de Referência em Hepatites Virais, Rio de Janeiro, RJ, Brazil
| | - Rodrigo Jardim
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório de Biologia Computacional e de Sistemas, Programa de Pós-Graduação em Biodiversidade e Saúde, Rio de Janeiro, RJ, Brazil
| | - Alberto Martín Rivera Dávila
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório de Biologia Computacional e de Sistemas, Programa de Pós-Graduação em Biodiversidade e Saúde, Rio de Janeiro, RJ, Brazil
| | - Vanessa Salete de Paula
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório de Virologia Molecular e Parasitologia, Rio de Janeiro, RJ, Brazil
| | - Juliana Gil Melgaço
- Bio-Manguinhos (FIOCRUZ), Laboratório de Tecnologia Imunológica, Rio de Janeiro, RJ, Brazil
| | - Barbara Vieira do Lago
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório Brasileiro de Referência em Hepatites Virais, Rio de Janeiro, RJ, Brazil
| | - Livia Melo Villar
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório Brasileiro de Referência em Hepatites Virais, Rio de Janeiro, RJ, Brazil.
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Wijewickrama ES, Abdul Hafidz MI, Robinson BM, Johnson DW, Liew A, Dreyer G, Caskey FJ, Bello AK, Zaidi D, Damster S, Salaro S, Luyckx VA, Bajpai D. Availability and prioritisation of COVID-19 vaccines among patients with advanced chronic kidney disease and kidney failure during the height of the pandemic: a global survey by the International Society of Nephrology. BMJ Open 2022; 12:e065112. [PMID: 36585149 PMCID: PMC9808761 DOI: 10.1136/bmjopen-2022-065112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Patients with advanced chronic kidney disease (CKD) or kidney failure receiving replacement therapy (KFRT) are highly vulnerable to COVID-19 infection, morbidity and mortality. Vaccination is effective, but access differs around the world. We aimed to ascertain the availability, readiness and prioritisation of COVID-19 vaccines for this group of patients globally. SETTING AND PARTICIPANTS Collaborators from the International Society of Nephrology (ISN), Dialysis Outcomes and Practice Patterns Study and ISN-Global Kidney Health Atlas developed an online survey that was administered electronically to key nephrology leaders in 174 countries between 2 July and 4 August 2021. RESULTS Survey responses were received from 99 of 174 countries from all 10 ISN regions, among which 88/174 (50%) were complete. At least one vaccine was available in 96/99 (97%) countries. In 71% of the countries surveyed, patients on dialysis were prioritised for vaccination, followed by patients living with a kidney transplant (KT) (62%) and stage 4/5 CKD (51%). Healthcare workers were the most common high priority group for vaccination. At least 50% of patients receiving in-centre haemodialysis, peritoneal dialysis or KT were estimated to have completed vaccination at the time of the survey in 55%, 64% and 51% of countries, respectively. At least 50% of patients in all three patient groups had been vaccinated in >70% of high-income countries and in 100% of respondent countries in Western Europe.The most common barriers to vaccination of patients were vaccine hesitancy (74%), vaccine shortages (61%) and mass vaccine distribution challenges (48%). These were reported more in low-income and lower middle-income countries compared with high-income countries. CONCLUSION Patients with advanced CKD or KFRT were prioritised in COVID-19 vaccination in most countries. Multiple barriers led to substantial variability in the successful achievement of COVID-19 vaccination across the world, with high-income countries achieving the most access and success.
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Affiliation(s)
| | | | | | - David W Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | - Gavin Dreyer
- Renal Medicine, Barts Health NHS Trust, London, UK
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Aminu K Bello
- Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Silvia Salaro
- International Society of Nephrology, Brussels, Belgium
| | - Valerie Ann Luyckx
- Nephrology, University Children's Hospital, Zurich, Switzerland
- Department of Paediatrics and Child Heath, University of Cape Town, Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard medical School, Boston, MA, USA
| | - Divya Bajpai
- Nephrology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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3
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Ding S, Wang D, Wang X. Hierarchically structural layered double oxides with stretchable nanopores for highly effective removal of protein-bound uremic toxins. Sep Purif Technol 2022; 301:122033. [PMID: 36071792 PMCID: PMC9436783 DOI: 10.1016/j.seppur.2022.122033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 12/02/2022]
Abstract
The global outbreak and prevalence of coronavirus disease 2019 (COVID-19) has triggered an urgent demand for family hemodialysis equipment. It is particularly vital to design and apply superior adsorbents to adsorb toxins for reducing the usage of dialysate. In this work, hierarchically structural MgAl layered double oxides (LDO) with stretchable nanopores were exploited through a facile one-pot trisodium citrate (TSC) assistant hydrothermal reaction followed by calcination treatment for effectively adsorbing protein-bound uremic toxins such as hippuric acid (HA) or indoxyl sulfate (IS). The optimized MgAl LDO possessed flower-like spherical morphology, ultrahigh specific surface area (187.3 m2/g) and uniquely stretchable nanopores, which were more conducive to incorporating anions due to their unique memory effect endowing them with promising adsorption capacities for HA or IS. And the adsorption data could be better conformed to pseudo-second-order kinetic model and Langmuir isotherm determining that the maximum adsorption capacity of HA and IS was 129.8 mg/g and 63.1 mg/g, respectively. Furthermore, the computation of molecular size paired with the analysis of adsorption mechanism accurately revealed that high-efficiency toxin capture was mainly attributed to electrostatic interaction for internal intercalation and surface adsorption. Therefore, the application of such delicate LDO as new premium adsorbent would facilitate the development and popularization of family hemodialysis equipment.
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Affiliation(s)
- Siping Ding
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai 201620, PR China
| | - Dong Wang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai 201620, PR China
| | - Xuefen Wang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai 201620, PR China
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4
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Bernardo AP, Carioni P, Stuard S, Kotanko P, Usvyat LA, Kovarova V, Arkossy O, Bellocchio F, Tupputi A, Gervasoni F, Winter A, Zhang Y, Zhang H, Ponce P, Neri L. Effectiveness of COVID-19 vaccines in a large European hemodialysis cohort. FRONTIERS IN NEPHROLOGY 2022; 2:1037754. [PMID: 37675035 PMCID: PMC10479614 DOI: 10.3389/fneph.2022.1037754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/17/2022] [Indexed: 09/08/2023]
Abstract
Background Hemodialysis patients have high-risk of severe SARS-CoV-2 infection but were unrepresented in randomized controlled trials evaluating the safety and efficacy of COVID-19 vaccines. We estimated the real-world effectiveness of COVID-19 vaccines in a large international cohort of hemodialysis patients. Methods In this historical, 1:1 matched cohort study, we included adult hemodialysis patients receiving treatment from December 1, 2020, to May 31, 2021. For each vaccinated patient, an unvaccinated control was selected among patients registered in the same country and attending a dialysis session around the first vaccination date. Matching was based on demographics, clinical characteristics, past COVID-19 infections and a risk score representing the local background risk of infection at vaccination dates. We estimated the effectiveness of mRNA and viral-carrier COVID-19 vaccines in preventing infection and mortality rates from a time-dependent Cox regression stratified by country. Results In the effectiveness analysis concerning mRNA vaccines, we observed 850 SARS-CoV-2 infections and 201 COVID-19 related deaths among the 28110 patients during a mean follow up of 44 ± 40 days. In the effectiveness analysis concerning viral-carrier vaccines, we observed 297 SARS-CoV-2 infections and 64 COVID-19 related deaths among 12888 patients during a mean follow up of 48 ± 32 days. We observed 18.5/100-patient-year and 8.5/100-patient-year fewer infections and 5.4/100-patient-year and 5.2/100-patient-year fewer COVID-19 related deaths among patients vaccinated with mRNA and viral-carrier vaccines respectively, compared to matched unvaccinated controls. Estimated vaccine effectiveness at days 15, 30, 60 and 90 after the first dose of a mRNA vaccine was: for infection, 41.3%, 54.5%, 72.6% and 83.5% and, for death, 33.1%, 55.4%, 80.1% and 91.2%. Estimated vaccine effectiveness after the first dose of a viral-carrier vaccine was: for infection, 38.3% without increasing over time and, for death, 56.6%, 75.3%, 92.0% and 97.4%. Conclusion In this large, real-world cohort of hemodialyzed patients, mRNA and viral-carrier COVID-19 vaccines were associated with reduced COVID-19 related mortality. Additionally, we observed a strong reduction of SARS-CoV-2 infection in hemodialysis patients receiving mRNA vaccines.
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Affiliation(s)
- Ana Paula Bernardo
- Fresenius Medical Care Portugal / Nephrocare Portugal, Vila Nova de Gaia, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), Porto University, Oporto, Portugal
| | - Paola Carioni
- Fresenius Medical Care Italia SpA, Palazzo Pignano, Italy
| | - Stefano Stuard
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Peter Kotanko
- Renal Research Institute, New York, NY, United States
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | | | - Otto Arkossy
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | | | | | | | - Anke Winter
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Yan Zhang
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Hanjie Zhang
- Renal Research Institute, New York, NY, United States
| | - Pedro Ponce
- Fresenius Medical Care Portugal / Nephrocare Portugal, Lisboa, Portugal
| | - Luca Neri
- Fresenius Medical Care Italia SpA, Palazzo Pignano, Italy
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Zhao H, Huang J, Huang L, Yang Y, Xiao Z, Chen Q, Huang Q, Ai K. Surface control approach for growth of cerium oxide on flower-like molybdenum disulfide nanosheets enables superior removal of uremic toxins. J Colloid Interface Sci 2022; 630:855-865. [DOI: 10.1016/j.jcis.2022.10.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
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6
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Bardossy AC, Angeles J, Booth S, Fike L, Wadley A, Rha B, Lacson E, Manley HJ, Johnson D, Apata IW, Novosad S. SARS-CoV-2 Infections among Vaccinated Patients on Maintenance Dialysis, January 1-August 31, 2021, United States. KIDNEY360 2022; 3:1934-1938. [PMID: 36514405 PMCID: PMC9717631 DOI: 10.34067/kid.0003092022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/13/2022] [Indexed: 01/12/2023]
Abstract
Dialysis facilities voluntarily reported severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in vaccinated dialysis patients detected between January 1, 2021, and August 31, 2021, to the Centers for Disease Control and Prevention.Among 4087 patients reported, most were symptomatic, a third required hospitalization, and 9% died within 30 days of diagnosis.Monitoring SARS-CoV-2 infections and outcomes among vaccinated people on dialysis provides valuable insight into this population.
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Affiliation(s)
- Ana Cecilia Bardossy
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jesenia Angeles
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie Booth
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lucy Fike
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashley Wadley
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Rha
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Ibironke W. Apata
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia,Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shannon Novosad
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Huang W, Li B, Jiang N, Zhang F, Shi W, Zuo L, Liu S, Tang B. Impact of the COVID-19 pandemic on patients with chronic kidney disease: A narrative review. Medicine (Baltimore) 2022; 101:e29362. [PMID: 35713437 PMCID: PMC9276167 DOI: 10.1097/md.0000000000029362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
ABSTRACT Severe acute respiratory disease coronavirus 2 is currently causing the coronavirus disease 2019 (COVID-19) pandemic, placing extreme strain on the global health system. Vaccination is the main measure for preventing the COVID-19 epidemic, especially for high-risk groups including patients with chronic kidney disease (CKD). However, CKD patients receiving dialysis or kidney transplant may be characterized by decreased renal function and immune disorders, which may have uncertainties in their health. This overview aims to introduce the possible impact of the COVID-19 vaccine on kidney disease and its application in patients with CKD to provide evidence for the COVID-19 vaccine in patients with CKD. The data for this study were collected from PubMed, Cochrane Library, Embase, ClinicalTrials.gov, and the China Knowledge Resource Integrated Database (CNKI). The following keywords were used: "COVID-19", "COVID-19 vaccine," and "CKD". The publication time of the papers was set from the establishment of the databases to September 2021. A total of 47 studies were included, and patients with CKD are a high-risk group for COVID-19 infection and severe illness. Vaccination is a powerful tool for preventing CKD patients from COVID-19. Because of possible side effects, the recurrence or deterioration of kidney disease may occur in CKD patients after vaccination. Although vaccination for patients with CKD remains a problem, with the advantages outweighing the disadvantages, stable CKD patients should complete a vaccination plan, and doctors should be aware of the recurrence or deterioration of kidney disease and close monitoring. DATA ACCESS STATEMENT Research data supporting this publication are available from the electronic databases of PubMed, Cochrane Library, Embase, ClinicalTrials.gov, and the China Knowledge Resource Integrated Database (CNKI).
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Affiliation(s)
- Wanbing Huang
- Department of Nephrology, Blood Purification Center, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Bohou Li
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Nan Jiang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Fengxia Zhang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wei Shi
- Department of Nephrology, The People's Hospital of Gaozhou, Maoming, Guangdong, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Shuangxin Liu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Bin Tang
- Department of Nephrology, Blood Purification Center, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
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8
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Speer C, Morath C, Töllner M, Buylaert M, Göth D, Nusshag C, Kälble F, Schaier M, Grenz J, Kreysing M, Reichel P, Hidmark A, Ponath G, Schnitzler P, Zeier M, Süsal C, Klein K, Benning L. Humoral Responses to Single-Dose BNT162b2 mRNA Vaccination in Dialysis Patients Previously Infected With SARS-CoV-2. Front Med (Lausanne) 2021; 8:721286. [PMID: 34485347 PMCID: PMC8415834 DOI: 10.3389/fmed.2021.721286] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/26/2021] [Indexed: 01/18/2023] Open
Abstract
Seroconversion rates following infection and vaccination are lower in dialysis patients compared to healthy controls. There is an urgent need for the characterization of humoral responses and success of a single-dose SARS-CoV-2 vaccination in previously infected dialysis patients. We performed a dual-center cohort study comparing three different groups: 25 unvaccinated hemodialysis patients after PCR-confirmed COVID-19 (Group 1), 43 hemodialysis patients after two-time BNT162b2 vaccination without prior SARS-CoV-2 infection (Group 2), and 13 single-dose vaccinated hemodialysis patients with prior SARS-CoV-2 infection (Group 3). Group 3 consists of seven patients from Group 1 and 6 additional patients with sera only available after single-dose vaccination. Anti-S1 IgG, neutralizing antibodies, and antibodies against various SARS-CoV-2 protein epitopes were measured 3 weeks after the first and 3 weeks after the second vaccination in patients without prior SARS-CoV-2 infection, 6 weeks after the onset of COVID-19 in unvaccinated patients, and 3 weeks after single-dose vaccination in patients with prior SARS-CoV-2 infection, respectively. Unvaccinated patients after COVID-19 showed a significantly higher neutralizing antibody capacity than two-time vaccinated patients without prior COVID-19 [median (IQR) percent inhibition 88.0 (71.5-95.5) vs. 50.7 (26.4-81.0); P = 0.018]. After one single vaccine dose, previously infected individuals generated 15- to 34-fold higher levels of anti-S1 IgG than age- and dialysis vintage-matched unvaccinated patients after infection or two-time vaccinated patients without prior SARS-CoV-2 infection with a median (IQR) index of 274 (151-791) compared to 18 (8-41) and 8 (1-21) (for both P < 0.001). With a median (IQR) percent inhibition of 97.6 (97.2-98.9), the neutralizing capacity of SARS-CoV-2 antibodies was significantly higher in single-dose vaccinated patients with prior SARS-CoV-2 infection compared to other groups (for both P < 0.01). Bead-based analysis showed high antibody reactivity against various SARS-CoV-2 spike protein epitopes after single-dose vaccination in previously infected patients. In conclusion, single-dose vaccination in previously infected dialysis patients induced a strong and broad antibody reactivity against various SARS-CoV-2 spike protein epitopes with high neutralizing capacity.
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Affiliation(s)
- Claudius Speer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit Heidelberg, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | | | - Mirabel Buylaert
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Daniel Göth
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Florian Kälble
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Schaier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Julia Grenz
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Martin Kreysing
- Department of Gastroenterology and Hepatology, University of Heidelberg, Heidelberg, Germany
| | - Paula Reichel
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Asa Hidmark
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Gerald Ponath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Virology, Department of Infectious Diseases, University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Caner Süsal
- Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany
| | - Katrin Klein
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Louise Benning
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
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9
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Strengert M, Becker M, Ramos GM, Dulovic A, Gruber J, Juengling J, Lürken K, Beigel A, Wrenger E, Lonnemann G, Cossmann A, Stankov MV, Dopfer-Jablonka A, Kaiser PD, Traenkle B, Rothbauer U, Krause G, Schneiderhan-Marra N, Behrens GMN. Cellular and humoral immunogenicity of a SARS-CoV-2 mRNA vaccine in patients on haemodialysis. EBioMedicine 2021; 70:103524. [PMID: 34391096 PMCID: PMC8357427 DOI: 10.1016/j.ebiom.2021.103524] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients with chronic renal insufficiency on maintenance haemodialysis face an increased risk of COVID-19 induced mortality and impaired vaccine responses. To date, only a few studies have addressed SARS-CoV-2 vaccine elicited immunity in this immunocompromised population. METHODS We assessed immunogenicity of the mRNA vaccine BNT162b2 in at-risk dialysis patients and characterised systemic cellular and humoral immune responses in serum and saliva using interferon γ release assay and multiplex-based cytokine and immunoglobulin measurements. We further compared binding capacity and neutralization efficacy of vaccination-induced immunoglobulins against emerging SARS-CoV-2 variants Alpha, Beta, Epsilon and Cluster 5 by ACE2-RBD competition assay. FINDINGS Patients on maintenance haemodialysis exhibit detectable but variable cellular and humoral immune responses against SARS-CoV-2 and variants of concern after a two-dose regimen of BNT162b2. Although vaccination-induced immunoglobulins were detectable in saliva and plasma, both anti-SARS-CoV-2 IgG and neutralization efficacy was reduced compared to a vaccinated non-dialysed control population. Similarly, T-cell mediated interferon γ release after stimulation with SARS-CoV-2 spike peptides was significantly diminished. INTERPRETATION Quantifiable humoral and cellular immune responses after BNT162b2 vaccination in individuals on maintenance haemodialysis are encouraging, but urge for longitudinal follow-up to assess longevity of immunity. Diminished virus neutralization and interferon γ responses in the face of emerging variants of concern may favour this at-risk population for re-vaccination using modified vaccines at the earliest opportunity. FUNDING Initiative and Networking Fund of the Helmholtz Association of German Research Centres, EU Horizon 2020 research and innovation program, State Ministry of Baden-Württemberg for Economic Affairs, Labour and Tourism.
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Affiliation(s)
- Monika Strengert
- Helmholtz Centre for Infection Research, Braunschweig, Germany; TWINCORE GmbH, Centre for Experimental and Clinical Infection Research, a joint venture of the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | - Matthias Becker
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Gema Morillas Ramos
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Alex Dulovic
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Jens Gruber
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Jennifer Juengling
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | | | | | | | | | - Anne Cossmann
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Metodi V Stankov
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Alexandra Dopfer-Jablonka
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany; German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig, Germany
| | - Philipp D Kaiser
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Bjoern Traenkle
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Ulrich Rothbauer
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany; Pharmaceutical Biotechnology, University of Tübingen, Germany
| | - Gérard Krause
- Helmholtz Centre for Infection Research, Braunschweig, Germany; TWINCORE GmbH, Centre for Experimental and Clinical Infection Research, a joint venture of the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | | | - Georg M N Behrens
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany; German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig, Germany; CiiM - Centre for Individualized Infection Medicine, Hannover, Germany.
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Speer C, Göth D, Benning L, Buylaert M, Schaier M, Grenz J, Nusshag C, Kälble F, Kreysing M, Reichel P, Töllner M, Hidmark A, Ponath G, Schnitzler P, Zeier M, Süsal C, Morath C, Klein K. Early Humoral Responses of Hemodialysis Patients after COVID-19 Vaccination with BNT162b2. Clin J Am Soc Nephrol 2021; 16:1073-1082. [PMID: 34031181 PMCID: PMC8425619 DOI: 10.2215/cjn.03700321] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients receiving hemodialysis are at high risk for both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe coronavirus disease 2019. A lifesaving vaccine is available, but sensitivity to vaccines is generally lower in patients on dialysis. Little is yet known about antibody responses after coronavirus disease 2019 (COVID-19) vaccination in this vulnerable group. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS In this prospective single-center study, we included 22 patients on dialysis and 46 healthy controls from Heidelberg University Hospital between December 2020 and February 2021. We measured anti-S1 IgG with a threshold index for detection greater than one, neutralizing antibodies with a threshold for viral neutralization of ≥30%, and antibodies against different SARS-CoV2 fragments 17-22 days after the first dose and 18-22 days after the second dose of the mRNA vaccine BNT162b2. RESULTS After the first vaccine dose, four of 22 (18%) patients on dialysis compared with 43 of 46 (93%) healthy controls developed positive anti-S1 IgG, with a median anti-S1 IgG index of 0.2 (interquartile range, 0.1-0.7) compared with nine (interquartile range, 4-16), respectively. SARS-CoV2 neutralizing antibodies exceeded the threshold for neutralization in four of 22 (18%) patients on dialysis compared with 43 of 46 (93%) healthy controls, with a median percent inhibition of 11 (interquartile range, 3-24) compared with 65 (interquartile range, 49-75), respectively. After the second dose, 14 of 17 (82%) patients on dialysis developed neutralizing antibodies exceeding the threshold for viral neutralization and antibodies against the receptor binding S1 domain of the spike protein, compared with 46 of 46 (100%) healthy controls, respectively. The median percent inhibition was 51 (interquartile range, 32-86) compared with 98 (interquartile range, 97-98) in healthy controls. CONCLUSIONS Patients receiving long-term hemodialysis show a reduced antibody response to the first and second doses of the mRNA vaccine BNT162b2. The majority (82%) develop neutralizing antibodies after the second dose but at lower levels than healthy controls.
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Affiliation(s)
- Claudius Speer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit Heidelberg, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Daniel Göth
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Louise Benning
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Mirabel Buylaert
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Schaier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Julia Grenz
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Florian Kälble
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Martin Kreysing
- Department of Gastroenterology and Hepatology, University of Heidelberg, Heidelberg, Germany
| | - Paula Reichel
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | | | - Asa Hidmark
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Gerald Ponath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Caner Süsal
- Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Katrin Klein
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
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