tetano
Editor, Senior Moderator
Clin J Am Soc Nephrol
. 2022 Feb 10;CJN.12250921.
doi: 10.2215/CJN.12250921. Online ahead of print.
Seroresponse to SARS-CoV-2 Vaccines among Maintenance Dialysis Patients over 6 Months
Caroline M Hsu[SUP] 1 [/SUP], Daniel E Weiner[SUP] 2 [/SUP], Harold J Manley[SUP] 3 [/SUP], Gideon N Aweh[SUP] 3 [/SUP], Vladimir Ladik[SUP] 3 [/SUP], Jill Frament[SUP] 3 [/SUP], Dana Miskulin[SUP] 2 [/SUP], Christos Argyropoulos[SUP] 4 [/SUP], Kenneth Abreo[SUP] 5 [/SUP], Andrew Chin[SUP] 6 [/SUP], Reginald Gladish[SUP] 7 [/SUP], Loay Salman[SUP] 8 [/SUP], Doug Johnson[SUP] 3 [/SUP], Eduardo K Lacson Jr[SUP] 2 3 [/SUP]
Affiliations
Abstract
Background and objectives: Although most patients receiving maintenance dialysis exhibit initial seroresponse to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, concerns exist regarding the durability of this antibody response. This study evaluated seroresponse over time.
Design, setting, participants, & measurements: This retrospective cohort study included patients on maintenance dialysis, from a midsize national dialysis provider, who received a complete SARS-CoV-2 vaccine series and had at least one antibody titer checked after full vaccination. IgG spike antibodies (anti-spike IgG) titers were assessed monthly with routine laboratory tests after vaccination; the semiquantitative assay reported a range between zero and ≥20 Index. Descriptive analyses compared trends over time by history of coronavirus disease 2019 (COVID-19) and vaccine type. Time-to-event analyses examined the outcome of loss of seroresponse (anti-spike IgG <1 Index or development of COVID-19). Cox regression adjusted for additional clinical characteristics.
Results: Among 1870 patients receiving maintenance dialysis, 1569 had no prior COVID-19. Patients without prior COVID-19 had declining titers over time. Among 443 recipients of BNT162b2 (Pfizer), median (interquartile range) anti-spike IgG titer declined from ≥20 (5.89 to ≥20) in month 1 after full vaccination to 1.96 (0.60-5.88) by month 6. Among 778 recipients of mRNA-1273 (Moderna), anti-spike IgG titer declined from ≥20 (interquartile range, ≥20 to ≥20) in month 1 to 7.99 (2.61 to ≥20) by month 6. The 348 recipients of Ad26.COV2.S (Janssen) had a lower titer response than recipients of an mRNA vaccine over all time periods. In time-to-event analyses, recipients of Ad26.COV2.S and mRNA-1273 had the shortest and longest time to loss of seroresponse, respectively. The maximum titer reached in the first 2 months after full vaccination was associated with durability of the anti-spike IgG seroresponse; patients with anti-spike IgG titer 1-19.99 had a shorter time to loss of seroresponse compared with patients with anti-spike IgG titer ≥20 (hazard ratio, 15.5; 95% confidence interval, 11.7 to 20.7).
Conclusions: Among patients receiving maintenance dialysis, vaccine-induced seroresponse wanes over time across vaccine types. Early titers after full vaccination are associated with the durability of seroresponse.
Keywords: COVID-19; COVID-19 vaccines; SARS-CoV-2; chronic hemodialysis; end-stage renal disease; maintenance; peritoneal dialysis.
. 2022 Feb 10;CJN.12250921.
doi: 10.2215/CJN.12250921. Online ahead of print.
Seroresponse to SARS-CoV-2 Vaccines among Maintenance Dialysis Patients over 6 Months
Caroline M Hsu[SUP] 1 [/SUP], Daniel E Weiner[SUP] 2 [/SUP], Harold J Manley[SUP] 3 [/SUP], Gideon N Aweh[SUP] 3 [/SUP], Vladimir Ladik[SUP] 3 [/SUP], Jill Frament[SUP] 3 [/SUP], Dana Miskulin[SUP] 2 [/SUP], Christos Argyropoulos[SUP] 4 [/SUP], Kenneth Abreo[SUP] 5 [/SUP], Andrew Chin[SUP] 6 [/SUP], Reginald Gladish[SUP] 7 [/SUP], Loay Salman[SUP] 8 [/SUP], Doug Johnson[SUP] 3 [/SUP], Eduardo K Lacson Jr[SUP] 2 3 [/SUP]
Affiliations
- PMID: 35144972
- DOI: 10.2215/CJN.12250921
Abstract
Background and objectives: Although most patients receiving maintenance dialysis exhibit initial seroresponse to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, concerns exist regarding the durability of this antibody response. This study evaluated seroresponse over time.
Design, setting, participants, & measurements: This retrospective cohort study included patients on maintenance dialysis, from a midsize national dialysis provider, who received a complete SARS-CoV-2 vaccine series and had at least one antibody titer checked after full vaccination. IgG spike antibodies (anti-spike IgG) titers were assessed monthly with routine laboratory tests after vaccination; the semiquantitative assay reported a range between zero and ≥20 Index. Descriptive analyses compared trends over time by history of coronavirus disease 2019 (COVID-19) and vaccine type. Time-to-event analyses examined the outcome of loss of seroresponse (anti-spike IgG <1 Index or development of COVID-19). Cox regression adjusted for additional clinical characteristics.
Results: Among 1870 patients receiving maintenance dialysis, 1569 had no prior COVID-19. Patients without prior COVID-19 had declining titers over time. Among 443 recipients of BNT162b2 (Pfizer), median (interquartile range) anti-spike IgG titer declined from ≥20 (5.89 to ≥20) in month 1 after full vaccination to 1.96 (0.60-5.88) by month 6. Among 778 recipients of mRNA-1273 (Moderna), anti-spike IgG titer declined from ≥20 (interquartile range, ≥20 to ≥20) in month 1 to 7.99 (2.61 to ≥20) by month 6. The 348 recipients of Ad26.COV2.S (Janssen) had a lower titer response than recipients of an mRNA vaccine over all time periods. In time-to-event analyses, recipients of Ad26.COV2.S and mRNA-1273 had the shortest and longest time to loss of seroresponse, respectively. The maximum titer reached in the first 2 months after full vaccination was associated with durability of the anti-spike IgG seroresponse; patients with anti-spike IgG titer 1-19.99 had a shorter time to loss of seroresponse compared with patients with anti-spike IgG titer ≥20 (hazard ratio, 15.5; 95% confidence interval, 11.7 to 20.7).
Conclusions: Among patients receiving maintenance dialysis, vaccine-induced seroresponse wanes over time across vaccine types. Early titers after full vaccination are associated with the durability of seroresponse.
Keywords: COVID-19; COVID-19 vaccines; SARS-CoV-2; chronic hemodialysis; end-stage renal disease; maintenance; peritoneal dialysis.