Ahmet MURT, Mehmet Riza ALTİPARMAK, Harika Oyku DİNC, Serkan Feyyaz YALİN, Meral MESE, Serap YADİGAR, Zeynep YİLDİZ, Bekir KOCAZEYBEK, Meltem PEKPAK, Muveddet Rezzan ATAMAN

Six months follow up of hemodialysis patients after SARS-CoV-2 vaccinations: Effects of the booster dose and vaccine t

Background: As hemodialysis patients are among the vulnerable groups for severe COVID-19, proper vaccination of these patients is quite important. However vaccine responsiveness is generally reduced in hemodialysis patients and strategies should be developed to maintain protection in the long term. Objectives: This study aimed to analyse the changes in antibody levels of SARS-CoV-2 vaccinated hemodialysis patients after six months and to compare the effectiveness of inactivated and mRNA vaccines. Methods: Eighty-five hemodialysis patients were followed up for six months after their initial vaccinations for SARS-CoV-2. Persistence of humoral responses were compared between patients who got inactivated or mRNA vaccines and also between patients who received a booster dose and those who didn’t. SARS-CoV-2 antibody titers were measured by a commercial test that measures IgG antibodies toward the receptor-binding domain of spike protein. Results: Seropositivity that was achieved by initial vaccination dropped abruptly by 6 months. Patients who received a booster dose had significantly higher antibody levels than those who didn’t (1120,8 ± 983,3 AU/mL vs 313,3 ± 435,3 AU/mL respectively; p<0,001) and higher seropositivity as well (88% vs 65%). Seropositivity with mRNA vaccine at the end of 6th month was 81,8% while this decreased to 50% for inactivated vaccine. Patients who received mRNA vaccine initially or as the third dose could maintain 88,4% of seropositivtiy and this was higher than other patients who have just got inactivated vaccine (p=0,013). Conclusion: Humoral immune response by SARS-CoV-2 vaccines is not very stable in hemodialysis patients and planning the booster doses should not be delayed. mRNA vaccines have better immunogenicity than inactivated vaccines.

Keywords:

SARS-CoV-2, immunization, vaccines, hemodialysis, protection,

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1.Wakasugi M, Kawamura K, Yamamoto S, KazamaJJ, Narita I. High Mortality Rate of Infectious Diseases in Dialysis Patients: A Comparison With the GeneralPopulation in Japan. Ther Apher Dial. 2012; 16(3):226-31.
2.Valeri AM, Robbins-Juarez SY, Stevens JS, et al.Presentation and outcomes of patients with ESKDand COVID-19. J Am Soc Nephrol. 2020;31(7):1409–15.
3.Yilmaz Z, Yilmaz S. COVID-19 in HemodialysisPatients. Dicle Med J. 2021; 48: 140-144
4.Litjens NHR, Huisman M, van den Dorpel M, BetjesMGH. Impaired Immune Responses and Antigen-Specific Memory CD4+ T Cells in HemodialysisPatients. J Am Soc Nephrol. Aug 2008; 19 (8): 1483-90.
5.Hasmann S, Paal M, Füeβl L, Fischereder M,Schönermarck U. Humoral immunity to SARS-CoV-2vaccination in haemodialysis patients. The LancetReg Health Eur. 2021 Nov; 10: 100237.
6.Strengert M, Becker M, Ramos GM, et al. Cellularand humoral immunogenicity of a SARS-CoV-2mRNA vaccine in patients on haemodialysis.EBioMedicine. 2021; 70: 103524. DOI:10.1016/j.ebiom.2021.103524
7.Murt A, Altiparmak MR, Yadigar S, et al. Antibodyresponses to the SARS-CoV-2 vaccines inhemodialysis patients: Is inactivated vaccineeffective? Ther Apher Dial. 2021; 1-6. Doi:10.1111/1744-9987.13752
8.Bachelet T, Bourdenx JP, Martinez C, et al.Humoral response after SARS-CoV-2 mRNA vaccines in dialysis patients: Integrating anti-SARS-CoV-2 Spike-Protein-RBD antibody monitoring to manage dialysis centers in pandemic times. PLoS One. 2021; 16(10): e0257646. Doi:10.1371/journal.pone.0257646.
9.Campo F, Venuti A, Pimpinelli F, et al. AntibodyPersistence 6 months post-vaccination withBNT162b2 among Health Care Workers. Vaccines(Basel). 2021 Oct 3; 9 (10): 1125. Doi:10.3390/vaccines9101125.
10.Shrotri M, Navaratnam AMD, Nguyen V, et al.Spike-antibody waning after second dose ofBNT162b2 or ChAdOx1. Lancet. 2021 Jul 31; 398:385-387. Doi: 10.1016/S0140-6736(21)01642-1.
11.Coliier AY, Yu J, McMahan K, et al. DifferentialKinetics of Immune Responses Elicited by COVID-19Vaccines. N Eng J Med. 2021 Nov 18; 385 (21):2010-2.
12.Levin EG, Lustig Y, Cohen C, et al. WaningImmune Humoral Response to BNT162b2 COVID-19Vaccine over 6 Months. N Eng J Med. 2021 Dec 9; 385 (24): e84.
13.Pahl MV, Gollapudi S, Sepassi L, et al. Effect ofend-stage renal disease on B-lymphocytesubpopulations, IL-7, BAFF and BAFF receptorexpression. Nephrol Dial Transplant. 2010 Jan;25(1): 205-12.
14.Weigert A, Bergman M-L, Gonçalves LA, et al.Longitudinal Analysis of Antibody Responses to themRNA BNT162b2 Vaccine in Patients UndergoingMaintenance Hemodialysis: A 6-Month Follow-Up.Front. Med (Lausanne). 2021 Dec 24; 8:796676. DOI: 10.3389/fmed.2021.796676
15.Eliakim-Raz N, Leibovici-Weisman Y, Stemmer A, et al. Antibody Titers Before and After a Third Doseof the SARS-CoV-2 BNT162b2 Vaccine in AdultsAged ≥ 60 years. JAMA. 2021 Dec 7;326(21):2203-4
16.Dekervel M, Henry N, Torreggiani M, et al.Humoral response to a third injection of BNT162b2vaccine in patients on maintenance haemodialysis.Clin Kidney J. 2021 Aug 13; 14(11): 2349-55.