Protective antibody response to mRNA-1273 and BNT162b2 vaccines in patients on maintenance hemodialysis: a prospective cohort study

Abstract

Background

SARS-CoV-2 infection is more frequent and severe in patients with chronic kidney disease (CKD) on maintenance hemodialysis. Vaccines are now available, but the protective response rates and determinants of humoral response to the vaccine are poorly described.

Methods

This prospective observational study described the response rates of detectable and protective antibody titers one month after each dose of an mRNA vaccine in a cohort of 851 patients on maintenance hemodialysis.

Findings

Among naïve SARS-CoV2 patients, a vast majority produced detectable (95.2%) or protective levels of antibodies (69.6%) one month after the second vaccine dose. In addition, the response rate was significantly higher with the mRNA-1273 than with the BNT162b2 vaccine, one month after the second dose (79.8 vs 59.1%, respectively, p<0.001). The main determinants for an inadequate humoral response were older age, treatment with immunosuppressants or oral anticoagulants, and low serum albumin. All the patients who encountered Covid19 before vaccination also reached a highly protective humoral response.

Interpretation

We found an acceptable humoral response rate in patients on maintenance hemodialysis, much higher than in transplant recipients. Therefore, the third dose of vaccine may be justified in those patients with an inadequate humoral response, particularly those with a history of organ transplantation or immunosuppressive treatment.