Abstract
Most trials on mRNA vaccines against SARS-CoV-2 did not include patients with chronic kidney disease (CKD), hemodialysis (HD) patients, or kidney transplant recipients (KTR). However, those patients have a higher risk for a severe course of COVID-19 disease and mortality. Available literature has demonstrated a reduced efficacy of mRNA vaccines in HD patients and KTR, while data on CKD patients is scarce. Additionally, factors associated with non-response are poorly understood and not well characterized. We assessed antibody (AB) response (n = 582, 160 CKD patients, 206 patients on HD, 216 KTR) after the administration of two doses of a mRNA-vaccine with either BNT162b2 or mRNA-1273. AB measurements were carried out after a median of 91 days after first vaccinations, demonstrating non-response in 12.5% of CKD patients, 12.1% of HD patients, and 50% of KTR. AB titers were significantly higher in CKD patients than in HD patients or KTR. Factors associated with non-response were treated with rituximab in CKD patients, the use of calcineurin inhibitors in HD patients and older age, and the use of BNT162b2, mycophenolic acid, or glucocorticoids and lower hemoglobin levels in KTR. This study contributes to the understanding of the extent and conditions that predispose for non-response in patients with impaired kidney function.
Highlights
To combat the ongoing COVID-19 pandemic, significant effort has been undertaken to develop highly effective and safe vaccines against SARS-CoV-2
Between February and April 2021, chronic kidney disease (CKD) patients, HD patients, and kidney transplantation (KT) recipients received two doses of mRNA-vaccination based on the recommendations of the Austrian
Further non-significant factors were treatment with RAAS inhibitors and the number of classes of antihypertensive drugs. This is one of the first studies showing a direct comparison of SARS-CoV-2 antibody titers in CKD patients with and without immunosuppressive treatment, HD patients, and kidney transplant recipients (KTR)
Summary
To combat the ongoing COVID-19 pandemic, significant effort has been undertaken to develop highly effective and safe vaccines against SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). The respective authorization trials as well as most follow-up trials on these mRNA vaccines did not include patients with chronic kidney disease (CKD), on hemodialysis (HD), or after kidney transplantation (KT). Several publications have already indicated a reduced humoral immune response in HD [3,4,5] and kidney transplant recipients (KTR) [6,7,8], while data in CKD patients with or without immunosuppressive treatment is scarce. Factors/conditions discussed to predispose non-response and a severe COVID-19 course in these patients are advanced age, comorbidities, the uremic environment in HD, and immunosuppressive medication in KTR
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