Abstract
The aim of this investigation was to determine the effect of SARS-Cov-2 vaccination in hemodialysis patients, search for risk factors for non- or low-response, and to measure the effect of a third booster vaccination in non- or low-responders. Methods SARS-CoV-2 IgG antibodies and the virus-neutralizing capacity were measured 4–5 weeks after a full standard vaccination in 95 chronic hemodialysis patients and 60 controls. IgG titers > 30 AU/mL served to classify participants as responders. Multivariable binary logistic regression analysis was used to search for risk factors of reduced vaccination success. Patients with vaccination failure were offered a third booster dosage. Results 82.1% of the patient cohort as compared to 98.3% of the healthy control group were able to mount SARS-CoV-2 titers above 30 AU/mL after two standard vaccine doses. Mean IgG antibody titers were lower in hemodialysis patients than controls (78 ± 35 vs. 90 ± 20 AU/mL, p = 0.002). Multivariable binary logistic regression analysis showed age and immunosuppressive medication as major risk factors for vaccination failure with a decreased probability of successful vaccination of −6.1% (95% CI −1.2 to −10.9) per increase in age of one year and −87.4% (95% CI −98.0 to −21.5) in patients on immunosuppressive therapy (crude odds ratio for vaccination failure for immunosuppressive therapy 6.4). Ten out of 17 patients with non-response to vaccination were offered a third dose. Booster vaccination after the second dose induced an increase in effective antibody titers of >30 AU/mL in seven out of ten patients 4–5 weeks later (70%). Conclusion Standard SARS-CoV-2 vaccination schemes are highly effective in mounting protective neutralizing IgG antibodies in chronic hemodialysis patients. Nevertheless, response to vaccination is diminished as compared to a healthy control group. Major risk factors for vaccination failure are older age and immunosuppressive therapy. In non- or low-responders to standard vaccination a third booster vaccination was able to induce effective antibody titers in about 70% of patients, indicating that a third booster vaccination might be preferable to decreasing immunosuppressive therapy.
Highlights
In December 2019, the first case of pneumonia caused by a novel zoonotic virus was published [1]
In total 95 hemodialysis patients were enrolled in this investigation
This study found that immunosuppressive medication represents a major risk factor for non-response to vaccination with an odds-ratio of about 10
Summary
In December 2019, the first case of pneumonia caused by a novel zoonotic virus was published [1]. In the context of this global pandemic, numerous high-risk groups for severe clinical course after SARS-CoV-2 infection have been identified so far. The questions as to which risk factors lead to a reduced response to vaccination in dialysis patients and whether a third booster-vaccination could lead to a successful formation of antibodies remain still unanswered. This prospective multicenter cohort study was performed to investigate the response rates to standard SARS-CoV-2 vaccination schedules, search for risk factors for non-response, and evaluate the effectiveness of a third booster vaccination in non- or low-responders in a cohort of 95 chronic hemodialysis patients
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