Abstract
PurposeThe predictive value of antibody titers after the first SARS-CoV-2 vaccination and long-term trajectories of antibody titers in hemodialysis patients are unknown.MethodsSARS-CoV-2 IgG antibodies and their neutralizing effect six weeks after the first and second vaccination were analysed in 30 hemodialysis patients. IgG titers served to classify participants as responders or non-responders and to calculate sensitivity, specificity, and accuracy. Associations between potential risk factors and post-vaccine non-response were analysed by Mann–Whitney-U test and Chi-Squared test. Long-term follow-up analysis (ANOVA) on the evolution of neutralizing IgG-titers was performed in 24 participants 94 and 135 days after the second immunization.ResultsIgG antibodies ≥ 1 AU/L (mean 9 ± 20 AU/L) after the first dose were found in 20 patients (66.7%). After the second dose only two participants (6.7%) remained sero-negative and 16.6% showed neutralizing levels below 30%, whereas 25 patients showed IgG antibodies with the high neutralizing activity of 86 ± 18%. Positive IgG antibodies 6 weeks after the first vaccination predicted vaccination effectiveness after two cycles with a specificity of 100%, sensitivity of 76%, and accuracy of 87%. Even low-dose immunosuppressive therapy increased the relative risk for non-response after the first and second dose 1.9 (95% CI 0.8–4.6) and 4.9 (95% CI 1.0–23.8) times, respectively. Over a period of about 4.5 months IgG titers slowly declined by 51% from baseline or by 0.45 AU/mL per day, respectively.ConclusionTwo cycles of SARS-CoV-2 vaccination-induced high seroconversion rates comparable to the general population. Immunosuppressive medication is a major risk factor for vaccination non-response. Mounted IgG antibodies showed a high neutralizing capacity as evidence of protective effectiveness. IgG antibodies after the first dose may serve to predict later vaccination outcome. Patients on dialysis display a more rapid decline in antibody titers on long-term follow-up compared to healthy controls.
Highlights
Different SARS-CoV-2 vaccines have been developed and marketed in different countries around the world
Little is known about the efficacy of a first dose anti-SARS-CoV-2 vaccination to mount anti-SARSCoV-2 IgG antibodies and if the standard two-dose fits all vaccination strategy in the general population is sufficiently effective in ESRD patients on hemodialysis
This study aimed to investigate the effectiveness of the first SARS-CoV-2 vaccination cycle on the evolution of antivirus antibodies and their neutralizing capacity in hemodialysis patients
Summary
Different SARS-CoV-2 vaccines have been developed and marketed in different countries around the world. Patients on hemodialysis are at high risk of developing severe courses of SARS-CoV-2 infections carrying a high mortality rate [2, 3]. Little is known about the efficacy of a first dose anti-SARS-CoV-2 vaccination to mount anti-SARSCoV-2 IgG antibodies and if the standard two-dose fits all vaccination strategy in the general population is sufficiently effective in ESRD patients on hemodialysis. The neutralizing activity and the long-term decline in antibody titers have not yet been fully elucidated in this vulnerable patient cohort. This prospective study aimed at describing the effect of SARS-CoV-2 vaccination on the long-term evolution of antibody titers and their neutralizing capacity in a cohort of hemodialysis patients
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