Abstract
Background/Aims: Chronic kidney disease CKD patients on intermittent hemodialysis IHD are exposed to SARS-CoV-2 infection and carry a risk of developing severe symptoms. The aim of this study was to evaluate the humoral and cellular immunity induced by two doses of mRNA vaccines, the Pfizer-BioNTech (Comirnaty) COVID-19 Vaccine and the Moderna (mRNA-1273) COVID-19 vaccine. Patients and methods: The study included 281 patients from five dialysis centers in northern Poland. Within 2 weeks prior to the first dose of the vaccine, a blood sample was collected for an evaluation of SARS-CoV-2 antibodies. Thirty to forty-five days after the second dose of the vaccine, a blood sample was taken to evaluate humoral and cellular response. Results: Patients with stage 5 CKD on IHD were characterized by a considerable SARS-CoV-2 vaccine-induced seroconversion rate. The strongest factors influencing the antibodies AB level after vaccination were a pre-vaccination history of SARS-CoV-2 infection, age, the neutrophil-to-lymphocyte ratio NLR, neutrophil absolute count, and the hemoglobin level. Cellular immunity was higher in patients with a pre-vaccination history of SARS-CoV-2 infection. Cellular immunity depended on the albumin level. Positive cellular response to vaccination was a positive factor reducing all-cause mortality, except for COVID-19 mortality (no such deaths were reported during our follow-up). Cellular immunity and humoral immunity were positively mutually dependent. High levels of albumin and hemoglobin, low neutrophil count, and a reduced NLR, translated into better response to vaccination. Conclusions: Patients with stage 5 CKD on IHD were characterized by a considerable SARS-CoV-2 vaccine-induced seroconversion rate and a good rate of cellular immunity. The factors that change with exacerbating inflammation and malnutrition (albumin, hemoglobin, neutrophil count, the NLR) affected the efficacy of the vaccination.
Highlights
The SARS-CoV-2 coronavirus belongs to the coronavirus (Coronavridae) family first identified in 1960s [1–3]
The aim of this study is to evaluate the humoral and cellular immunity induced by two doses of mRNA vaccines, the Pfizer-BioNTech (Comirnaty)
Within 2 weeks prior to the first dose of the vaccine, blood samples were collected for an evaluation of SARS-CoV-2 antibodies
Summary
The SARS-CoV-2 coronavirus belongs to the coronavirus (Coronavridae) family first identified in 1960s [1–3]. Members of the family were responsible for typically mild respiratory infections in humans. The 21st century has seen the emergence of new human coronavirus species that most probably developed as a result of mutations of animal viruses. In 2020, the first cases of a SARS-CoV infection causing severe acute respiratory syndrome (SARS) were reported. The pathogen was later given the official name of SARS-CoV-2 (SARS coronavirus 2). It has been responsible for the ongoing epidemic of the COVID-19 (coronavirus disease 2019) infectious disease. According to the WHO data, there have been more than 250 million SARS-CoV-2 infections and more than 5 million related deaths worldwide to date, i.e., 11 November 2021
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