Abstract
The aim of this study was to analyze the waning of anti-spike (S) antibodies after mRNA vaccination against COVID-19 in maintenance dialysis patients, and to assess the safety and effectiveness of the complementary third dose. This was a prospective, longitudinal study in which we analyzed the kinetics of antibodies up to six months after a two-dose vaccination (first protocol) in infection-naïve dialysis patients (IN-Ds), previously infected dialysis patients (PI-Ds) and subjects without chronic kidney disease (the controls), as well as their humoral response to the third dose of the same mRNA vaccine (second protocol). The respective reduction in antibody titer after 3 and 6 months by 82.9% and 93.03% in IN-Ds (n = 109), 73.4% and 93.36% in PI-Ds (n = 32) and 75.5% and 88.8% in the controls (n = 20) was demonstrated. Consequently, a protective antibody titer above 141 BAU/mL was found in only 47.7% and 23.8% of IN-Ds after 3 and 6 months, respectively. After the third vaccine dose, a significant increase in antibody titer was observed in all groups, with increases by a factor of ×51.6 in IN-Ds, ×30.1 in the controls and ×8.4 in PI-Ds. The median antibody titer after the third dose differed significantly between groups, and was the highest in PI-Ds: PI-Ds, 9090 (3300–15,000) BAU/mL; the controls, 6945 (2130–11,800); IN-Ds, 3715 (1470–7325) (p < 0.001). In conclusion, we observed similar degrees of antibody waning in all patients. After 3 months, over half of the infection-naïve dialysis patients had a very low antibody titer, and almost twenty percent of them had no antibodies at all. The humoral response to the third dose was very good, raising their titer of antibodies to a higher level than those in the general population who have received the primary two-dose scheme. The results support the administration of a complementary third dose of the mRNA vaccine for dialysis patients as soon as possible.
Highlights
Vaccinations significantly reduced the mortality associated with the COVID-19 pandemic in the general population [1]
We analyzed the kinetics of SARS-CoV-2 anti-spike (S) IgG antibodies up to six months after a two-dose mRNA vaccination against COVID-19, and compared the durability of the humoral response between infection-naïve dialysis patients (IN-Ds), previously infected dialysis patients (PI-Ds) and subjects without chronic kidney disease
The cohort was stratified based on evidence of a previous SARS-CoV-2 infection into 109 IN-D patients and 32 PI-D patients
Summary
Vaccinations significantly reduced the mortality associated with the COVID-19 pandemic in the general population [1]. The neutralizing antibodies produced as a result of immunization act as a shield that prevents or significantly reduces the spread of the virus in the body. Booster doses of vaccines restore vaccine effectiveness by increasing the neutralizing antibody titer and improving its efficacy against variants of the virus [4]. Patients with chronic kidney disease that are dependent on dialysis are among the populations with the highest risk of death from COVID-19 [5]. Their 28-day probability of death before the start of population vaccinations was 25% for all hemodialyzed patients and 33.5% for those who were admitted into hospitals, according to a European Renal
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