Vaccine In Hemodialysis Patients Research Articles

Investigating the effect of serum level of uric acid on the immunogenicity of hepatitis B vaccination in dialysis patients

IntroductionHBV infection is a significant concern in dialysis patients, influenced by various factors. This study aims to investigate the impact of serum uric acid levels on the immunogenicity of hepatitis Bvaccination in dialysis patients.MethodA cross-sectional study was conducted, involving 125 hemodialysis patients. Prior to dialysis, assessments were made for uric acid, vitamin D, HBsAg, andHBsAb. Patients were divided into two groups based on uric acid levels: high level (≥ 6.5 mg/dl) and low level (< 6.5 mg/dl). Each group received three doses of a high-dose hepatitis B vaccine (40 mcg) at 0, 1, and 6 months. After 8 weeks of the 3rd dose of the vaccine, the anti-hepatitis B antibody titer (HBsAb) was measured and recorded. Data were analyzed using SPSS version 22.ResultsAmong patients with high uric acid, 30 (26.8%) had low HBsAb and 82 (73.2%) had high HBsAb (> 10). In patients with low uric acid, 1 (7.7%) had low HBsAb and 12 (92.3%) had high HBsAb (> 10). There was no statistically significant difference inHBsAb between the two groups. The immune response of HBsAb and uric acid did not show significance based on demographic variables and laboratory results.ConclusionThis study found no correlation between uric acid levels and the immunogenicity of hepatitis B vaccination in hemodialysis patients. However, it is important to note that the group with low serum uric acid was very small compared to the other group and this may have influenced these results. Further studies with larger patient populations are needed to provide more conclusive evidence in this area.

Two versus three doses of COVID-19 vaccine and post-vaccination COVID-19 infection in hemodialysis patients

Background and aimPatients with chronic kidney disease including those undergoing hemodialysis (HD) constitute a particularly challenging group regarding COVID-19 vaccination. The present study aimed to compare the rate of reinfection after two and three doses of Sinopharm COVID-19 vaccine in HD patients. Patients and methodsThe study included 80 HD patients who received three doses of Sinopharm COVID-19 vaccine. In addition, there were another 80 patients who received only two doses of the vaccine. Patients in the latter group were selected based on propensity matching score with 1:1 ratio. Patients were monitored for post-vaccination COVID-19 infection using PCR examination of nasopharyngeal swabs. Patients were also monitored for post-vaccination complications including general complaints (headache, fever, fatigue), injection site complaints (arm pain, swelling, itching, rash), musculoskeletal complaints (muscle spasm or pain, joint pain) and others. All patients were followed for six months. ResultsThe present study included 80 patients submitted to COVID-19 vaccination with two doses of Sinopharm vaccine (GI) and other 80 patients who received three doses of the same vaccine (GII). At the end of follow up, 11 patients (13.8 %) in GI caught COVID-19 infection. In contrast, no patient in GII had infection (p<0.001). Comparison between patients who had COVID-19 infection and those without infection revealed that the former subgroup had significantly lower BMI (23.3 ± 2.3 versus 27.5 ± 8.1 Kg/m2), higher frequency of associated Hepatitis C (HCV) infection (54.6 % versus 2.9 %, p<0.001) and higher serum ferritin levels [median (IQR): 1101.0 (836.0-1564.0) versus 675.0 (467.0-767.7) ng/mL, p=0.01]. Binary logistic regression analysis identified high serum ferritin levels [OR (95% CI): 0.014 (0.001-0.15), p<0.001] and associated HCV infection [OR (95% CI): 0.99 (0.98-1.01), p=0.02] as significant predictors of post-vaccination COVID-19 infection in multivariate analysis. ConclusionsA three dose regime of Sinopharm COVID-19 vaccine associated with significantly lower rate of reinfection COVID-19 infection in HD patients. Infected patients had significantly lower BMI, higher frequency of HCV and higher ferritin levels.

Comparison of Humoral Response between Third and Fourth Doses of COVID-19 Vaccine in Hemodialysis Patients.

Dialysis patients are more likely to die or become hospitalized from coronavirus disease 2019 (COVID-19). Currently, only a few studies have evaluated the efficacy of a fourth booster vaccination in hemodialysis (HD) patients and there is not enough evidence to recommend for or against a fourth booster vaccination. This study compared the humoral response and disease severity of patients on HD who received either three or four doses of COVID-19 vaccine. A total of 88 patients were enrolled. Humoral response to vaccination was measured by quantifying immunoglobulin G levels against the receptor binding domain of SARS-CoV-2 (anti-RBD IgG) at five different times and plaque reduction neutralization tests (PRNT) at two different times after vaccination over a period of 18 months. Antibody levels were measured at approximately two-month intervals after the first and second dose, then four months after the third dose, and then one to six months after the fourth dose of vaccine. PRNT was performed two months after the second and four months after the third dose of vaccine. We classified patients into four groups according to the number of vaccine doses and presence of COVID-19 infection. Severe infection was defined as hospital admission for greater than or equal to two weeks or death. There was no difference in antibody levels between naïve and infected patients except after a fourth vaccination, which was effective for increasing antibodies in infection-naïve patients. Age, sex, body mass index (BMI), dialysis vintage, and presence of diabetes mellitus (DM) did not show a significant correlation with antibody levels. Four patients who experienced severe COVID-19 disease tended to have lower antibody levels prior to infection. A fourth dose of SARS-CoV-2 vaccine significantly elevated antibodies in infection-naïve HD patients and may be beneficial for HD patients who have not been previously infected with SARS-CoV-2 for protection against severe infection.

Measuring anti-spike IgG Antibody Response to SARS-CoV-2 vaccination in Patients Receiving Hemodialysis in Pakistan

The current state of the evidence is equivocal for IgG antibody response to SARS-CoV-2 vaccination in hemodialysis patients. Here, we assess the immune response in hemodialysis patients who have received a complete series of vaccines with or without a history of prior COVID infection irrespective of the vaccine administered. In this cross-sectional study, we obtained serum samples from Hemodialysis patients (n = 101). Our study found that nearly three-quarters of patients (72.2%) had two doses of either Sinovac or Sinopharm vaccine administered, and ninety-seven percent of participants were considered seropositive (COVID Ab titers &gt; 7.1 BAU/ml). Mean COVID19 spike antibody titers were 1892.4 BAU/mL and median titers were 971 BAU/mL. The comparative analysis was performed between patients who completed two-doses less than 6 months ago and more than 6 months ago when their antibody levels were measured. Mean and median antibody titers were 1895.8 and 792 BAU/mL in the former group compared to 1981.1 and 1033 BAU/mL respectively (P value 0.84) in the latter group, indicating no significant difference. There were also no statistically significant differences in IgG antibodies among subgroups defined by diabetes, hypertension, CAD or gender. However, older patients (age &gt;55 years) had significantly higher anti-spike antibody titers as compared to younger patients (2417.8 BAU/mL vs 1377.3 BAU/mL, P value 0.008). The result of this study provides important evidence, which can lead to vaccine efficacy especially in older populations. Future studies should address whether booster vaccination may play a role in providing an effective and long-lasting protection among vulnerable patients undergoing hemodialysis treatment.

Using Artificial Intelligence Algorithms to Predict the Overall Survival of Hemodialysis Patients during the COVID-19 Pandemic: A Prospective Cohort Study.

Hemodialysis (HD) patients are a vulnerable population at high risk for severe complications from COVID-19. The impact of partial COVID-19 vaccination on the survival of HD patients remains uncertain. This prospective cohort study was designed to utilize artificial intelligence algorithms to predict the survival impact of partial COVID-19 vaccination in HD patients. A cohort of 433 HD patients was utilized to develop machine learning models based on a subset of clinical features assessed between July 1, 2021, and April 29, 2022. The patient cohort was randomly split into training (80%) and testing (20%) sets for model development and evaluation. Machine learning models, including CatBoost, LightGBM, RandomForest, and XGBoost, were applied to evaluate their discriminative performance using the patient cohorts. Among these models, LightGBM achieved the highest F1 score of 0.95, followed by CatBoost, RandomForest, and XGBoost, with AUC values of 0.94 on the testing dataset. The SHapley Additive explanation summary (SHAP) plot derived from the XGBoost model indicated that key features such as age, albumin, and vaccination details had a significant impact on survival. Moreover, the fully vaccinated group exhibited higher levels of anti-S RBD antibodies. This prospective cohort study involved utilizing artificial intelligence algorithms to predict overall survival in HD patients during the COVID-19 pandemic. These predictive models assisted in identifying high-risk individuals and guiding vaccination strategies for HD patients, ultimately improving overall prognosis. Further research is warranted to validate and refine these predictive models in larger and more diverse populations of HD patients.

Hemodiyaliz hastalarında aşılanma oranları ve farkındalığı

Aims: Vaccination is main risk reducing strategy for vaccine-preventable infections in chronic kidney disease (CKD) patients, but vaccination rates in hemodialysis patients are not at the desired level. In this study, we aimed to search the rates of influenza, pneumococcal, hepatitis B and coronavirus disease-2019 (COVID-19) vaccination, the vaccination awareness and the reasons for not taking vaccination in hemodialysis patients.&#x0D; Methods: In this cross-sectional study, 232 CKD patients undergoing hemodialysis in two centers for at least six months were included. The patients completed the questionnaire about vaccination. The data about patients’ history of vaccination regarding influenza, pneumococcal, hepatitis B and COVID-19 vaccines; patients’ attitudes and knowledge about vaccination; the source of information about vaccination were collected via this questionnaire.&#x0D; Results: The rates of pneumococcal, influenza, hepatitis B and COVID-19 vaccination were 9.9%, 56.6%, 38.8% and 87.1%, respectively. In patients with missing vaccination, the main reasons for not taking vaccination were lack of knowledge about vaccination (48.7%), the thought that the vaccine is not beneficial (12.5%) and fear of adverse effects (3.4%). The main sources of information about vaccination were healthcare workers (90.5%), radio/televison (1.7%) and internet (1.7%). &#x0D; Conclusion: Our findings showed that the rates of influenza, pneumococcal and hepatitis B vaccination were below the targeted levels and the main reason was the lack of information about vaccination and the main source of information about vaccination was health personnel. Strategies should be developed to increase the awareness and rate of vaccination for vaccine-preventable infections in CKD patients.

Investigation of COVID-19 vaccination among maintenance hemodialysis patients in Sichuan, China.

To investigate the current status of COVID-19 vaccination in maintenance hemodialysis (MHD) patients and its influencing factors. In total, 585 patients undergoing regular hemodialysis in Sichuan Province of China from January to March 2022 were selected to complete a questionnaire survey on their knowledge, attitudes and practices regarding COVID-19 vaccination. Independent t tests and logistic multivariate analysis were used to analyze the influencing factors of COVID-19 vaccination in hemodialysis patients. The survey showed that 37.44% of MHD patients had been vaccinated with the COVID-19 vaccine. Being married was associated with COVID-19 vaccination in patients with MHD (odds ratio [OR] = 1.969 95% CI 0 .870 ~ 4.453). MHD patients living in county areas have higher rates of COVID-19 vaccination (OR = 0.572 95% CI 0.301 ~ 1.087). Family /relatives/friends who are healthcare workers are associated with COVID-19 vaccination for MHD patients (OR = 1.840 95% CI 1.140 ~ 2.970). Other vaccination history within 5 years was a factor in COVID-19 vaccination for MHD patients (OR = 5.592 95% CI 2.997 ~ 10.434). Attitude (OR = 0.885 95% CI 0.808 ~ 0.905), and practice (OR = 0.756 95% CI 0.697 ~ 0.819) scores on the COVID-19 vaccination knowledge and practice questionnaire were related to the vaccination status of MHD patients. MHD patients had lower rates of COVID-19 vaccination. Marital status, living environment, whether family/relatives/friends were medical workers, and the score of the COVID-19 vaccine knowledge and practice questionnaire were the factors influencing their vaccination status. Clinical attention should be given to the adverse reactions of COVID-19 vaccination in MHD patients to improve the awareness of primary medical staff on hemodialysis, and families and society should pay more attention to COVID-19 vaccination in MHD patients.

Immunogenicity and safety of inactivated SARS-CoV-2 vaccine in haemodialysis patients: a prospective cohort study

End-stage renal disease patients on haemodialysis (HD) have been largely excluded from SARS-CoV-2 vaccine trials due to safety reasons and shown to mount lower responses to vaccination. This study aims to evaluate the immunogenicity and safety of inactivated COVID-19 vaccine among HD patients compared to healthy controls. All subjects who received the primary inactivated COVID-19 vaccination had their blood samples tested 21 days after the second dose. We report the immunogenicity based on anti-RBD IgG titre (IU/mL), the inhibition rate of neutralizing antibodies (NAbs) (%) to RBD, and seroconversion rates. Adverse events were assessed within 30 min and on the 7th day after each dose. Among 75 HD patients and 71 healthy controls, we observed no significant difference in all immunogenicity measures: anti-RBD IgG GMT (277.91 ± 7.13 IU/mL vs. 315.50 ± 3.50 IU/mL, p = 0.645), NAbs inhibition rate (82% [53–96] vs. 84% [39–98], p = 0.654), and seroconversion rates (anti-RBD IgG: 86.7% vs. 85.9%, p = 0.895; NAbs: 45.3% vs. 60.6%, p = 0.065). The number of adverse events is not significantly different between the two groups. The primary inactivated SARS-CoV-2 vaccination elicits an adequate antibody response and can be safely administered in haemodialysis patients.

Duration of Protection From Pneumonia After Pneumococcal Vaccination in Hemodialysis Patients (DOPPIO): Protocol for a Prospective Multicenter Study.

Pneumonia is a leading cause of death in patients with end-stage chronic kidney disease treated with dialysis. Current vaccination schedules recommend pneumococcal vaccination. However, this schedule disregards findings of rapid titer decline in adult hemodialysis patients after 12 months. The primary objective is to compare pneumonia rates between recently vaccinated patients and patients vaccinated more than 2 years ago. As an exploratory objective, antipneumococcal antibody titers in hemodialysis patients will be determined as a function. Factors influencing antibody kinetics will be identified. Within this prospective multicenter study, we aim to compare 2 strata of vaccinated patients: those recently vaccinated and those vaccinated more than 2 years ago. A total of 792 patients will be enrolled. Twelve partner sites (within the German Centre for Infection Research [DZIF]) with allocated dialysis practices participate in this study. All dialysis patients who are vaccinated against pneumococcal infection in accordance with Robert Koch Institute guidelines prior to enrollment will be eligible. Data on baseline demographics, vaccination history, and underlying disease will be assessed. Pneumococcal antibody titers will be determined at baseline and every 3 months for 2 years. DZIF clinical trial units coordinate titer assessment schedules and actively follow-up on study patients for 2-5 years after enrollment, including validation of end points of hospitalization, pneumonia, and death. The study has enrolled 792 patients and the last follow-up has been completed. Currently, the statistical and laboratory analyses are ongoing. Results will increase physician adherence to current recommendations. Establishing a framework for the efficient evaluation of guideline recommendations through a combination of routine and study data will inform the evidence base for future guidelines. ClinicalTrials.gov NCT03350425; https://clinicaltrials.gov/ct2/show/NCT03350425. DERR1-10.2196/45712.

Comparison of Humoral Antibody Responses and Seroconversion Rates between Two Homologous ChAdOx1 nCoV-19 and mRNA-1273 Vaccination in Patients Undergoing Maintenance Hemodialysis.

Hemodialysis patients are at an increased risk of SARS-CoV-2 infection and are excluded from preauthorization COVID-19 vaccine trials; therefore, their immunogenicity is uncertain. To compare the antibody responses to homologous ChAdOx1 and mRNA-1273 SARS-CoV-2 vaccination in hemodialysis patients, 103 age- and sex-matched hemodialysis patients with two homologous prime-boost vaccinations were recruited to detect anti-receptor-binding domain (RBD) IgG levels and seroconversion rates (SCRs) 14 days after a prime dose (PD14), before and 28 days after a boost dose (pre-BD0 and BD28). Both mRNA-1273 and ChAdOx1 vaccinations elicited immunogenicity in study subjects, and the former induced higher anti-RBD IgG levels than the latter. The SCRs of both groups increased over time and varied widely from 1.82% to 97.92%, and were significantly different at PD14 and pre-BD0 regardless of different thresholds. At BD28, the SCRs of the ChAdOx1 group and the mRNA-1273 group were comparable using a threshold ≥ 7.1 BAU/mL (93.96% vs. 97.92%) and a threshold ≥ 17 BAU/mL (92.73% vs. 97.92%), respectively, but they were significantly different using a threshold ≥ 20.2% of convalescent serum anti-RBD levels (52.73% vs. 95.83%). The seroconversion (≥20.2% of convalescent level) at BD28 was associated with mRNA-1273 vaccination after being adjusted for age, sex, body mass index, and the presence of solicited reactogenicity after a prime vaccination. Our prospective, observational cohort indicates that a full prime-boost mRNA-1273 vaccination is likely to provide higher immune protection in hemodialysis patients compared to ChAdOx1, and this population with a prime-boost ChAdOx1 vaccination should be prioritized for a third dose.

The Humoral Response to SARS-CoV-2 Vaccine in Hemodialysis Patients Is Correlated with Nutritional Status.

Hemodialysis patients are highly susceptible to poor nutritional status. Our objective was to investigate whether poor nutritional status during mRNA-SARS-CoV-2 vaccination is correlated with impaired vaccine responses. This retrospective study was conducted in two hospital-based dialysis units. The nutritional status of hemodialysis patients was assessed, using a malnutrition inflammation score (MIS) at the time of their first BNT162b2 vaccine dose. One month after the second vaccine dose, we performed a quantitative assessment of antibodies against the spike protein (anti-S1 IgG). A total of 115 hemodialysis patients, with an average age of 72 were enrolled in the study. Among them, 39 (33.9%) were female, and 67 (58.2%) had diabetes mellitus. In 43/115 (37.4%) patients, moderate to severe malnutrition (MIS > 5) was detected. Comparatively, malnourished patients showed a lower log-transformed mean level of anti-S1 IgG compared to those with normal nutrition (2.91 ± 0.83 vs. 3.25 ± 0.72, respectively, p = 0.024). In a multivariable analysis that adjusted for age, sex, and KT/V, the nutritional status assessed by an MIS remained inversely associated with an anti-S1 IgG response [B; -0.066 (-0.117 to -0.015)]. In conclusion, moderate to severe malnutrition in hemodialysis patients is associated with reduced humoral responses to BNT162b2 vaccination.

Long-Term Neutralizing Antibody Titers After BNT162b2 Vaccination in Hemodialysis Patients

Long-Term Neutralizing Antibody Titers After BNT162b2 Vaccination in Hemodialysis Patients

#5916 ANALYSIS OF SARS-COV2 INFECTION AND COVID-19 VACCINATION IN TWO DIAVERUM CLINICS IN NORTH MACEDONIA

Abstract Background and Aims Hemodialysis patients as a separate group of immunosuppressive patients are at highest risk of severe clinical complications and death caused by infection with SARS-CoV-2 virus. With the introduction of COVID-19 vaccination in hemodialysis patients, the situation has changed significantly. The aim of the study was to analyze the difference in morbidity and mortality between two groups of hemodialysis patients, vaccinated and unvaccinated for Covid-19 in two Diaverum Clinics. Method The study is based on analysis of the data of hemodialysis patients in two Diaverum clinics during the period from April 2020, when the first case of SARS-CoV-2 virus was detected in Diaverum Kochani Clinic, to August 2022, when the last case of SARS-CoV-2 virus was detected in both clinics. Analytical data are taken from IRIMS database used only by Diaverum Clinics worldwide. Results During the period of observation, a total number of 214 hemodialysis patients were treated in both Diaverum Clinics. Regarding gender distribution 63% are males and 37% are females. From the total number of patients in both clinics, 67% (143) were vaccinated with two or three doses of the COVID 19 vaccines, while the remaining 33% (71) patients were COVID-19 unvaccinated. The majority of the patients (67%) were vaccinated with Chinese vaccine Sinopharm; 19% with Sinovac; 7% with Astra Zeneca; 7% with Pfizer BioNTech (the vaccines that were available in that period in our country). In 2020 a total of 28 COVID infection occurred in both clinics, all of them were unvaccinated patients; 16 of them were hospitalized and 9 of them died. Hospitalization rate was 57% and mortality rate 32% among the positive patients. In 2021 a total of 35 COVID infections were registered, 18 were hospitalized (unvaccinated 61% vs 39% vaccinated). 26% (9) of the positive patients died, 6 were unvaccinated and 3 were vaccinated with 2 doses. Hospitalization rate was 51% and mortality rate 26%. In 2022 a total of 43 COVID infections occurred, only 4 were hospitalized and only 1 patient died; hospitalization rate 9%; mortality rate 2,3%. When the whole study period was analyzed, the infection rate between the vaccinated and unvaccinated patients in both clinics was statistically not significant, 51% vs 46,5%, p = 0,5634 (Fisher exact two-tailed test). But, when the hospitalization rate was compared between vaccinated and unvaccinated patients, 12,3% vs 84,8%, the difference was highly statistically significant (p = 0,0001). When death rate was compared between the two groups, the difference was also highly statistically significant, 5,5% vs 45,4% in the unvaccinated group (p = 0,0001). Conclusion The results of our study showed no difference in the infection rate between vaccinated and unvaccinated patients, but they confirmed high level of protection from hospitalization and mortality in vaccinated patients.

Yellow Fever Vaccination in Hemodialysis Patients: A Systematic Review

Introduction: Yellow fever is an infectious disease endemic to Africa, and Central and South America with a significant impact on public health, causing outbreaks and epidemics. Clinical manifestations can vary from asymptomatic to more severe and lethal disease outcomes. The primary prevention of yellow fever occurs through the vaccination of individuals, which confers immunity for life. Patients with chronic kidney disease, especially those undergoing dialysis, have low vaccination and seroconversion rates. As mentioned above, this research aimed to perform a systematic review of the yellow fever vaccination protocol in hemodialysis patients. Methods: A systematic review on vaccination against yellow fever in hemodialysis patients using databases, PubMed and Biblioteca Virtual em Saúde (BVS), was performed. For data collection, combinations were made using the following descriptors: protocols, vaccination, yellow fever, kidney dialysis, chronic kidney failure, chronic kidney disease, and group risk included in the title and abstract description. Articles with no subject related to the search were excluded and also if they were duplicated. Results: In this review, 90 scientific articles were identified in both databases. After applying exclusion criteria, a total of 3 articles were selected. Conclusion: We recommend carefully assessing the risk-benefit and contraindications for the patient, emphasizing the risk groups. There is an evident lack of studies on the subject, and there is a need to broaden investigations related toimmunization for patients on dialysis. The review is registered in the PROSPERO system with the number 323550.

Maintenance of Potent Cellular and Humoral Immune Responses in Long-Term Hemodialysis Patients after 1273-mRNA SARS-CoV-2 Vaccination.

Continuous evaluation of the coronavirus disease 2019 (COVID-19) vaccine effectiveness in hemodialysis (HD) patients is critical in this immunocompromised patient group with higher mortality rates due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The response towards vaccination in HD patients has been studied weeks after their first and second SARS-CoV-2 vaccination dose administration, but no further studies have been developed in a long-term manner, especially including both the humoral and cellular immune response. Longitudinal studies that monitor the immune response to COVID-19 vaccination in individuals undergoing HD are therefore necessary to prioritize vaccination strategies and minimize the pathogenic effects of SARS-CoV-2 in this high-risk group of patients. We followed up HD patients and healthy volunteers (HV) and monitored their humoral and cellular immune response three months after the second (V2+3M) and after the third vaccination dose (V3+3M), taking into consideration previous COVID-19 infections. Our cellular immunity results show that, while HD patients and HV individuals secrete comparable levels of IFN-γ and IL-2 in ex vivo stimulated whole blood at V2+3M in both naïve and COVID-19-recovered individuals, HD patients secrete higher levels of IFN-γ and IL-2 than HV at V3+3M. This is mainly due to a decay in the cellular immune response in HV individuals after the third dose. In contrast, our humoral immunity results show similar IgG binding antibody units (BAU) between HD patients and HV individuals at V3+3M, independently of their previous infection status. Overall, our results indicate that HD patients maintain strong cellular and humoral immune responses after repeated 1273-mRNA SARS-CoV-2 vaccinations over time. The data also highlights significant differences between cellular and humoral immunity after SARS-CoV-2 vaccination, which emphasizes the importance of monitoring both arms of the immune response in the immunocompromised population.

Investigation of COVID-19 Vaccine Acceptance and Early Side Effects of COVID-19 Vaccine in Hemodialysis Patients

Investigation of COVID-19 Vaccine Acceptance and Early Side Effects of COVID-19 Vaccine in Hemodialysis Patients

Nuritional status and humeral response to SARS-COV-2 vaccine in hemodialysis patients

Nuritional status and humeral response to SARS-COV-2 vaccine in hemodialysis patients

Trajectory of Humoral Responses to Two Doses of ChAdOx1 nCoV-19 Vaccination in Patients Receiving Maintenance Hemodialysis.

The ChAdOx1 nCoV-19 (AZD1222) vaccine is one of the most commonly delivered SARS-CoV-2 vaccines worldwide; however, few clinical studies have investigated its immunogenicity in dialysis patients. We prospectively enrolled 123 patients on maintenance hemodialysis at a medical center in Taiwan. All patients were infection-naive, had received two doses of the AZD1222 vaccine, and were monitored for 7 months. The primary outcomes were anti-SARS-CoV-2 receptor-binding domain (RBD) antibody concentrations before and after each dose and 5 months after the second dose and neutralization capacity against ancestral SARS-CoV-2, delta, and omicron variants. The anti-SARS-CoV-2 RBD antibody titers significantly increased with time following vaccination, with a peak at 1 month after the second dose (median titer, 498.8 U/mL; interquartile range, 162.5 to 1,050 U/mL), and a 4.7-fold decrease at 5 months. At 1 month after the second dose, 84.6, 83.7, and 1.6% of the participants had neutralizing antibodies against the ancestral virus, delta variant, and omicron variant, respectively, measured by a commercial surrogate neutralization assay. The geometric mean 50% pseudovirus neutralization titers for the ancestral virus, delta variant, and omicron variant were 639.1, 264.2, and 24.7, respectively. The anti-RBD antibody titers correlated well with neutralization capacity against the ancestral virus and delta variant. Transferrin saturation and C-reactive protein were associated with neutralization against the ancestral virus and delta variant. Although two doses of the AZD1222 vaccine initially elicited high anti-RBD antibody titers and neutralization against the ancestral virus and delta variant in hemodialysis patients, neutralizing antibodies against omicron variant were rarely detected, and the anti-RBD and neutralization antibodies waned over time. Additional/booster vaccinations are warranted in this population. IMPORTANCE Patients with kidney failure have worse immune response following vaccination compared to general population, but few clinical studies have investigated immunogenicity of ChAdOx1 nCoV-19 (AZD1222) vaccination in hemodialysis patients. Here, we showed two doses of AZD1222 vaccines lead to high seroconversion rate of anti-SARS-CoV-2 receptor-binding domain (RBD) antibodies, and more than 80% patients acquired neutralizing antibodies against ancestral virus and delta variant. However, seldom did they obtain neutralizing antibodies against the omicron variant. The geometric mean 50% pseudovirus neutralization titer against the ancestral virus was 25.9-fold higher than that against the omicron variant. Also, there was a substantial decay in anti-RBD titers with time. Our findings provided evidence supporting that more protective measures, including additional/booster vaccinations, is warranted in these patients during the current COVID-19 pandemic.

Humoral response after BNT162b2 vaccine in Japanese hemodialysis patients

BackgroundHemodialysis patients are more likely to be severely affected if infected by COVID-19. Contributing factors include chronic kidney disease, old age, hypertension, type 2 diabetes, heart disease, and cerebrovascular disease. Therefore, action against COVID-19 for hemodialysis patients is an urgent issue. Vaccines are effective in preventing COVID 19 infection. In hemodialysis patients, however, responses to hepatitis B and influenza vaccines are reportedly weak. The BNT162b2 vaccine has shown an efficacy rate of about 95% in the general population, but as far as we know there are only several reports of efficacy data in hemodialysis patients in Japan.MethodsWe assessed serum anti-SARS-CoV-2 IgG antibody (Abbott SARS-CoV-2 IgG II Quan) in 185 hemodialysis patients and 109 health care workers. The exclusion criterion was positivity for SARS-CoV-2 IgG antibody before vaccination. Adverse reactions to BNT162b2 vaccine were evaluated through interviews.ResultsFollowing vaccination, 97.6% of the hemodialysis group and 100% of the control group were positive for the anti-spike antibody. The median level of anti-spike antibody was 2,728.7 AU/mL (IQR, 1,024.2–7,688.2 AU/mL) in the hemodialysis group and 10,500 AU/ml (IQR, 9,346.1–2,4500 AU/mL) in the health care workers group. The factors involved in the low response to the BNT152b2 vaccine included old age, low BMI, low Cr index, low nPCR, low GNRI, low lymphocyte count, steroid administration, and complications related to blood disorders.ConclusionsHumoral responses to BNT162b2 vaccine in hemodialysis patients are weaker than in a healthy control sample. Booster vaccination is necessary for hemodialysis patients, especially those showing a weak or non-response to the two-dose BNT162b2 vaccine.Trial registration UMIN, UMIN000047032. Registered 28 February 2022, https://center6.umin.ac.jp/cgi-bin/ctr/ctr_reg_rec.cgi.

Adverse events following the first, second and third doses of a COVID-19 vaccine in hemodialysis patients

Background This study aimed to identify adverse events following the first three doses of COVID-19 vaccines in hemodialysis (HD) patients. Risk factors associated with postvaccination adverse events were explored. Methods Postvaccination adverse events in 438 HD patients who received 3 doses of COVID-19 vaccines were prospectively assessed. The adverse events among three doses were compared using generalized linear mixed models. Factors associated with adverse events were assessed with multivariate analyses. Results The vast majority of participants received Oxford/AstraZeneca ChAdOx1 as their first two doses and Moderna mRNA-1273 as their third dose. Overall, 79%, 50% and 84% of the participants experienced at least one adverse event after their first, second, and third doses, respectively. These adverse events were mostly minor, short-lived and less than 5% reported daily activities being affected. Compared with the first dose, the second dose caused a lower rate of adverse events. Compared with the first dose, the third dose elicited a higher rate of injection site reactions and a lower rate of systemic reactions. Multivariate analyses showed that every 10-year increase of age (odds ratio 0.67, 95% confidence intervals 0.57-0.79) was associated with decreased risk of adverse events, while female sex (2.82, 1.90-4.18) and arteriovenous fistula (1.73, 1.05–2.84) were associated with increased risk of adverse events. Compared with Oxford/AstraZeneca ChAdOx1, Moderna mRNA-1273 was associated with an increased risk of injection site reactions. Conclusions COVID-19 vaccination was well tolerated in HD patients. Age, sex, dialysis vascular access and vaccine types were associated with postvaccination adverse events.