Seroresponse to SARS-CoV-2 Vaccines among Maintenance Dialysis Patients over 6 Months. Issue 3 (March 2022)

• Record Type: Journal Article
• Authors: Hsu, Caroline M.; Weiner, Daniel E.; Manley, Harold J.; Aweh, Gideon N.; Ladik, Vladimir; Frament, Jill; Miskulin, Dana; Argyropoulos, Christos; Abreo, Kenneth; Chin, Andrew; Gladish, Reginald; Salman, Loay; Johnson, Doug; Lacson, Eduardo K.
• Is Part Of: Clinical journal of the American Society of Nephrology. Volume 17:Issue 3(2022)
• Page Start: 403
• Page End: 413
• Publication Date: 2022-03
• Subjects: chronic hemodialysis -- end-stage renal disease -- peritoneal dialysis -- COVID-19 -- COVID-19 vaccines -- maintenance -- SARS-CoV-2
• DOI: 10.2215/CJN.12250921
• Languages: English
• ISSNs: 1555-9041

Abstract

Visual Abstract: Abstract : Background and objectives: Although most patients receiving maintenance dialysis exhibit initial seroresponse to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, concerns exist regarding the durability of this antibody response. This study evaluated seroresponse over time. Design, setting, participants, & measurements: This retrospective cohort study included patients on maintenance dialysis, from a midsize national dialysis provider, who received a complete SARS-CoV-2 vaccine series and had at least one antibody titer checked after full vaccination. IgG spike antibodies (anti-spike IgG) titers were assessed monthly with routine laboratory tests after vaccination; the semiquantitative assay reported a range between zero and ≥20 Index. Descriptive analyses compared trends over time by history of coronavirus disease 2019 (COVID-19) and vaccine type. Time-to-event analyses examined the outcome of loss of seroresponse (anti-spike IgG <1 Index or development of COVID-19). Cox regression adjusted for additional clinical characteristics. Results: Among 1870 patients receiving maintenance dialysis, 1569 had no prior COVID-19. Patients without prior COVID-19 had declining titers over time. Among 443 recipients of BNT162b2 (Pfizer), median (interquartile range) anti-spike IgG titer declined from ≥20 (5.89 to ≥20) in month 1 after full vaccination to 1.96 (0.60–5.88) by month 6. Among 778 recipients of mRNA-1273 (Moderna), anti-spike IgG titer declined from ≥20 (interquartile range, ≥20 to ≥20) in month 1 to 7.99 (2.61 to ≥20) by month 6. The 348 recipients of Ad26.COV2.S (Janssen) had a lower titer response than recipients of an mRNA vaccine over all time periods. In time-to-event analyses, recipients of Ad26.COV2.S and mRNA-1273 had the shortest and longest time to loss of seroresponse, respectively. The maximum titer reached in the first 2 months after full vaccination was associated with durability of the anti-spike IgG seroresponse; patients with anti-spike IgG titer 1–19.99 had a shorter time to loss of seroresponse compared with patients with anti-spike IgG titer ≥20 (hazard ratio, 15.5; 95% confidence interval, 11.7 to 20.7). Conclusions: Among patients receiving maintenance dialysis, vaccine-induced seroresponse wanes over time across vaccine types. Early titers after full vaccination are associated with the durability of seroresponse.