Hou Yi-Chou, Lu Kuo-Cheng, Kuo Ko-Lin
Division of Nephrology, Department of Medicine, Cardinal-Tien Hospital, New Taipei City 231, Taiwan.
School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan.
Vaccines (Basel). 2021 Aug 10;9(8):885. doi: 10.3390/vaccines9080885.
The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic has posed a huge threat to global health because of its rapid spread and various mutant variants. Critical illness occurs in the elderly and vulnerable individuals, such as those with chronic kidney disease. The severity of SARS-CoV-2 infection is associated with the severity of chronic kidney disease (CKD)and even kidney transplantation (KT) because of the chronic use of immunosuppressive agents. To develop adaptive immunity against SARS-CoV-2, vaccination against the spike protein is important. Current phase III trials of vaccines against SARS-CoV-2 have not focused on a specific group of individuals, such as patients with CKD or those undergoing dialysis or kidney transplantation. Chronic use of immunosuppressive agents might disturb the immune response to the SARS-CoV-2 spike protein. On the basis of limited evidence, the immune compromised status of CKD patients might decrease neutralizing antibody development after a single dose of a specific vaccine. Boosting dosage more than the protocol might increase the titer of the neutralizing antibody in CKD patients. Further evidence is needed to understand the factors disturbing the immunogenicity of the SARS-CoV-2 vaccine, and CKD patients should receive the recommended dose of the SARS-CoV-2 vaccine due to their relatively immune compromised status.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行因其快速传播和各种变异毒株，对全球健康构成了巨大威胁。危重症发生在老年人和弱势群体中，如患有慢性肾脏病的人群。由于长期使用免疫抑制剂，SARS-CoV-2感染的严重程度与慢性肾脏病（CKD）甚至肾移植（KT）的严重程度相关。为了产生针对SARS-CoV-2的适应性免疫，针对刺突蛋白进行疫苗接种很重要。目前针对SARS-CoV-2疫苗的III期试验尚未聚焦于特定人群，如CKD患者、透析患者或肾移植患者。长期使用免疫抑制剂可能会干扰对SARS-CoV-2刺突蛋白的免疫反应。基于有限的证据，CKD患者的免疫受损状态可能会降低单剂特定疫苗后中和抗体的产生。超过方案的加强剂量可能会提高CKD患者中和抗体的滴度。需要更多证据来了解影响SARS-CoV-2疫苗免疫原性的因素，并且CKD患者因其相对免疫受损的状态，应接种推荐剂量的SARS-CoV-2疫苗。
