Buchwinkler Lukas, Solagna Claire Anne, Messner Janosch, Pirklbauer Markus, Rudnicki Michael, Mayer Gert, Kerschbaum Julia
Department of Internal Medicine IV-Nephrology and Hypertension, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
J Clin Med. 2021 Dec 28;11(1):148. doi: 10.3390/jcm11010148.
Most trials on mRNA vaccines against SARS-CoV-2 did not include patients with chronic kidney disease (CKD), hemodialysis (HD) patients, or kidney transplant recipients (KTR). However, those patients have a higher risk for a severe course of COVID-19 disease and mortality. Available literature has demonstrated a reduced efficacy of mRNA vaccines in HD patients and KTR, while data on CKD patients is scarce. Additionally, factors associated with non-response are poorly understood and not well characterized. We assessed antibody (AB) response ( = 582, 160 CKD patients, 206 patients on HD, 216 KTR) after the administration of two doses of a mRNA-vaccine with either BNT162b2 or mRNA-1273. AB measurements were carried out after a median of 91 days after first vaccinations, demonstrating non-response in 12.5% of CKD patients, 12.1% of HD patients, and 50% of KTR. AB titers were significantly higher in CKD patients than in HD patients or KTR. Factors associated with non-response were treated with rituximab in CKD patients, the use of calcineurin inhibitors in HD patients and older age, and the use of BNT162b2, mycophenolic acid, or glucocorticoids and lower hemoglobin levels in KTR. This study contributes to the understanding of the extent and conditions that predispose for non-response in patients with impaired kidney function.
大多数针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的信使核糖核酸（mRNA）疫苗试验未纳入慢性肾脏病（CKD）患者、血液透析（HD）患者或肾移植受者（KTR）。然而，这些患者患重症冠状病毒病2019（COVID-19）及死亡的风险更高。现有文献表明，mRNA疫苗在HD患者和KTR中的疗效降低，而关于CKD患者的数据较少。此外，与无应答相关的因素了解不足且特征不明。我们评估了在接种两剂BNT162b2或mRNA-1273的mRNA疫苗后抗体（AB）应答情况（n = 582，160例CKD患者、206例HD患者、216例KTR）。在首次接种疫苗后中位91天进行AB检测，结果显示12.5%的CKD患者、12.1%的HD患者和50%的KTR无应答。CKD患者的AB滴度显著高于HD患者或KTR。与无应答相关的因素在CKD患者中为使用利妥昔单抗治疗，在HD患者中为使用钙调神经磷酸酶抑制剂及年龄较大，在KTR中为使用BNT162b2、霉酚酸或糖皮质激素及血红蛋白水平较低。本研究有助于了解肾功能受损患者无应答的程度及易患条件。
