Department of Nephrology and Dialysis, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia.
Surgical Department of Transplantology and Dialysis, Moscow Regional Research and Clinical Institute ("MONIKI"), Moscow, Russia.
Ren Fail. 2022 Dec;44(1):392-398. doi: 10.1080/0886022X.2022.2042310.
Patients with end-stage kidney disease receiving maintenance hemodialysis (HD) are at increased risk for mortality after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared with the general population. However, it is currently unknown whether the long-term SARS-CoV-2 humoral and cellular immune responses in patients receiving HD are comparable to individuals with normal kidney function.
The prospective cohort study included 24 patients treated with maintenance HD and 27 non-renal controls with confirmed history of coronavirus disease (COVID-19). In all participants the levels of specific IgG were quantified at three timepoints: 10, 18, and 26 weeks from disease onset. In a subgroup of patients, specific T-cell responses were evaluated.
The seropositivity rate declined in controls over time and was 85% and 70.4% at weeks 18 and 26, respectively. All HD patients remained seropositive over the study period. Seropositivity rate at week 26 was greater among patients receiving HD: RR = 1.4 [95%CI: 1.17-1.94] (reciprocal of RR = 0.7 [95% CI: 0.52-0.86]), = 0.0064. In both groups, IgG levels decreased from week 10 to week 26, but antibodies vanished more rapidly in controls than in HD group (ANOVA = 0.0012). The magnitude of T-cell response was significantly lower in controls than in HD patients at weeks 10 ( = 0.019) and 26 ( = 0.0098) after COVID-19 diagnosis, but not at week 18.
Compared with non-renal adults, patients receiving HD maintain significant long-term humoral and cellular immune responses following natural COVID-19.
与普通人群相比，接受维持性血液透析（HD）的终末期肾病患者在感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）后死亡风险增加。然而，目前尚不清楚接受 HD 治疗的患者的 SARS-CoV-2 体液和细胞免疫反应是否与肾功能正常的个体相当。
这项前瞻性队列研究纳入了 24 名接受维持性 HD 治疗的患者和 27 名有明确冠状病毒疾病（COVID-19）病史的非肾脏对照者。在所有参与者中，在疾病发作后 10、18 和 26 周三个时间点量化了特异性 IgG 水平。在患者亚组中评估了特异性 T 细胞反应。
对照组的血清阳性率随时间推移而下降，分别在第 18 和 26 周时为 85%和 70.4%。所有 HD 患者在整个研究期间均保持血清阳性。第 26 周时 HD 患者的血清阳性率更高：RR=1.4[95%CI：1.17-1.94]（倒数 RR=0.7[95%CI：0.52-0.86]），P=0.0064。在两组中，IgG 水平从第 10 周下降到第 26 周，但在对照组中抗体消失速度快于 HD 组（方差分析 P=0.0012）。与 HD 患者相比，对照组在 COVID-19 诊断后第 10 周（P=0.019）和第 26 周（P=0.0098）时的 T 细胞反应幅度明显较低，但在第 18 周时则不然。
与非肾脏成人相比，接受 HD 治疗的患者在自然感染 COVID-19 后可长期保持显著的体液和细胞免疫反应。
