Raja Niranjan, Rajagopalan Arul, Arunachalam Jegan, Prasath Arun, Durai Rakesh, Rajendran Manorajan
Department of Nephrology, Madurai Medical College, Madurai, India.
Kidney Res Clin Pract. 2022 May;41(3):342-350. doi: 10.23876/j.krcp.21.184. Epub 2022 Mar 3.
The coronavirus disease 2019 (COVID-19) vaccine is not readily available in many countries where dosing interval is spaced more than ideal. Patients with chronic kidney disease, especially those on maintenance hemodialysis, have a tendency for a reduced immune response. This study was undertaken to demonstrate the distinct humoral immune response to the viral vector COVID-19 vaccine in patients with kidney failure receiving maintenance hemodialysis.
The study was carried out with two cohorts: 1) patients receiving maintenance hemodialysis and 2) healthcare workers from the same dialysis center as controls, each group with 72 subjects. Participants received a dose of Covishield ChAdOx1 nCoV-19 coronavirus vaccine. The humoral immunological response was determined using electrochemiluminescence immunoassay which quantitatively measures antibodies to the severe acute respiratory syndrome coronavirus 2 spike protein receptor-binding domain.
All study subjects in the control group developed a humoral response (antibody titer of ≥0.8 U/mL), while only 64 of 72 in the dialysis group (88.9%) were responders. Age (ρ = -0.234, p = 0.04) and sodium level (ρ = 0.237, p = 0.04) correlated with low antibody titer in bivariate analysis. In multivariate analysis, only age (odds ratio, 1.10; 95% confidence interval, 1.01-1.22; p = 0.045) was associated with nonresponders.
Our study demonstrated a weak antibody response of hemodialysis patients to the viral vector COVID-19 vaccine. Older age was associated with nonresponders. Evaluation of both humoral and cellular immunity after the second vaccine dose and serial antibody titers can help determine the need for booster shots.
2019冠状病毒病（COVID-19）疫苗在许多国家并不容易获得，这些国家的给药间隔时间比理想间隔更长。慢性肾脏病患者，尤其是接受维持性血液透析的患者，免疫反应往往会降低。本研究旨在证明接受维持性血液透析的肾衰竭患者对病毒载体COVID-19疫苗有明显的体液免疫反应。
本研究分为两个队列进行：1）接受维持性血液透析的患者；2）来自同一透析中心的医护人员作为对照，每组72名受试者。参与者接种一剂Covishield ChAdOx1 nCoV-19冠状病毒疫苗。使用电化学发光免疫分析法测定体液免疫反应，该方法可定量测量针对严重急性呼吸综合征冠状病毒2刺突蛋白受体结合域的抗体。
对照组所有研究对象均产生了体液反应（抗体滴度≥0.8 U/mL），而透析组72人中只有64人（88.9%）有反应。在双变量分析中，年龄（ρ = -0.234，p = 0.04）和钠水平（ρ = 0.237，p = 0.04）与低抗体滴度相关。在多变量分析中，只有年龄（比值比，1.10；95%置信区间，1.01-1.22；p = 0.045）与无反应者相关。
我们的研究表明，血液透析患者对病毒载体COVID-19疫苗的抗体反应较弱。年龄较大与无反应者相关。在接种第二剂疫苗后评估体液免疫和细胞免疫以及连续抗体滴度有助于确定是否需要加强接种。
