Biedunkiewicz Bogdan, Tylicki Leszek, Ślizień Waldemar, Lichodziejewska-Niemierko Monika, Dąbrowska Małgorzata, Kubanek Alicja, Rodak Sylwia, Polewska Karolina, Tylicki Piotr, Renke Marcin, Dębska-Ślizień Alicja
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland.
NZOZ Diaverum, 81-519 Gdynia, Poland.
Vaccines (Basel). 2022 Mar 11;10(3):433. doi: 10.3390/vaccines10030433.
The aim of this study was to analyze the waning of anti-spike (S) antibodies after mRNA vaccination against COVID-19 in maintenance dialysis patients, and to assess the safety and effectiveness of the complementary third dose. This was a prospective, longitudinal study in which we analyzed the kinetics of antibodies up to six months after a two-dose vaccination (first protocol) in infection-naïve dialysis patients (IN-Ds), previously infected dialysis patients (PI-Ds) and subjects without chronic kidney disease (the controls), as well as their humoral response to the third dose of the same mRNA vaccine (second protocol). The respective reduction in antibody titer after 3 and 6 months by 82.9% and 93.03% in IN-Ds (n = 109), 73.4% and 93.36% in PI-Ds (n = 32) and 75.5% and 88.8% in the controls (n = 20) was demonstrated. Consequently, a protective antibody titer above 141 BAU/mL was found in only 47.7% and 23.8% of IN-Ds after 3 and 6 months, respectively. After the third vaccine dose, a significant increase in antibody titer was observed in all groups, with increases by a factor of ×51.6 in IN-Ds, ×30.1 in the controls and ×8.4 in PI-Ds. The median antibody titer after the third dose differed significantly between groups, and was the highest in PI-Ds: PI-Ds, 9090 (3300−15,000) BAU/mL; the controls, 6945 (2130−11,800); IN-Ds, 3715 (1470−7325) (p < 0.001). In conclusion, we observed similar degrees of antibody waning in all patients. After 3 months, over half of the infection-naïve dialysis patients had a very low antibody titer, and almost twenty percent of them had no antibodies at all. The humoral response to the third dose was very good, raising their titer of antibodies to a higher level than those in the general population who have received the primary two-dose scheme. The results support the administration of a complementary third dose of the mRNA vaccine for dialysis patients as soon as possible.
本研究旨在分析维持性透析患者接种新冠病毒mRNA疫苗后抗刺突（S）抗体的衰减情况，并评估补充第三剂疫苗的安全性和有效性。这是一项前瞻性纵向研究，我们分析了未感染过新冠病毒的透析患者（IN-Ds）、既往感染过新冠病毒的透析患者（PI-Ds）和无慢性肾病的受试者（对照组）在两剂接种（第一方案）后长达六个月的抗体动力学，以及他们对同一mRNA疫苗第三剂的体液反应（第二方案）。结果显示，IN-Ds组（n = 109）在3个月和6个月时抗体滴度分别下降了82.9%和93.03%，PI-Ds组（n = 32）分别下降了73.4%和93.36%，对照组（n = 20）分别下降了75.5%和88.8%。因此，在3个月和6个月后，分别只有47.7%和23.8%的IN-Ds患者的保护性抗体滴度高于141 BAU/mL。在接种第三剂疫苗后，所有组的抗体滴度均显著升高，IN-Ds组升高了51.6倍，对照组升高了30.1倍，PI-Ds组升高了8.4倍。第三剂疫苗接种后的抗体滴度中位数在各组之间存在显著差异，PI-Ds组最高：PI-Ds组为9090（3300−15,000）BAU/mL；对照组为6945（2130−11,800）；IN-Ds组为3715（1470−7325）（p < 0.001）。总之，我们观察到所有患者的抗体衰减程度相似。3个月后，超过一半的未感染过新冠病毒的透析患者抗体滴度极低，其中近20%的患者完全没有抗体。对第三剂疫苗的体液反应非常好，将他们的抗体滴度提高到了高于接受两剂基础接种方案的普通人群的水平。研究结果支持尽快为透析患者接种mRNA疫苗的补充第三剂。
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