Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Nephron. 2023;147(3-4):185-192. doi: 10.1159/000525519. Epub 2022 Jul 27.
Hemodialysis patients are at high risk for severe COVID-19 disease. Despite a high early seropositivity rate, dialysis patients mount a dampened immune response following two doses of an mRNA vaccine. This study aimed to evaluate the serologic response to a booster dose of BNT162b2 vaccine, 6 months after the second dose, among hemodialysis patients.
This prospective study included 80 hemodialysis patients and 56 healthcare workers serving as controls. Serologic samples were evaluated before and ∼3 weeks after the third vaccine dose. The primary outcomes were the seropositivity rate and the log-transformed anti-SARS-COV-2 S1 (RBD) IgG as a continuous variable after the third dose. Secondary outcomes were the proportion of participants with "high response," defined as antibody levels >1,000 AU/mL, and "robust response," defined as antibody levels >4,160 AU/mL, according to prespecified cutoff values associated with neutralizing antibodies. Univariate and multivariate analyses were conducted to identify predictors of antibody response.
Among 80 hemodialysis patients, seropositivity rates improved from 78% (62/80) before the third dose, up to 96% (77/80) after the booster dose. The S1-RBD log-transformed antibody level increased significantly following the third dose from 2.15 ± 0.75 to 3.99 ± 0.83 compared with 2.65 ± 0.4 to 4.31 ± 0.42 in the control group. Among the hemodialysis patients, 88% (70/80) became "high responders" (>1,000 AU/mL), and of these, 79% (63/80) mounted a "robust response" (>4,160 AU/mL). Baseline antibody level, dialysis therapy, and hypoalbuminemia were independent predictors of impaired antibody response.
A third dose of BNT162b2 COVID-19 vaccine, 6 months after the standard two-dose vaccination regimen, substantially improved humoral response in hemodialysis patients.
血液透析患者患严重 COVID-19 疾病的风险很高。尽管早期血清阳性率很高，但透析患者在接受两剂 mRNA 疫苗后，免疫反应减弱。本研究旨在评估 BNT162b2 疫苗加强剂量在接受标准两剂疫苗接种方案 6 个月后对血液透析患者的血清学反应。
这项前瞻性研究纳入了 80 名血液透析患者和 56 名医护人员作为对照。在第三次疫苗接种前和大约 3 周后评估血清学样本。主要结局是第三次接种后的血清阳性率和连续变量的抗 SARS-COV-2 S1（RBD）IgG 对数转换值。次要结局是根据与中和抗体相关的预设临界值，定义为抗体水平>1000 AU/mL 的“高反应”比例和定义为抗体水平>4160 AU/mL 的“强反应”比例。进行单变量和多变量分析以确定抗体反应的预测因素。
在 80 名血液透析患者中，第三次接种前的血清阳性率从 78%（62/80）提高到接种后的 96%（77/80）。与对照组相比，第三次接种后 S1-RBD 对数转换抗体水平从 2.15±0.75 显著增加到 3.99±0.83，从 2.65±0.4 增加到 4.31±0.42。在血液透析患者中，88%（70/80）成为“高反应者”（>1000 AU/mL），其中 79%（63/80）产生了“强反应”（>4160 AU/mL）。基线抗体水平、透析治疗和低白蛋白血症是抗体反应受损的独立预测因素。
在接受标准两剂疫苗接种方案 6 个月后，第三次接种 BNT162b2 COVID-19 疫苗可显著改善血液透析患者的体液反应。
