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作者信息

Quiroga Borja, Soler María José, Ortiz Alberto, Sequera Patricia de

机构信息

IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain.

Nephrology Department, Vall d'Hebrón University Hospital, 08035 Barcelona, Spain.

出版信息

Nefrologia. 2022 Dec 16. doi: 10.1016/j.nefro.2022.12.006.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has negatively impacted on patients of the whole CKD spectrum, causing high rates of morbi-mortality. SARS-CoV-2 vaccines opened a new era, but patients with CKD (including kidney transplant, hemodialysis and peritoneal dialysis) were systematically excluded from pivotal clinical trials. The Spanish Society of Nephrology promoted the multicentric national SENCOVAC study aimed at assessing immunological responses after vaccination in patients with CKD. During the first year after vaccination, patients with non-dialysis CKD and those on hemodialysis and peritoneal dialysis presented good anti-Spike antibody responses to vaccination, especially after receiving the third and fourth doses. However, kidney transplant recipients presented suboptimal responses after any vaccination schedule (initial, third and fourth dose). Especially worrisome is the situation of a patients with a persistently negative humoral response that do not seroconvert after boosters. In this regard, monoclonal antibodies targeting SARS-CoV-2 have been approved for high-risk patients, although they may become obsolete as the viral genome evolves. The present report reviews the current status of SARS-CoV-2 vaccination in the CKD spectrum with emphasis on lessons learned from the SENCOVAC study. Predictors of humoral response, including vaccination schedules and types of vaccines, as well as the integration of vaccines, monoclonal antibodies and antiviral agents are discussed.

摘要

严重急性呼吸综合征冠状病毒2(SARS-CoV-2)对整个慢性肾脏病(CKD)谱系的患者产生了负面影响,导致高病亡率。SARS-CoV-2疫苗开启了一个新时代,但CKD患者(包括肾移植、血液透析和腹膜透析患者)被系统性地排除在关键临床试验之外。西班牙肾脏病学会推动了多中心的全国性SENCOVAC研究,旨在评估CKD患者接种疫苗后的免疫反应。在接种疫苗后的第一年,非透析CKD患者以及血液透析和腹膜透析患者对疫苗接种呈现出良好的抗刺突抗体反应,尤其是在接种第三剂和第四剂后。然而,肾移植受者在任何接种方案(初始、第三剂和第四剂)后反应欠佳。特别令人担忧的是,部分患者体液反应持续呈阴性,在接种加强针后仍未发生血清转化。在这方面,针对SARS-CoV-2的单克隆抗体已被批准用于高危患者,尽管随着病毒基因组的演变它们可能会过时。本报告回顾了CKD谱系中SARS-CoV-2疫苗接种的现状,重点是从SENCOVAC研究中吸取的经验教训。讨论了体液反应的预测因素,包括接种方案和疫苗类型,以及疫苗、单克隆抗体和抗病毒药物的联合应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3a57/9756643/eeb4b0d37539/gr1_lrg.jpg

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