Senthilkumaran Guhan, Rajarathinam Vaishanavi D, Govindarajan Srinivasaraman, V S Jibia, Balasubramanian Chelvamalai M, Devaraju Prem K, Murugesan Vinoj, P Shankar, Lamech Tanuj M, Arumugam Venkatesh, Gopalakrishnan Natarajan
Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India.
Radiologist, Anderson Diagnostics and Labs, Chennai, Tamil Nadu, India.
Indian J Nephrol. 2024 Mar-Apr;34(2):129-133. doi: 10.4103/ijn.ijn_7_23. Epub 2023 Aug 4.
COVID-19, caused by SARS-CoV-2, has resulted in significant mortality and morbidity worldwide. Patients of chronic kidney disease who are on maintenance hemodialysis represent a vulnerable population cohort that is susceptible to severe disease. Hence, it is of utmost importance to prioritize vaccination in this population and to assess their response to said vaccination.
This prospective analytical study was conducted at the Institute of Nephrology, Madras Medical College, between August 2021 and February 2022. Patients of chronic kidney disease stage 5 dialysis (CKD5D) who were on maintenance hemodialysis and who consented to receive COVID-19 vaccine were studied. Serum samples were obtained before vaccination, ≥28 days after receiving the first dose of the vaccine, and ≥28 days after receiving the second dose. Antibody titers against the spike protein were estimated using the Roche chemiluminescent immunosorbent assay. Patients were grouped into non-responders/seronegative (<0.8 U/ml) and responders/seropositive (≥0.8 U/ml), with a value ≥250 U/ml considered as robust response.
A total of 96 patients were included. The mean age was 36.70 (±11.53) years and 77.1% of them were male. The median dialysis vintage was 2 (IQR: 0.95-5) years. Twelve patients (9.9%) had a prior COVID-19 infection. Sixty-seven (69.8%) patients had received Covaxin and 29 (30.2%) had received Covishield vaccines. Among the 17 patients who were seronegative at baseline, 4 (23.52%) became seropositive after the first dose of the vaccine, and 11 (64.7%) were seropositive after the second dose, with high titers ("robust response") achieved in two patients (11.76%). No antibody response, despite two doses of the vaccine, was noted in six patients (35.29%).
Our study showed a high baseline seropositivity rate, even prior to vaccination, which indicated a high rate of subclinical COVID infection. Among those who were seronegative at baseline, the seroconversion rate after two doses of Covaxin or Covishield was 64.70%.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）已在全球范围内导致了显著的死亡率和发病率。维持性血液透析的慢性肾脏病患者是易患重症疾病的弱势群体。因此，在这一人群中优先接种疫苗并评估他们对该疫苗的反应至关重要。
这项前瞻性分析研究于2021年8月至2022年2月在马德拉斯医学院肾脏病研究所进行。对接受维持性血液透析且同意接种COVID-19疫苗的5期慢性肾脏病透析（CKD5D）患者进行了研究。在接种疫苗前、接种第一剂疫苗后≥28天以及接种第二剂疫苗后≥28天采集血清样本。使用罗氏化学发光免疫吸附测定法估计针对刺突蛋白的抗体滴度。患者被分为无反应者/血清阴性（<0.8 U/ml）和有反应者/血清阳性（≥0.8 U/ml），抗体滴度≥250 U/ml被视为强反应。
共纳入96例患者。平均年龄为36.70（±11.53）岁，其中77.1%为男性。透析中位时间为2（四分位间距：0.95 - 5）年。12例患者（9.9%）曾有COVID-19感染史。67例（69.8%）患者接种了科维信疫苗，29例（30.2%）接种了科维希尔德疫苗。在17例基线血清阴性的患者中，4例（23.52%）在接种第一剂疫苗后转为血清阳性，11例（64.7%）在接种第二剂疫苗后转为血清阳性，2例患者（11.76%）获得了高滴度（“强反应”）。6例患者（35.29%）尽管接种了两剂疫苗，但未出现抗体反应。
我们的研究显示，即使在接种疫苗之前，基线血清阳性率也很高，这表明亚临床COVID感染率很高。在基线血清阴性的患者中，两剂科维信或科维希尔德疫苗后的血清转化率为64.70%。
