Tsai Wan-Chuan, Chu Fang-Yeh, Chiu Yen-Ling, Wu Hon-Yen, Yang Ju-Yeh, Pai Mei-Fen, Hsu Shih-Ping, Tung Kuei-Tung, Shu Kai-Hsiang, Lin Wan-Yu, Peng Yu-Sen
Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Center for General Education and Department of Applied Cosmetology, Lee-Ming Institute of Technology, New Taipei City, Taiwan.
Hum Vaccin Immunother. 2025 Dec;21(1):2561176. doi: 10.1080/21645515.2025.2561176. Epub 2025 Sep 15.
Patients with end-stage kidney disease (ESKD) undergoing dialysis have impaired vaccine responses. Many countries recommend extended primary series and regular COVID-19 boosters for this group, but data on long-term humoral responses after repeated doses or breakthrough infection are limited. In this prospective cohort study of 498 dialysis patients, most received homologous ChAdOx1 nCoV-19 as a primary series, mRNA-1273 for the third and fourth doses, and bivalent Moderna vaccines for later doses. Neutralizing antibodies (via surrogate virus neutralization test) and anti - receptor-binding domain (RBD) antibodies were measured up to 15 months post-vaccination or infection. The primary endpoint was seroprotection (neutralization inhibition ≥30%); the secondary was anti-RBD seroprotection (≥100 U/mL). Seroprotection increased from 16% (neutralizing) and 2% (anti-RBD) after the first dose to ~100% after the third and subsequent doses. Neutralizing inhibition rose from 5% (dose 1) to ~90% (doses 4-6). Anti-RBD titers declined 66%-85% by 6 months and >90% by 12-15 months. Younger age, receipt of a fourth dose, and vaccine platform were significant predictors of neutralizing titers. Breakthrough infection led to higher and more sustained anti-RBD titers, particularly in patients with hybrid immunity. Patients with stronger immunity had fewer symptoms. In conclusion, serial COVID-19 vaccinations elicited robust humoral responses in dialysis patients, with younger age, receipt of a booster dose, and vaccine platform, emerging as significant predictors. Although antibody titers declined over time, they were better maintained in those with hybrid immunity. These findings support the implementation of personalized booster strategies to optimize protection in immunocompromised populations.
接受透析的终末期肾病（ESKD）患者的疫苗反应受损。许多国家建议为该群体延长初始疫苗接种系列并定期接种新冠病毒加强针，但关于重复接种或突破性感染后的长期体液反应的数据有限。在这项对498名透析患者的前瞻性队列研究中，大多数患者初始接种系列为同源的ChAdOx1 nCoV-19疫苗，第三剂和第四剂接种mRNA-1273疫苗，后续接种二价Moderna疫苗。在接种疫苗或感染后的15个月内，检测中和抗体（通过替代病毒中和试验）和抗受体结合域（RBD）抗体。主要终点是血清保护（中和抑制≥30%）；次要终点是抗RBD血清保护（≥100 U/mL）。血清保护率从第一剂后的16%（中和）和2%（抗RBD）增加到第三剂及后续剂量后的约100%。中和抑制率从5%（第1剂）上升到约90%（第4 - 6剂）。抗RBD滴度在6个月时下降66% - 85%，在12 - 15个月时下降>90%。年龄较小、接种第四剂以及疫苗平台是中和滴度的显著预测因素。突破性感染导致更高且更持久的抗RBD滴度，尤其是在具有混合免疫的患者中。免疫力较强的患者症状较少。总之，系列新冠病毒疫苗接种在透析患者中引发了强烈的体液反应，年龄较小、接种加强针以及疫苗平台成为显著的预测因素。尽管抗体滴度随时间下降，但在具有混合免疫的患者中维持得更好。这些发现支持实施个性化加强策略，以优化对免疫功能低下人群的保护。
