Impaired immune response to SARS-CoV-2 vaccination in dialysis patients and in kidney transplant recipients

Background: Kidney failure patients on dialysis or after renal transplantation have a high risk for severe COVID-19 infection and vaccination against SARS-CoV-2 is the only expedient prophylaxis. Generally, immune responses are attenuated in kidney failure patients, however, systematic analyses of immune responses to SARS-CoV-2 vaccination in dialysis patients and in kidney transplant recipients (KTR) are still missing. Methods: In this prospective multicentric cohort study, antibody responses COVID-19 mRNA vaccines (BNT162b2; Biontech/Pfizer or mRNA-1273; Moderna) were measured in 32 dialysis patients and in 28 KTRs. SARS-CoV-2-specific antibodies and neutralization capacity were evaluated and compared to controls (n=78) in a similar age-range. Results: After the first vaccination, SARS-CoV-2-specific antibodies were nearly undetectable in kidney failure patients. After the second vaccination, 93% of the controls and 88% of dialysis patients but only 37% of KTRs developed SARS-CoV-2-specific IgG above cut-off. Moreover, mean IgG levels were significantly lower in KTRs (54±93 BAU/ml) compared to dialysis patients (503±481 BAU/ml, p<0.01). Both KTRs as well as dialysis patients had significantly lower IgG levels compared to controls (1992±2485 BAU/ml; p<0.001 and p<0.01). Importantly, compared to controls, neutralizing antibody titers were significantly lower in KTRs and dialysis patients. After the second vaccination, 76% of KTRs did not show any neutralization capacity against SARS-CoV-2 suggesting impaired seroprotection. Conclusions: Kidney failure patients show a significantly weaker antibody response compared to controls. Most strikingly, only one out four KTRs developed neutralizing antibodies against SARS-CoV-2 after two doses of vaccine. These data suggest that vaccination strategies need modification in immune transplant and dialysis patients.

Download Full-text

Renin-Angiotensin System Blockers and the Risk of COVID-19-Related Mortality in Patients with Kidney Failure

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.18961220 ◽

2021 ◽

pp. CJN.18961220

Author(s):

Maria Jose Soler ◽

Marlies Noordzij ◽

Daniel Abramowicz ◽

Gabriel de Arriba ◽

Carlo Basile ◽

...

Keyword(s):

Kidney Transplant ◽

Mortality Risk ◽

Kidney Failure ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Transplant Recipients ◽

Angiotensin Ii Receptor ◽

Kidney Transplant Recipients ◽

Dialysis Patients ◽

Converting Enzyme Inhibitors

Background: There is concern about potential deleterious effects of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) in patients with COVID-19. Patients with kidney failure, who often use ACEi/ARB, are at higher risk of more severe COVID-19. However, there are no data available on the association of ACEi/ARB use with COVID-19 severity in this population. Methods: Data were retrieved from the ERACODA database of kidney transplant and dialysis patients affected by COVID-19, between February 1 and October 1 2020, and had information on 28-day mortality. Cox proportional-hazards regression was used to calculate hazard ratios (HRs) for the relation between ACEi/ARB use and 28-day mortality risk. Additionally, we studied the association of ACEi/ARB discontinuation with 28-day mortality. Results: We evaluated 1,511 patients, 459 kidney transplant recipients and 1,052 dialysis patients. At COVID-19 diagnosis, 189 (41%) of the transplant and 288 (27%) of the dialysis patients were on ACEi/ARB. In transplant, 88 (19%) and in dialysis patients 244 (23%) died within 28 days of initial presentation. In transplant and dialysis patients, there was no association between ACEi/ARB use and 28-day mortality in both crude and adjusted models (adjusted HR=1.12, 95%CI: 0.69-1.83 in transplant; 1.04, 95%CI: 0.73-1.47 in dialysis patients). Among transplant recipients, ACEi/ARB discontinuation was associated with higher mortality risk after adjustment for demographics and comorbidities, but the association was no longer statistically significant after adjustment for COVID-19 severity (adjusted HR=1.36, 95%CI: 0.40-4.58). Among dialysis patients, ACEi/ARB discontinuation was not associated with mortality in any model. Similar results were obtained across subgroups when ACEi and ARB were studied separately and when other outcomes for COVID-19 severity were studied e.g., hospital admission, intensive care unit admission or need for ventilator support. Conclusions: Amongst kidney transplant and dialysis patients with COVID-19, there was no significant association of ACEi/ARB use or ACEi/ARB discontinuation with mortality.

Download Full-text