4.7 Article

A prospective observational study for justification, safety, and efficacy of a third dose of mRNA vaccine in patients receiving maintenance hemodialysis

Journal

KIDNEY INTERNATIONAL
Volume 101, Issue 2, Pages 390-402

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.kint.2021.10.040

Keywords

BNT162b2; COVID-19; hemodialysis; mRNA vaccine; SARS-CoV-2

Funding

  1. Hospices Civils de Lyon (Annee Medaille d'Or)
  2. Institut National de la Sante et de la Recherche Medicale (Poste Accueil)
  3. Societe Francaise de Transplantation
  4. Fondation pour la Recherche Medicale [PME20180639518]
  5. Etablissement Francais du Sang

Ask authors/readers for more resources

The level of protection provided by two doses of COVID-19 mRNA vaccines in patients receiving maintenance hemodialysis (MHD) is uncertain. This study found that vaccination significantly reduced the incidence and severity of COVID-19, but 11% of patients infected after two doses still died. Lack of protection in SARS-CoV-2-naive patients could be due to defective T-cell response and failure to generate sufficient neutralizing antibodies after vaccination. Administering a third dose of vaccine improved protection in low/no responders. High responders did not show an increase in antibodies after the third dose but experienced more side effects. The antibody and T-cell response after two doses can guide personalized administration of the third dose in MHD patients.
The level of protection achieved by the standard two doses of COVID-19 mRNA vaccines in patients receiving maintenance hemodialysis (MHD) remains unclear. To study this we used the French Renal Epidemiology and Information Network (REIN) Registry to compare the incidence and severity of 1474 cases of COVID-19 diagnosed in patients receiving MHD after none, one or two doses of vaccine. Vaccination significantly reduce COVID-19 incidence and severity, but 11% of patients infected after two doses still died. Lack of vaccinal protection in patients naive for SARS-CoV-2 could be due to defective Tfh response [38% of patients with negative spike-specific CD4(+) T-cell interferon gamma release assay] and failure to generate viral neutralizing titers of anti-spike receptor binding domain (RBD) IgGs (63% of patients with titer at or under 997 BAU/ml, defining low/no responders) after two doses of vaccine. To improve protection, a third dose of vaccine was administered to 75 patients [57 low/no responders, 18 high responders after two doses] from the ROMANOV cohort that prospectively enrolled patients receiving MHD vaccinated with BNT162b2 (Pfizer). Tolerance to the third dose was excellent. High responders to two doses did not generate more anti-RBD IgGs after three doses but had more side effects. Importantly, 31 (54%) of low/no responders to two doses reached neutralizing titers of anti-RBD IgGs after three doses. A positive interferon gamma release assay and/or suboptimal titer of anti-RBD IgGs after two doses were the only predictive variables for response to three doses in multivariate analysis. Thus, the standard scheme of vaccination insufficiently protects patients receiving MHD. Anti-RBD IgG and specific CD4(+) T-cell response after two doses can guide personalized administration of the third dose, which improves the humoral response of SARS-CoV-2-naive patients receiving MHD.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.7
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available