Journal
INFECTIOUS DISEASES AND THERAPY
Volume 11, Issue 1, Pages 351-365Publisher
SPRINGER LONDON LTD
DOI: 10.1007/s40121-021-00574-9
Keywords
COVID-19; Dialysis; Inactivated vaccine; Neutralizing antibody; Receptor-binding domain
Categories
Funding
- National Research Council of Thailand (NRCT)
- Ministry of Higher Education, Science, Research, and Innovation of Thailand
- Department of Medical Services, Ministry of Public Health of Thailand [102912]
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Patients with end-stage kidney disease (ESKD) had suboptimal humoral immune responses but comparable SARS-CoV-2-specific cell-mediated immune responses to healthy controls after two doses of SARS-CoV-2 vaccination. Old age, high ferritin level, and low absolute lymphocyte count were independently associated with poor humoral immune responses.
Introduction Patients with end-stage kidney disease (ESKD) are at risk of severe coronavirus disease and mortality. Immunogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) inactivated whole-virus vaccine in patients with ESKD has never been explored. Methods We conducted a prospective cohort study of 60 patients with ESKD and 30 healthy controls. All participants received two doses of an inactivated whole-virus SARS-CoV-2 vaccine (Sinovac Biotech Ltd) 4 weeks apart. SARS-CoV-2-specific humoral and cell-mediated immune responses were investigated and referenced with healthy controls. Results After two doses, an anti-receptor-binding domain immunoglobulin G of 50 AU/ml or greater was present in 53 of 60 patients (88%) in the ESKD group and all participants (100%) in the control group (P = 0.05). The percentage of patients with ESKD and controls with neutralizing antibodies of 35% threshold or greater was 58% and 88%, respectively (P = 0.01). Furthermore, the proportion of patients with ESKD and S1-specific T cell response was comparable with controls (82% vs. 77%, P = 0.45). Old age, high ferritin level, and low absolute lymphocyte count were independently associated with poor humoral immune responses. Conclusions Patients with ESKD could develop similar SARS-CoV-2-specific cell-mediated immune responses compared to healthy controls, although suboptimal humoral immune responses were observed following two doses of SARS-CoV-2 vaccination. Therefore, patients with ESKD and the abovementioned factors are at risk of generating inadequate humoral immune responses, and a vaccine strategy to elicit greater immunogenicity among these relatively immunocompromised patients is warranted. (Thai Clinical Trials Registry, TCTR20210226002).
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