High immunogenicity of a messenger RNA based vaccine against SARS-CoV-2 in chronic dialysis patients

Longlune, Nathalie; Nogier, Marie Béatrice; Miedougé, Marcel; Gabilan, Charlotte; Cartou, Charles; Seigneuric, Bruno; Del Bello, Arnaud; Marion, Olivier; Faguer, Stanislas; Izopet, Jacques; Kamar, Nassim

BACKGROUND: Patients with chronic kidney disease, dialysis patients and kidney-transplant patients are at high risk of developing severe coronavirus disease-19 (COVID-19). Data regarding the immunogenicity of anti-Severe Acute Respiratory Syndrome coronavirus-2 messenger RNA (anti-SARS-CoV-2 mRNA) vaccines in dialysis patients were published recently. We assessed the immunogenicity of anti-SARS-CoV-2 mRNA vaccine in dialysis patients. PATIENTS AND METHODS: One hundred-nine patients on hemodialysis (n = 85) or peritoneal dialysis (n = 24) have received two injections of 30-μg doses of BNT162b2 mRNA COVID-19 Vaccine (Pfizer-BioNTech), that were administered intramuscularly 28 days apart. Those who were still seronegative after the second dose were given a third dose one month later. Anti-SARS-CoV-2 antibodies were tested before and after vaccination. RESULTS: Ninety-one out of the 102 patients who had at least a one-month follow-up after the second (n = 97) or the third (n = 5) vaccine doses had anti-SARS-CoV-2 antibodies. The seroconversion rate was 88.7% (86 out of 97 patients) among SARS-CoV-2 seronegative patients at the initiation of vaccination. Receiving immunosuppressive therapy was an independent predictive factor for non-response to vaccination. CONCLUSION: Due to high immunogenicity and safety of mRNA vaccines, we strongly recommend prioritizing a two-doses vaccination of dialysis patients. A third dose can be required in non-responders to two doses. When possible, patients waiting for a kidney transplantation, should be offered the vaccine before transplantation.