Antibody response to mRNA SARS-CoV-2 vaccines in hemodialysis patients

Paal, Michael; Arend, Florian M; Lau, Tobias; Hasmann, Sandra; Soreth-Rieke, Daniela; Sorodoc-Otto, Johanna; Beuthien, Wilke; Krappe, Julia; Toepfer, Marcell; von Gersdorff, Gero; Thaller, Norbert; Rau, Simon; Northoff, Bernd; Teupser, Daniel; Bruegel, Mathias; Fischereder, Michael; Schönermarck, Ulf

BACKGROUND: Some studies have shown an attenuated immune response in hemodialysis patients after vaccination. The present study examines the humoral response after mRNA vaccination against SARS-CoV-2 in a large population of hemodialysis patients from different outpatient dialysis centers. METHODS: We retrospectively assessed antibodies against SARS-CoV-2 spike protein and nucleocapsid protein (chemiluminescence immunoassays, Roche diagnostics) three to six weeks after the second mRNA vaccine dose in 179 maintenance hemodialysis and 70 non-dialysis patients (control cohort). Differences in Anti-SARS CoV-2 spike protein titers were statistically analysed with respect to patient-relevant factors, including age, gender, previous COVID-19 infection, systemic immunosuppressive therapy and time on dialysis. RESULTS: We found a favorable, but profoundly lower SARS-CoV-2 spike protein antibody response in comparison to a non-dialysis cohort (median 253.5 vs. 1756 U/ml, p < 0.001). In multivariate analysis previous COVID-19 infection (p < 0.001) and female gender were associated with a significantly higher vaccine response (p 0.006) in hemodialysis patients, while there was a significant inverse correlation with increasing patient age and systemic immunosuppression (p < 0.001). There was no statistically significant correlation between the antibody titer and time on dialysis. Immune response in hemodialysis patients with a previous COVID-19 infection led to substantially higher antibody titers that were equal to those of vaccinated non-dialysis individuals with previous infection. CONCLUSION: We strongly argue in favor of regular antibody testing after COVID-19 vaccination in hemodialysis patients. Further studies should elucidate the utility of booster vaccinations to foster a stronger and persistent antibody response.