Seroresponse to SARS-CoV-2 vaccines among maintenance dialysis patients

Hsu, C. M.; Weiner, D. E.; Aweh, G. N.; Manley, H. J.; Ladik, V.; Frament, J.; Miskulin, D.; Agyropoulos, C.; Abreo, K.; Chin, A.; Gladish, R.; Salman, L.; Johnson, D.; Lacson, E. K.

Importance: Vaccines against SARS-CoV-2 are highly effective in the general population; however, their efficacy may be diminished in maintenance dialysis patients, a population particularly vulnerable to COVID-19 infection and morbidity. Objective: We assessed vaccine response in a national sample of maintenance dialysis patients and identified predictors of response. Design: Retrospective cohort study Setting: 130 Dialysis Clinic, Inc (DCI) facilities Participants: Maintenance dialysis patients without known prior COVID-19 or a positive baseline antibody titer Exposure(s): Vaccine type and clinical characteristics Main Outcome(s): Using a semi-quantitative assay for antibodies against SARS-CoV-2 spike antigen, vaccine response was defined as at least one titer [≥]1 U/L between 14 and 74 days after completion of a SARS-CoV-2 vaccine series. Regression analysis was used to identify characteristics associated with response. Results: Among 1528 patients, 437 received BNT162b2/Pfizer vaccine, 766 received mRNA-1273/Moderna, and 325 received Ad26.COV2.S/Janssen. Serologic response differed significantly by vaccine type: 381/437 (87%) among BNT162b2/Pfizer recipients, 736/766 (96%) among mRNA-1273/Moderna recipients, and 119/325 (37%) among Ad26.COV2.S/Janssen recipients. Vaccine type, older age, immune-modulating medication, history of transplantation, and lower serum albumin were associated with vaccine non-response. Conclusions and Relevance: Serologic response to mRNA vaccines is robust among maintenance dialysis patients. Future research should evaluate durability of this response, correlation between seroresponse and protection from COVID-19, and the role of the AD26.COV2.S/Janssen vaccine in this vulnerable population.