Immunogenicity of COVID-19 Vaccination in Patients With End-Stage Renal Disease Undergoing Maintenance Hemodialysis: The Efficacy of a Mix-and-Match Strategy

다국어 초록 (Multilingual Abstract)

Background: The objective of this study was to evaluate the immunogenicity of coronavirus disease 2019 (COVID-19) vaccination in patients with end-stage renal disease (ESRD) on hemodialysis.
Methods: ESRD patients at the hemodialysis center of a tertiary-care university-affiliated hospital and healthy employees at the clinical laboratory center were prospectively recruited between March and June 2021. For severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) antibody analysis, blood samples were collected serially on days 0, 14, 28, and 56 after the first vaccine dose, and on days 7 and 50 after the second dose. Antibodies against the SARS-CoV-2 spike protein were quantified, and SARS-CoV-2 neutralizing antibodies were measured in the serum and plasma.
Results: Thirty-one ESRD patients and 55 healthy employees were regularly monitored.
Twenty-five (80.6%) ESRD patients on hemodialysis received a mix-and-match strategy with ChAdOx1-BNT162b2 (AZ–Pf group) and six (19.4%) received two doses of ChAdOx1 (AZ–AZ group). ESRD patients on hemodialysis showed lower binding antibody titers and neutralizing antibody activities compared to healthy participants following the first vaccination with ChAdOx1. After the second dose, AZ-Pf group had higher immunogenicity than healthy people on days 7 and 50. The binding antibody titer and neutralizing antibody activities on days 7 and 50 were significantly higher in the AZ–Pf group than in the AZ–AZ group.
Conclusion: ESRD patients on hemodialysis receiving the mix-and-match strategy (ChAdOx1–BNT162b2) have COVID-19 vaccine immunogenicity comparable to healthy individuals receiving two doses of ChAdOx1.

참고문헌 (Reference)

1 Kamar N, "Three doses of an mRNA Covid-19 vaccine in solid-organ transplant recipients" 385 (385): 661-662, 2021

2 Dinits-Pensy M, "The use of vaccines in adult patients with renal disease" 46 (46): 997-1011, 2005

3 Alemzadeh E, "The effect of low serum calcium level on the severity and mortality of Covid patients : a systematic review and meta-analysis" 9 (9): 1219-1228, 2021

4 Espi M, "The ROMANOV study found impaired humoral and cellular immune responses to SARS-CoV-2 mRNA vaccine in virus-unexposed patients receiving maintenance hemodialysis" 100 (100): 928-936, 2021

5 Polack FP, "Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine" 383 (383): 2603-2615, 2020

6 Liu Y, "Risk factors for calciphylaxis in Chinese hemodialysis patients : a matched case-control study" 43 (43): 406-416, 2021

7 Jager KJ, "Results from the ERA-EDTA Registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe" 98 (98): 1540-1548, 2020

8 Khoury DS, "Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection" 27 (27): 1205-1211, 2021

9 Carr EJ, "Neutralising antibodies after COVID-19 vaccination in UK haemodialysis patients" 398 (398): 1038-1041, 2021

10 Zhou X, "Low serum calcium: a new, important indicator of COVID-19 patients from mild/moderate to severe/critical" 40 (40): BSR2020269-, 2020

11 Abu Jabal K, "Impact of age, ethnicity, sex and prior infection status on immunogenicity following a single dose of the BNT162b2 mRNA COVID-19 vaccine: real-world evidence from healthcare workers, Israel, December 2020 to January 2021" 26 (26): 2100096-, 2021

12 Stuart ASV, "Immunogenicity, safety, and reactogenicity of heterologous COVID-19 primary vaccination incorporating mRNA, viral-vector, and protein-adjuvant vaccines in the UK(Com-COV2) : a single-blind, randomised, phase 2, non-inferiority trial" 399 (399): 36-49, 2022

13 Di Filippo L, "Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19" 68 (68): 475-478, 2020

14 Pal R, "High prevalence of hypocalcemia in non-severe COVID-19 patients: a retrospective case-control study" 7 : 590805-, 2021

15 Normark J, "Heterologous ChAdOx1 nCoV-19 and mRNA-1273 vaccination" 385 (385): 1049-1051, 2021

16 Yanay NB, "Experience with SARS-CoV-2 BNT162b2 mRNA vaccine in dialysis patients" 99 (99): 1496-1498, 2021

17 Chen N, "Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China : a descriptive study" 395 (395): 507-513, 2020

18 Romiszewski P, "Effects of subclinical inflammation on C-reactive protein and haptoglobin levels as well as specific humoral immunity in dogs vaccinated against canine distemper and parvovirus" 14 (14): 70-, 2018

19 Yan Z, "COVID-19 vaccinations: a comprehensive review of their safety and efficacy in special populations" 9 (9): 1097-, 2021

20 Brosh-Nissimov T, "BNT162b2 vaccine breakthrough : clinical characteristics of 152 fully vaccinated hospitalized COVID-19 patients in Israel" 27 (27): 1652-1657, 2021

21 Dagan N, "BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting" 384 (384): 1412-1423, 2021

22 박준성 ; 김근호 ; 강종명 ; 이창화, "Application of Cystatin C Reduction Ratio to High-Flux Hemodialysis as an Alternative Indicator of the Clearance of Middle Molecules" 대한내과학회 25 (25): 77-81, 2010