Short-term antibody response after 1 dose of BNT162b2 vaccine in patients receiving hemodialysis

CMAJ. 2021 May 31;193(22):E793-E800. doi: 10.1503/cmaj.210673. Epub 2021 May 12.


Background: Patients receiving in-centre hemodialysis are at high risk of exposure to SARS-CoV-2 and death if infected. One dose of the BNT162b2 SARS-CoV-2 vaccine is efficacious in the general population, but responses in patients receiving hemodialysis are uncertain.

Methods: We obtained serial plasma from patients receiving hemodialysis and health care worker controls before and after vaccination with 1 dose of the BNT162b2 mRNA vaccine, as well as convalescent plasma from patients receiving hemodialysis who survived COVID-19. We measured anti-receptor binding domain (RBD) immunoglobulin G (IgG) levels and stratified groups by evidence of previous SARS-CoV-2 infection.

Results: Our study included 154 patients receiving hemodialysis (135 without and 19 with previous SARS-CoV-2 infection), 40 controls (20 without and 20 with previous SARS-CoV-2 infection) and convalescent plasma from 16 patients. Among those without previous SARS-CoV-2 infection, anti-RBD IgG was undetectable at 4 weeks in 75 of 131 (57%, 95% confidence interval [CI] 47% to 65%) patients receiving hemodialysis, compared with 1 of 20 (5%, 95% CI 1% to 23%) controls (p < 0.001). No patient with nondetectable levels at 4 weeks developed anti-RBD IgG by 8 weeks. Results were similar in non-immunosuppressed and younger individuals. Three patients receiving hemodialysis developed severe COVID-19 after vaccination. Among those with previous SARS-CoV-2 infection, median anti-RBD IgG levels at 8 weeks in patients receiving hemodialysis were similar to controls at 3 weeks (p = 0.3) and to convalescent plasma (p = 0.8).

Interpretation: A single dose of BNT162b2 vaccine failed to elicit a humoral immune response in most patients receiving hemodialysis without previous SARS-CoV-2 infection, even after prolonged observation. In those with previous SARS-CoV-2 infection, the antibody response was delayed. We advise that patients receiving hemodialysis be prioritized for a second BNT162b2 dose at the recommended 3-week interval.

MeSH terms

  • Adult
  • Antibodies, Viral / biosynthesis
  • Antibodies, Viral / blood*
  • BNT162 Vaccine
  • COVID-19 / immunology
  • COVID-19 Vaccines / immunology*
  • Female
  • Humans
  • Immunoglobulin G / biosynthesis
  • Immunoglobulin G / blood*
  • Immunoglobulin M / biosynthesis
  • Immunoglobulin M / blood
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Renal Dialysis*
  • Risk Factors
  • Spike Glycoprotein, Coronavirus / immunology
  • Time Factors
  • Young Adult


  • Antibodies, Viral
  • COVID-19 Vaccines
  • Immunoglobulin G
  • Immunoglobulin M
  • Spike Glycoprotein, Coronavirus
  • BNT162 Vaccine