Longevity of Humoral Response Six Months Following BNT162b2 Vaccine in Dialysis Patients

Timna Agur; Naomi Ben-Dor; Michal Herman-Edelstein; Tali Steinmetz; Shelly Lichtenberg; Shira Schneider; Dafna Yahav; Benaya Rozen-Zvi; Boris Zingerman

doi:10.3389/fmed.2022.781888

Longevity of Humoral Response Six Months Following BNT162b2 Vaccine in Dialysis Patients

Front Med (Lausanne). 2022 Mar 25:9:781888. doi: 10.3389/fmed.2022.781888. eCollection 2022.

Authors

Timna Agur^{1

2}, Naomi Ben-Dor^{1

2}, Michal Herman-Edelstein^{1

2}, Tali Steinmetz^{1

2}, Shelly Lichtenberg^{1

2}, Shira Schneider^{1

2}, Dafna Yahav^{2

3}, Benaya Rozen-Zvi^{1

2}, Boris Zingerman^{1

2}

Affiliations

¹ Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel.
² Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Infectious Diseases Unit, Rabin Medical Center, Petah Tikva, Israel.

Abstract

Background: End-stage kidney disease substantially increases the risk of severe COVID-19. However, despite early robust immunogenicity of the mRNA-SARS-CoV-2 vaccination in patients with hemodialysis, the longevity of humoral response in this high-risk population is still unknown.

Methods: A prospective cohort study aimed to evaluate the longevity of serologic response in patients with hemodialysis, compared with a control group, 6 months following the second dose of the BNT162b2 vaccine. We assessed antibody response by quantitative measurement of IgG antibodies against the receptor-binding domain of the Spike protein (anti-S1-RBD IgG). Study outcomes were defined as a seropositivity rate and log-transformed anti-S1-RBD IgG levels at 6 months, and the change in antibody levels between 3 and 6 months.

Findings: The cohort included 104 patients with hemodialysis and 84 controls. At a median time of 184 days (IQR, 183-188) following the second dose of the vaccine, 83/104 (79.8%) patients with hemodialysis maintained seropositivity for the anti-S1-RBD IgG level compared to 83/84 (98.8%) in the control group (p < 0.001). The log-transformed antibody level was significantly lower in the hemodialysis group (2.23 ± 0.39 log AU/ml vs. 2.69 ± 0.65 log AU/ml, respectively, p < 0.001). Older age and hypoalbuminemia were the only variables that were found to be associated with reduced log-transformed antibody levels in univariate and multivariate analysis. There was no interaction between dialysis status and an antibody-level decline rate (p = 0.972).

Conclusion: Among patients with hemodialysis, a seropositivity rate and anti-S1-RBD antibody titers were substantially reduced compared with a control group, at 6 months following the second dose of the BNT162b2 vaccine. These findings support the prioritization of patients with hemodialysis for a third "booster" dose.

Keywords: BNT162b2; COVID-19; SARS-COV-2; anti-spike antibody; hemodialysis.