key: cord-0025978-y1u9j9wd
authors: Einbinder, Yael; Hornik-Lurie, Tzipi; Cohen-Hagai, Keren; Goldman, Shira; Tanasiychuk, Tatiana; Nacasch, Naomi; Erez, Daniel; Magen, Sophie; Zitman-Gal, Tali; Wiener-Well, Yonit; Frajewicki, Victor; Benchetrit, Sydney; Shavit, Linda; Bnaya, Alon
title: Comparison of long-term antibody response to mRNA SARS-CoV-2 vaccine among peritoneal dialysis and hemodialysis patients
date: 2021-11-12
journal: Nephrol Dial Transplant
DOI: 10.1093/ndt/gfab321
sha: 3ce4ac19505ca354bbb2f6f6ca2208614c70c455
doc_id: 25978
cord_uid: y1u9j9wd

nan

Coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality in patients on maintenance hemodialysis (HD) [1] . Vaccination against SARS-CoV-2 is the main priority to prevent COVID-19. Early humoral response among HD patients was lower compared to the general population [2] [3] [4] . Humoral response among peritoneal dialysis (PD) patients was evaluated in small groups, only. Evaluation of late antibody levels was not reported among this population.

This multicenter study assessed antibody levels 6 months after a two-dose regimen of the Pfizer BNT162b2 vaccine in PD compared to HD patients. 

0.261; p<0.001, -0.260, p=0.005 and -0.169, p=0.18, respectively). Antibody titers were assessed across three age groups, <60-years-old (n=34), 60-75-years-old (n=80) and >75-years (n=68).

Two HD patients and no PD patients younger than age 60 had antibody levels <50 AU/ml (5.9%), compared with 17 (21.3%) patients and 18 (26.5%) patients in the 60-75 years-old and >75 years-old, respectively (p=0.05). Antibody levels were not different between HD and PD across the three age groups (Figure 1 ).

This study describes antibody levels against S1 subunit of SARS-CoV-2 among HD and PD demonstrated similar response to the HD population [4] . A report comparing humoral response to whole-virus SARS-CoV-2 vaccination demonstrated a non-significant advantage among HD vs. PD patients [5] . Late antibody response among HD population reported by Nacasch et al., demonstrated antibody levels ≥50 AU/ml in 81% of patients, which correlated with immunosuppressive therapy and age [6] . While serology is commonly used as a surrogate marker of protection from viral infections, the clinical implications of antibody levels and protective threshold against COVID-19 are unknown. Post-vaccination titers were reported to be strongly predictive of immune protection. [7, 8] A real-word study demonstrated correlation between breakthrough infection and low antibody titers one week before infection [9] . However, protective thresholds might vary between age groups and sub-populations.

The strength of this report is the relatively large number of PD participants and its multicenter design, which allowed us to avoid a "center effect". The study assessed late serological response; earlier antibody levels were not available and therefore information regarding the dynamics of antibody titers after vaccination was not available. Other aspects of the immune system, most importantly the cellular response, were not assessed.

In summary, HD and PD patients maintained significant humoral response 6 months after a 2dose regimen of vaccine. No difference between dialysis modalities was documented. Antibody levels correlated with age, so when considering giving a "booster" dose to these populations, the current report indicates prioritizing patients over the age of 60 years.

Research IgG anti-spike is presented as AU/ml units in logarithmic scale.

The urgent need to vaccinate dialysis patients against severe acute respiratory syndrome coronavirus 2: a call to action

Humoral Response to the Pfizer BNT162b2

Vaccine in Patients Undergoing Maintenance Hemodialysis

Humoral Response after SARS-CoV-2

mRNA Vaccination in a Cohort of Hemodialysis Patients and Kidney Transplant Recipients

Antibody response to mRNA SARS-CoV-2 vaccine among dialysis patients -a prospective cohort study

Anti-SARS-CoV-2 spike protein S1 receptor-binding domain antibody to an inactivated whole-virus SARS-CoV-2 vaccination in end-stage kidney disease patients: an initial report

Long-term Antibody Response to the

BNT162b2 Vaccine Among Maintenance Hemodialysis Patients

Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection

Evidence for antibody as a protective correlate for COVID-19 vaccines

Covid-19 Breakthrough Infections in Vaccinated Health Care Workers

SD) 2.06±0.60* 1.298±0

Urine output (ml) 968±607 NA Note: Continuous variables that were not normally distributed were compared using Mann-Whitney U test *Weekly Kt

We thank Faye Schreiber, MS for editing the manuscript. She is an employee of Meir Medical Center. Dr. Pnina Shitrit, Dr. Ilan Rosenberg, Dr. Erez Sarel, and Dr. Ori Wand who contributed to HD data collection, are employees of Meir Medical Center.