key: cord-0803442-l3xyk18o authors: Georgery, Hélène; Devresse, Arnaud; Yombi, Jean-Cyr; Belkhir, Leila; De Greef, Julien; Scohy, Anais; Kanaan, Nada; Kabamba, Benoit; Morelle, Johann; Goffin, Eric title: High response rate to BNT162b2 mRNA COVID-19 vaccine among self-care dialysis patients date: 2021-06-11 journal: Clin Kidney J DOI: 10.1093/ckj/sfab101 sha: 5b47b9347546cc859f2dd99a7a9e778230ad5b61 doc_id: 803442 cord_uid: l3xyk18o nan Coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is particularly life threatening in patients with kidney failure under dialysis [1] [2] [3] , with mortality rate at 28 days of 21.2% in the ERA-EDTA registry [4] and 25% in the ERACODA (European Renal Association COVID-19 Database) database [5] . Vaccination campaigns have started in most countries, with a robust humoural response in up to 90% of patients on haemodialysis (HD), albeit delayed and at rates below those achieved in healthy controls [6] [7] [8] , but higher than in kidney transplant recipients (KTRs) under chronic immunosuppression therapy [7, 9, 10] . Very few data are currently available in patients on selfcare dialysis. This peculiar population is younger-except for older patients on peritoneal dialysis (PD)-with few comorbidities and less likely to be infected with COVID-19 than in-centre HD patients, as they can easily achieve efficient social distancing because of their home therapy. However, a significant proportion of self-care dialysis patients is still given chronic immunosuppression, mostly to avoid acute rejection of a failed kidney graft, raising the question of the effectiveness of the vaccination. We assessed the serological response 28 days after the second dose of the BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) in all adult patients treated in our self-care dialysis unit, with simultaneously two different electro-chemiluminescent immunoassays using a recombinant nucleocapsid (N) antigen and testing for antibodies against the spike protein receptor-binding, with a cut-off index >1.0 and >0.8 U/mL, respectively. Out of 91 patients in the unit, 13 (14%) refused the vaccination because of a fear of adverse events and/or in line with the conspiracy theory, and 12 (13%) received a delayed vaccination because of hesitations, organizational difficulties or current medical complications. Six patients (7%) had a previous documented SARS-CoV-2 infection. Sixty-six (72%) patients [54% males, median age 54 (19-82) years, 6% diabetics] received two doses of BNT162b2 mRNA COVID-19 vaccine between 26 February and 9 April 2021. Twenty-one (32%) were on self-care HD (in a satellite unit) (SC-HD), 30 (45%) on home HD and 15 (23%) on PD, respectively ( Figure 1 ). Ten patients (15%) had antibodies against the N antigen; the six patients with a past SARS-CoV-2 infection and four other patients without previous diagnosis of COVID-19. Sixty-four (97%) vaccinated patients mounted a serological response against the spike protein receptor-binding domain. The response rate is very similar (96%) when considering only the 54 patients without history of COVID-19 and without anti-SARS-CoV-2 N antibody. The total antibody titers were >250 U/mL in 51 (80%) and between 0. cyclosporine as anti-rejection therapy, and a 71-year-old diabetic male, both on PD and older than the patients who mounted a serologic response. The influence of a chronic immunosuppressive therapy prescription at the time of vaccination was evaluated. Fifty (76%) patients were not given any immunosuppressive therapy: 41 (82%) patients mounted an antibody titer >250 U/mL and 8 patients between 0.8 and 250 [median 59.2 (6.4-200. 3)] U/mL, respectively. Sixteen (24%) patients were taking chronic immunosuppressive therapy for various reasons: 10 as a maintenance therapy to avoid acute rejection of a failed kidney transplant, 3 after solid organ (2 liver and 1 heart) transplantation, 1 for multiple myeloma, 1 for systemic lupus erythematosus and 1 as a preventive measure of sclerosing encapsulation peritonitis (Table 1) . Fifteen (94%) of them developed a positive serology 28 days after the second vaccine administration, but with lower titers than patients without any immunosuppressive therapy: 10 (67%) had an antibody titer >250 U/mL and 5 between 0.8 and 250 [median 18.8 (7.8-52.2)] U/mL, respectively. The serological response of patients from our self-care dialysis unit is higher than that of in-centre HD patients [6, 7, 11] , suggesting that older age and comorbidities might detrimentally affect the serological response after vaccination, as observed in other populations [12] . Interestingly, 94% of our self-care dialysis patients still given chronic immunosuppression mounted a satisfactory immunization rate, suggesting that the level of immunosuppression and/or the type of immunosuppressant agents used may influence the serologic response, as already suspected [13] . These encouraging results in the efficacy of SARS-CoV-2 vaccination in our self-care dialysis patients emphasize the importance of promoting vaccination in this population. CKD is a key risk factor for COVID-19 mortality Electronic health record analysis identifies kidney disease as the leading risk factor for hospitalization in confirmed COVID-19 patients Initial effects of COVID-19 on patients with ESKD Results from the ERA-EDTA Registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe ERACODA Collaborators. COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration Antibody response to the BNT162b2 vaccine in maintenance hemodialysis patients Immune response to SARS-CoV-2 infection and vaccination in patients receiving kidney replacement therapy Experience with SARS-CoV-2 BNT162b2 mRNA vaccine in dialysis patients Immunogenicity of a single dose of SARS-CoV-2 messenger RNA vaccine in solid organ transplant recipients Low immunization rates among kidney transplant recipients who received two doses of the mRNA-1273 SARS-CoV-2 vaccine Immunogenicity of SARS-CoV-2 vaccine in dialysis Associations of the BNT162b2 COVID-19 vaccine effectiveness with patient age and comorbidities Safety and immunogenicity of one versus two doses of the COVID-19 vaccine BNT162b2 for patients with cancer: interim analysis of a prospective observational study To the team of the self-care dialysis unit at Cliniques universitaires Saint-Luc for their involvement in the care of the patients. None declared.