Rémi Goupil1, Mehdi Benlarbi1, William Beaubien-Souligny1, Annie-Claire Nadeau-Fredette1, Debashree Chatterjee1, Guillaume Goyette1, Lakshman Gunaratnam1, Caroline Lamarche1, Alexander Tom1, Andrés Finzi1, Rita S Suri2. 1. Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que. 2. Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que. rita.suri@mcgill.ca.
Abstract
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.
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.
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