COVID-19 Vaccine Responses in Patients With CKD

Patients with chronic kidney disease (CKD) are at high risk for serious complications associated with SARS-CoV-2 infections and can benefit from vaccination. Researchers in Uzbekistan, led by Sherzod Abdullaev, conducted a study to examine the effectiveness of available COVID-19 vaccines in patients with CKD. Results of the study were reported at the ERA 60th Congress in a presentation titled Evaluation of Antibody Responses to SARS-CoV-2 Vaccines in Patients With CKD.

The study cohort included 198 consecutive adult patients with CKD in a single center in Uzbekistan. The patients were divided into four cohorts: (1) hemodialysis, n=116; (2) peritoneal dialysis, n=110; (3) kidney transplant recipients, n=22; and (4) nondialysis-dependent CKD (stage 4 and 5, estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m²), n=49. All participants received complete vaccination with any of the available vaccines: Pfizer-BioNTech, Moderna, AstraZeneca, Sputnik V, or ZF-UZ-Vac2001. Antibodies were measured at baseline and on day 28 following the last vaccine dose, and compared between the cohorts. Factors associated with the development of antibodies were analyzed.

In the overall cohort, 55% (n=109) were male and the mean age was 54.3 years. Twenty-five patients (12.6%) received Pfizer-BioNTech vaccine, 42 (21.2%) received Moderna vaccine, 28 (14.1%) received the AstraZeneca vaccine, 36 (18.2%) received Sputnik V vaccine, and 67 (33.9%) received ZF-UZ-VAC2001 vaccine. The distribution of vaccine types differed across the four subgroups.

Of the 198 patients, 155 underwent testing for antibody response at 28 days after the final vaccination dose (97 in the hemodialysis group, 8 in the peritoneal dialysis group, 16 kidney transplant recipients, and 34 in the nondialysis-dependent CKD group). Of those, 137 patients (88%) presented antibody responses, three (2%) were doubtful, and 15 (10%) had a negative result.

Of the patients who did not develop antibody responses, three were in the hemodialysis group (2%), two were in the peritoneal dialysis group (1%), eight were in the kidney transplant recipient group (6%), and two were in the nondialysis-dependent CKD group (1%); P<.01.

Patients who received the Pfizer-BioNTech, Moderna, and AstraZeneca vaccines had higher antibody titers than those who received Sputnik V and ZF-UZ-VAC2001 vaccines (P<.01). The differences were significant across all four cohorts.

Increasing age (P<.01), history of cardiovascular disease (P=.02), and lower eGFR (P<.05) were associated with negative antibody response. There was an association between previous COVID-19 infection and higher antibody titers at 28 days (P<.05). There were no significant associations between antibody response and sex, ethnicity, body mass index, diabetes, or donor type.

In conclusion, the authors said, “Our study has shown a much lower seropositivity rate among the kidney transplant recipients after SARS-CoV-2  vaccine than other cohorts of CKD patients, suggesting that kidney transplant patients require persistent isolation measures and booster doses of a COVID-19 vaccine. Increasing age, history of CKD, and lower eGFR were factors associated with a nonresponse. Potential differences between COVID-19 vaccines should be explored in prospective long-term follow-up studies. These findings complement those of earlier studies and highlight the need for a tailored approach to the vaccination.”

Source: Abdullaev S, Sharapov O, Igamberdieva R. Evaluation of antibody responses to SARS-CoV-2 vaccines in patients with CKD. Presentation #2765. Abstract of a presentation at the European Renal Association 60th Congress; June 15-18, 2023; Milan, Italy.