SARS-CoV-2 Booster Effect and Waning Immunity in Hemodialysis Patients

Abstract

Background: Dialysis patients are extremely vulnerable to SARS-CoV-2 infection. We recently reported the results of a prospective cohort study measuring serial monthly semi quantitative IgG antibody levels to the SARS-CoV-2 spike protein receptor binding domain in fully vaccinated in-center hemodialysis patients after receiving the BNT162b2 (Pfizer-BioNTech) mRNA vaccination. Methods: Prospective cohort study measuring the serologic response of hemodialysis patients to a booster dose of BNT162b2 vaccine at an average of 2, 6 and 11 weeks post vaccination. Results: Of 35 hemodialysis patients in the original cohort, 27 (77.1%) received a third dose of BNT162b2. Antibody level significantly increased from pre-booster to 2 weeks post-booster (median (25th, 75th percentile) from 59.94 (29.69, 177.8) to 6216 (3806, 11730)), an average increase of 112 fold. Antibody levels dropped to a median of 2654 BAU/mL (1650, 8340) 6 weeks post-booster and to a median of 1444 BAU/mL (1102, 2020) between weeks 6 and 11 post-booster. Antibody levels at 11 weeks remained an average of 40 fold higher than pre-booster levels. Overall, antibody levels declined 47% month to month post-booster. Nine (33%) patients had negative or borderline detectable antibody levels pre-booster and 8 of 9 developed positive (>35.2 BAU/mL) antibody levels post-booster. Those with prior infection had a lower proportional increase in antibody level (51 fold) compared with the median change in COVID naive patients (144 fold) from pre-booster to 2 weeks post-booster. Conclusions: Our data demonstrates that hemodialysis patients obtain a robust humoral response from a third dose of the BNT162b2 vaccine although antibody levels wane over time.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

Funding for this project was provided by the University of Virginia Division of Nephrology / University of Virginia Nephrology Clinical Research Center. No external funding or contributions were provided regarding this work.

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This research proposal was reviewed and approved by the University of Virginia Institutional Review Board for Health Sciences Research (tracking number: HSR 210095)

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Data Availability

Data is not freely available externally. Please contact author if interested in de-identified data set for research purposes

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