Dialysis Patients Mount Best COVID Vax Response After Third Dose

Even people with end-stage renal disease (ESRD) were able to bolster an immune response to the COVID-19 vaccine, researchers reported.

According to a systematic review and meta-analysis of 32 studies, the overall immunogenicity rate for people on dialysis was 86% (95% CI 81-89), noted Chih-Hsiang Chang, MD, of Chang Gung Memorial Hospital in Linkou, Taiwan, and colleagues in JAMA Network Open.

After the first vaccination dose, those on dialysis saw an immune response rate of 41% (95% CI 32-52, I²=87.3%), which subsequently jumped to 89% (95% CI 85-91, I²=66.7%) after the second dose.

Even more promising, dialysis patients were able to get to a 94% (95% CI 86-97, I²=50.1%) immune response rate after receiving a third vaccine dose.

However, dialysis patients still maintained a significantly lower immunogenicity rate than those with ESRD not on dialysis after the first (relative risk [RR] 0.61, 95% CI 0.47-0.79, I²=70.2%) and second doses (RR 0.88, 95% CI 0.82-0.93, I²=72.2%).

“Our findings suggest that in the dialysis population, scheduled, earlier second vaccination, not a delayed second COVID-19 vaccine dose protocol, may be better,” the researchers wrote.

Chang’s group also noted that diabetes seemed to play a large role in mediating vaccine immune response. Specifically, a higher prevalence of diabetes was tied with a lower immune response rate (regression coefficient -0.06, 95% CI -0.10 to -0.02, P=0.004).

Additional, larger studies should focus on the exact inverse relationship between diabetes, ESRD, and nonresponse to vaccination, they suggested, but also pointed out that this has been seen before with hyporesponsiveness after hepatitis B vaccination.

Not surprisingly, ESRD patients who had already been infected with COVID-19 saw a significantly higher post-vaccination immune response rate than those who never had it (96% vs 86%, P=0.02).

As for type of dialysis, there wasn’t a significant difference in immune response for those on hemodialysis compared with peritoneal dialysis (87% vs 94%, P=0.15).

For the systematic review, Chang’s group browsed the PubMed, Embase, and Medline databases for articles published from January 2020 through July 2021. Antibody response rates were obtained from data on neutralizing antibodies, anti-SARS-CoV-2 spike receptor-binding domain proteins, or anti-spike proteins.

For the meta-analysis, data on 4,917 patients were included, spanning across the four vaccines: Pfizer-BioNTech, Moderna, Johnson & Johnson, and AstraZeneca. The majority of the patients had received the Pfizer vaccine. Mean age of patients ranged from 61 to 76 years, and most were on hemodialysis. The mean dialysis vintage ranged from 1.7 to 7 years.

“Further investigations of immune response and side effects of SARS-CoV-2 vaccines in patients receiving dialysis, as well as the benefits and real world clinical efficacy of different vaccine protocols, different types of vaccine, are warranted,” the group concluded, noting that dialysis patients should schedule their second — or third — vaccine dose “without delay.”

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