Humoral response after the fourth dose of the SARS-CoV-2 vaccine in the CKD spectrum: a prespecified analysis of the SENCOVAC study

• Published in: Nephrology, dialysis, transplantation Vol. 38; no. 4; pp. 969 - 981
• Main Authors: Quiroga, Borja, Soler, María José, Ortiz, Alberto, Jarava Mantecón, Carlos Jesús, Gomes Pérez, Virginia Olinda, Bordils, Antoni, Lacueva, José, Marin Franco, Antonio José, Delgado Conde, Pablo, Muñoz Ramos, Patricia, Calderón González, Carmen, Cazorla López, Juan Manuel, Sanchez-Rodriguez, Jinny, Sánchez Horrillo, Ana, Monzón Vázquez, Tania Raquel, Leyva, Alba, Rojas, José, Gansevoort, Ron T, de Sequera, Patricia
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 31.03.2023
• Subjects: Antibodies, Viral; COVID-19 - prevention & control; COVID-19 Vaccines; Humans; Prospective Studies; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - therapy; SARS-CoV-2; COVID-19; dialysis; kidney transplant; SARS-CoV-2; vaccines; CKD
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfac307

ABSTRACT Background There is scarce evidence on the fourth dose of severe acute respiratory syndrome coronavirus 2 vaccines in chronic kidney disease (CKD) patients. We evaluated the humoral response and effectivity of the fourth dose in the CKD spectrum: non-dialysis CKD (ND-CKD), haemodialysis (HD), peritoneal dialysis (PD) and kidney transplant (KT) recipients. Methods This is a prespecified analysis of the prospective, observational, multicentric SENCOVAC study. In patients with CKD who had received a complete initial vaccination and one or two boosters and had anti-Spike antibody determinations 6 and 12 months after the initial vaccination, we analysed factors associated with persistent negative humoral response and higher anti-Spike antibody titres as well as the efficacy of vaccination on coronavirus disease 2019 (COVID-19) severity. Results Of 2186 patients (18% KT, 8% PD, 69% HD and 5% ND-CKD), 30% had received a fourth dose. The fourth dose increased anti-Spike antibody titres in HD (P = .001) and ND-CKD (P = .014) patients and seroconverted 72% of previously negative patients. Higher anti-Spike antibody titres at 12 months were independently associated with repeated exposure to antigen (fourth dose, previous breakthrough infections), previous anti-Spike antibody titres and not being a KT recipient. Breakthrough COVID-19 was registered in 137 (6%) patients, 5% of whom required admission. Admitted patients had prior titres <620 UI/ml and median values were lower (P = .020) than in non-admitted patients. Conclusions A fourth vaccine dose increased anti-Spike antibody titres or seroconverted many CKD patients, but those with the highest need for a vaccine booster (i.e. those with lower pre-booster antibody titres or KT recipients) derived the least benefit in terms of antibody titres. Admission for breakthrough COVID-19 was associated with low anti-Spike antibody titres. Graphical Abstract Graphical Abstract