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Goupil and colleagues do not report any relevant financial information. Healio Primary Care was unable to confirm the relevant financial information from Anand and colleagues at the time of publication.
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Despite a weakened immunity, patients on dialysis maintained the IgG antibody levels of the receptor binding domain for at least 6 months after a SARS-CoV-2 infection, according to a sample of US dialysis facilities.
A second study from Canada showed that a dose of the Pfizer / BioNTech vaccine “did not induce a humoral immune response” even after “prolonged observation” in most dialysis recipients without prior SARS-CoV-2 infection. This study also showed a delayed response in patients with previous SARS-CoV-2 infection.
“Really a benchmark”
In the first study Shuchi Anand, MD, MS, The director of the Center for Tubulointerstitial Kidney Disease at Stanford University and colleagues prospectively examined the plasma of 2,215 dialysis recipients who tested positive for SARS-CoV-2 antibodies in July 2020 to determine the persistence of the SARS-CoV-2 receptor binding domain (RBD ) to evaluate) IgG over 6 months.
“At present, this type of work is really a measure of vaccination response assessment to help clinicians, for example, in relation to a person with a natural infection, decide what protection their patient may have received after vaccination.” Anand told Healio Primary Care.
Anand and colleagues reported in Annals of Internal Medicine that 93% of patients had an assay-detectable reaction (IgG index value 1) during the 6-month follow-up period. Of the 1,323 (60%) participants who had high index values (IgG 10) in July 2020, 76% continued to have high index values in December 2020.
Overall, the researchers found a “slow and steady decline” in adjusted median patient index values, which began at 21 on July 21, 2020 and was 13 in December 2020 (P <0.001). A patient's age, gender, race / ethnicity, and diabetes status did not affect the response pathway. Patients who had no detectable response to the assay were usually white, 18 to 44 years old, or 80 years old and older, and were less likely to have diabetes and hypoalbuminemia.
Anand said the research team was “surprised to see that most patients received antibodies after a natural infection”.
“One reason we were finding could be that although this population has comorbidities, we are investigating them after they have been exposed to SARS-CoV-2 and survived the infection. So your health is better than that of the sickest patients on dialysis, ”said Anand. “Another reason could be that there is data to suggest that people with symptomatic or severe infection have a more intense antibody response.”
The researchers are currently studying the response of dialysis recipients to the COVID-19 vaccination.
“We hope to see a measurable antibody response to SARS-CoV-2 in a majority of dialysis patients, which would mean our population is at lower risk of death or other complications from COVID-19,” Anand said. “This would be a fantastic public health achievement as dialysis patients are among the fatalities when hospitalized with COVID-19.”
The effectiveness of the vaccine is “uncertain” for dialysis recipients
In the second study Remi Goupil, MD, MSc, A nephrologist at the Hôpital du Sacré-Coeur de Montréal in Canada and colleagues reported that the effectiveness of the Pfizer / BioNTech vaccine in patients on hemodialysis “remains uncertain”.
The researchers analyzed serial plasma from 154 dialysis recipients (135 had no previous SARS-CoV-2 infection) and 40 healthcare controls (half had no previous SARS-CoV-2 infection) before and after their first dose of the Pfizer / BioNTech COVID-19 vaccine. They also evaluated convalescent plasma from 16 dialysis recipients who survived COVID-19.
“We wanted to find out whether there were short-term antibody reactions after a single dose of the [Pfizer-BioNTech] mRNA vaccines are comparable between patients receiving hemodialysis and healthy individuals, and how this compares to antibody responses in patients receiving hemodialysis and surviving a natural infection with SARS-CoV-2, ”wrote Goupil and colleagues in Canadian Medical Association Journal.
The researchers reported that in patients without prior SARS-CoV-2 infection, 57% (95% CI, 47-65) of dialysis recipients and 5% (95% CI, 1-) did not see anti-RBD IgG levels were 23) of controls. None of the patients with undetectable anti-RBD levels by week 4 had detectable levels by week 8. The results were similar in non-immunocompromised and younger people, according to Goupil and colleagues.
Among those with previous SARS-CoV-2 infection, mean anti-RBD IgG levels at week 8 in dialysis recipients were comparable to controls at week 3 (P = 0.3) and convalescent plasma from dialysis recipients who developed COVID -19 recovered (P = 0.8).
Based on their findings, the researchers recommended that recipients on dialysis for the second dose of the Pfizer / BioNtech vaccine be given priority within the recommended 3-week interval that is known to be effective. ”
References:
Anand S. et al. Ann Intern Med. 2021; doi: 10.7326 / M21-0256.
Goupil R et al. CMAJ. 2021; doi: 10.1503 / cmaj.210673.
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Paul Komenda, MD, FRCPC, MHA
The limitations of the study by Anand and colleagues were lack of correlation with symptomatic infections, and because of the timing of the study, not much can be inferred about protection from re-infection with escape variants that are more common today. However, the results may provide some indication of the shelf life of protective antibodies after 6 months against wild-type infections in a population that tends to be older and have higher comorbidities.
In the second study, Goupil and colleagues wrote that a single dose of the Pfizer / BioNTech vaccine in dialysis patients is unlikely to provide antibody-mediated protection. Due to the vulnerability of this population, they should be prioritized in order to receive a second dose of vaccine and further studies of the reactivity and durability of this vaccine in this population with mitigation strategies to protect these patients in the interim are needed.
Paul Komenda, MD, FRCPC, MHA
Chief Medical Officer of Quanta Dialysis Technologies
Associate Professor of Medicine at the University of Manitoba
Medical Director, Home Dialysis Program, Seven Oaks General Hospital
Disclosure: Komenda does not report any relevant financial information.
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