Assessment of humoral immune response to different COVID-19 vaccines in patients undergoing maintenance hemodialysis

El-Hameed, Ayman Abd; Ahmed, Mohammed Fouad; Ehmemeed, Ali Omar Ahmed; Mokhtar, Ahmad; Abdelhamid, Walid Ahmed Ragab

doi:10.1590/2175-8239-JBN-2022-0184en

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Brazilian Journal of Nephrology

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Original Articles • Braz. J. Nephrol. 45 (4) • Oct-Dec 2023 • https://doi.org/10.1590/2175-8239-JBN-2022-0184en copy

Assessment of humoral immune response to different COVID-19 vaccines in patients undergoing maintenance hemodialysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

The immune response to different Coronavirus Disease 2019 (COVID-19) vaccines is under-investigated in end-stage kidney disease (ESKD) patients, especially in the Middle East and North Africa. We carried out this research to estimate the effectiveness of COVID-19 immunization in ESKD patients on regular hemodialysis (HD).

Methods:

In this prospective observational study, we enrolled 60 ESKD patients on regular HD who had completed COVID-19 vaccination and 30 vaccinated healthy participants. Serum levels of severe acute respiratory syndrome coronavirus 2 immunoglobulin G (SARS-COV2 IgG) were quantified 1 month after completing the vaccination schedule, and all participants were followed up from October 2021 to March 2022. The vaccines used in the study were from Pfizer-BioNTech, AstraZeneca, and Sinopharm.

Results:

The median level of SARS-COV2 IgG was lower in HD patients than in healthy participants (p < 0.001). Regarding the type of COVID-19 vaccination, there was no statistical difference in SARS-COV2 IgG levels among HD patients. During the observation period, none of the HD patients had COVID-19.

Conclusion:

COVID-19 vaccination appeared to be protective in HD patients for 6 months and the side effects of vaccines were tolerable.

Keywords:
SARS-CoV-2; Immunoglobulin G; Renal Dialysis; BNT162 Vaccine; ChAdOx1 nCoV-19

	HD group (n = 60)	Control group (n = 30)	χ²	p-value
Age in years			T
• Mean ± SD	55.2 ± 12.7	51.1 ± 8.5	1.81	0.074
Sex
• Males	37 (61.7%)	14 (46.7%)	1.83	0.178
• Females	23 (38.3%)	16 (53.3%)	1.83	0.178
Smoking	18 (30.0%)	9 (30.0%)	0	1
Obesity	12 (20.0%)	11(36.7%)	2.9	0.087
Duration of HD - median (range) in years	6.5 (0.5-30)	–	–	–
Underlying cause of ESKD		–	–	–
Interstitial nephritis	8 (13.3%)
Polycystic kidney disease	4 (6.7%)
Diabetes Mellitus	17 (28.3%)
Hypertension	22 (36.6%)
Preeclampsia	3 (5.0%)
FSGS	3 (5.0%)
Obstructive uropathy	3 (5.0%)

Variables	HD patients (n = 60) Mean ± SD
kt/v (%)	1.3 ± 0.11
Hemoglobin (gm/dL)	10.3 ± 1.7
WBC (mm³⁾	6.4 ± 2.2
Lymphocytes (mm³⁾	1.7 ± 0.63
Platelets (mm³⁾	242 ± 76.7
Blood Urea Nitrogen (mg/dL)	67.5 ± 14.8
Serum creatinine (mg/dL)	11.1 ± 2.9
Serum sodium (mmol/L)	131.2 ± 2.9
Serum potassium (mmol/L)	4.45 ± 0.61
Serum calcium (mg/dL)	8.7 ± 0.88
Serum phosphorus (mg/dL)	5.02 ± 1.3
Serum uric acid (mg/dL)	6.9 ± 1.3
Serum total proteins (gm/dL)	6.9 ± 0.72
Serum albumin (gm/dL)	3.9 ± 0.55
Serum ferritin (ng/mL)	343.1 ± 366.5
Parathyroid hormone (pg/mL)	454.1 ± 499.9
CRP (mg/L)	8.8 ± 10.9

Variables	HD patients (n = 60)		Control group (n = 30)		χ²	P
Variables	n.	%	n.	%	χ²	P
Fatigue	16	26.7	11	36.7	0.95	0.33
Fever	18	30	12	40	0.9	0.34
Pain	3	5	–	–	f	0.55
Arthralgia	2	3.3	–	–	f	0.99
Headache	1	1.7	1	3.3	f	0.99

Variables	HD patients (n = 60)	Control group (n = 30)	U	P
Age per years
<60	3663 (1035–6558)	10042 (5018–13680)	6.2	0.0001
≥60	1936 (682–4522)	10065 (9978–12216)	2.8	0.005
U	3.4	0.36
P1	0.001	0.89
Sex
Males	2176 (682-6558)	10292.5 (7384–13680)	5.5	0.0001
Females	2734 (987-5697)	9821 (5018–13680)	5.2	0.0001
U	0.11	2
P1	0.91	0.04
Obesity
Obese	2080 (987-4385)	10060 (6178–13680)	4.1	0.0001
Non obese	2728 (682-6558)	10042 (5018–12216)	6.2	0.0001
U	0.81	0.32
P1	0.42	0.75

Variables	Serum SARS-COV2 IgG (AU/mL) among HD patients (n = 60)
Variables	R	P
Age (per year)	–0.510	0.0001^ Correlation is significant at the 0.01 level (2-tailed),
Duration of HD (in years)	–0.291	0.024^* *Correlation is significant at the 0.05 level (2-tailed).
kt/v (%)	+0.726	0.0001^ Correlation is significant at the 0.01 level (2-tailed),
Hemoglobin (gm/dL)	+0.14	0.314
WBC (mm³)	+0.073	0.58
Lymphocytes (mm³)	+0.124	0.345
Platelets (mm³)	+0.033	0.799
Blood urea Nitrogen (mg/dL)	+0.044	0.736
Serum creatinine (mg/dL)	+0.077	0.559
Serum sodium (mmol/L)	–0.215	0.098
Serum potassium (mmol/L)	+0.012	0.925
Serum calcium (mg/dL)	–0.034	0.798
Serum phosphorus (mg/dL)	–0.039	0.766
Serum uric Acid (mg/dL)	–0.045	0.734
Serum total Protein (gm/dL)	+0.123	0.349
Serum albumin (gm/dL)	–0.159	0.224
Serum ferritin (ng/mL)	+0.105	0.425
Parathyroid hormone (pg/mL)	–0.148	0.26
C Reactive Protein (mg/L)	+0.206	0.115

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[1] Correspondence to: Walid Ahmed Ragab Abdelhamid. Email: WAAbdelHamid@medicine.zu.edu.eg