key: cord-0831998-rlzx1828
authors: Housset, Pierre; Kubab, Sabah; Hanafi, Latifa; Pardon, Agathe; Vittoz, Nathalie; Bozman, Dogan-Firat; Caudwell, Valérie; Faucon, Anne-Laure
title: Humoral response after a fourth “booster” dose of a Covid-19 vaccine following a 3-dose regimen of mRNA-based vaccination in dialysis patients
date: 2022-04-12
journal: Kidney Int
DOI: 10.1016/j.kint.2022.04.006
sha: f5ba3c7230f669d5c55d76dff7e0d56bd7b1d83c
doc_id: 831998
cord_uid: rlzx1828

nan

Despite an initial satisfactory increase in SARS-CoV-2 anti-spike antibody (Ab) titer after completing a 3-dose regimen in the first set of vaccination in dialysis patients, 1 Ab titer substantially decreases at 6 months in this population. 2 Other authors suggested that for the B.1.1.529 Omicron variant, three vaccine doses might be insufficient in in-centre hemodialysis patients. 3 We assessed the dynamics of the anti-SARS-CoV-2 spike protein S1 total immunoglobulin Ab (Roche Elecsys® immunoassay 4 ) of both hemodialysis (n=17) and peritoneal dialysis (n=28) patients who received a 3-dose regimen of the mRNA BNT162b2 (Pfizer-BioNTech®), followed by a fourth "booster" dose of mRNA vaccine (BNT162b2 n=43, or mRNA-1273 [Moderna®], n=2), after a median of 7.6 [interquartile range, IQR: 7.1;7.8] months after the third dose ( Figure S1 ). Patients with a breakthrough infection (symptomatic or not) before the fourth dose were excluded ( Figure S2 ). Figure 1 , Figure S3 ), which corresponds to a 19fold increase (median) in anti-spike Ab titer. Ab titer after the fourth dose was 3.4 fold higher (median) than the Ab peak reached after the third dose. Dose 4 appeared well tolerated ( Figure S4 ), and no serious adverse event was observed. After the fourth dose, only two patients developed a breakthrough infection (vs. seven cases of Covid-19 after the third dose) (Table S2) .

To conclude, our finding shows that a 3-dose regimen of an mRNA based vaccine with a fourth booster dose appears to produce an important antibody response in dialysis patients, with a significant increase in anti-spike Ab titer. Long-term follow-up studies are needed to assess if this vaccination strategy elicits a durable and robust protective immune response against SARS-CoV-2 in dialysis patients. 

SARS-CoV-2 Antibody Response After a Third Dose of the BNT162b2 Vaccine in Patients Receiving Maintenance Hemodialysis or Peritoneal Dialysis

Waning but persistent humoral response 6 months after the third dose of the mRNA BNT162b2 vaccine in hemodialysis and peritoneal dialysis patients

Omicron neutralising antibodies after COVID-19 vaccination in haemodialysis patients

Development and Validation of the Elecsys Anti-SARS-CoV-2 Immunoassay as a Highly Specific Tool for Determining Past Exposure to SARS-CoV-2

The authors thank patients for their participation to the study.Authors' contributions: research idea and study design: PH, ALF; data acquisition: PH, ALF; anti-spike serology testing: SK; data analysis and interpretation: PH, ALF; statistical analysis: ALF. Each author contributed important intellectual content during manuscript drafting or revision.