SARS-CoV-2 mRNA Vaccine-Induced Cellular and Humoral Immunity in Hemodialysis Patients
Ewa Kwiatkowska,
Krzysztof Safranow,
Iwona Wojciechowska-Koszko,
Paulina Roszkowska,
Violetta Dziedziejko,
Marek Myślak,
Jacek Różański,
Kazimierz Ciechanowski,
Tomasz Stompór,
Jarosław Przybyciński,
Piotr Wiśniewski,
Norbert Kwella,
Sebastian Kwiatkowski,
Tomasz Prystacki,
Wojciech Marcinkowski,
Leszek Domański
Affiliations
Ewa Kwiatkowska
Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
Krzysztof Safranow
Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland
Iwona Wojciechowska-Koszko
Independent Laboratory of Immunological Diagnostics, Department of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
Paulina Roszkowska
Independent Laboratory of Immunological Diagnostics, Department of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
Violetta Dziedziejko
Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland
Marek Myślak
Department of Nephrology and Kidney Transplantation, Provincial Integrated Hospital, Arkońska 4, 71-455 Szczecin, Poland
Jacek Różański
Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
Kazimierz Ciechanowski
Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
Tomasz Stompór
Department of Nephrology, Transplantology and Internal Diseases, University of Warmia and Mazury, 10-719 Olsztyn, Poland
Jarosław Przybyciński
Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
Piotr Wiśniewski
Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
Norbert Kwella
Department of Nephrology, Transplantology and Internal Diseases, University of Warmia and Mazury, 10-719 Olsztyn, Poland
Sebastian Kwiatkowski
Department of Obstetrics and Gynecology, Pomeranian Medical University, 70-111 Szczecin, Poland
Tomasz Prystacki
Fresenius Nephrocare, 60-118 Poznań, Poland
Wojciech Marcinkowski
Fresenius Nephrocare, 60-118 Poznań, Poland
Leszek Domański
Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
Background/Aims: Chronic kidney disease CKD patients on intermittent hemodialysis IHD are exposed to SARS-CoV-2 infection and carry a risk of developing severe symptoms. The aim of this study was to evaluate the humoral and cellular immunity induced by two doses of mRNA vaccines, the Pfizer-BioNTech (Comirnaty) COVID-19 Vaccine and the Moderna (mRNA-1273) COVID-19 vaccine. Patients and methods: The study included 281 patients from five dialysis centers in northern Poland. Within 2 weeks prior to the first dose of the vaccine, a blood sample was collected for an evaluation of SARS-CoV-2 antibodies. Thirty to forty-five days after the second dose of the vaccine, a blood sample was taken to evaluate humoral and cellular response. Results: Patients with stage 5 CKD on IHD were characterized by a considerable SARS-CoV-2 vaccine-induced seroconversion rate. The strongest factors influencing the antibodies AB level after vaccination were a pre-vaccination history of SARS-CoV-2 infection, age, the neutrophil-to-lymphocyte ratio NLR, neutrophil absolute count, and the hemoglobin level. Cellular immunity was higher in patients with a pre-vaccination history of SARS-CoV-2 infection. Cellular immunity depended on the albumin level. Positive cellular response to vaccination was a positive factor reducing all-cause mortality, except for COVID-19 mortality (no such deaths were reported during our follow-up). Cellular immunity and humoral immunity were positively mutually dependent. High levels of albumin and hemoglobin, low neutrophil count, and a reduced NLR, translated into better response to vaccination. Conclusions: Patients with stage 5 CKD on IHD were characterized by a considerable SARS-CoV-2 vaccine-induced seroconversion rate and a good rate of cellular immunity. The factors that change with exacerbating inflammation and malnutrition (albumin, hemoglobin, neutrophil count, the NLR) affected the efficacy of the vaccination.
