Influencers of COVID Vaccine Response in Dialysis Patients

TOPLINE:

Among patients undergoing maintenance dialysis, chronic heart failure and hypoalbuminaemia were significantly associated with a poor humoral response at 3 months after completing three doses of the SARS-CoV-2 messenger RNA (mRNA) vaccine; however, no association was observed between haemodialysis-related variables and antibody response levels.

METHODOLOGY:

• Researchers in France performed a retrospective observational study to identify factors associated with a poor humoral response after completion of the SARS-CoV-2 mRNA vaccination schedule (three doses) in 80 adult patients (median age, 71 years; 44% women) undergoing maintenance dialysis for more than 3 months.
• Anti-SARS-CoV-2 antibody levels were measured using a quantitative serology test at two timepoints: 3 months after the third dose and either 7 months after the third dose or 3 months after the fourth (second booster) dose.
• On the basis of antibody titres at 3 months after the third dose, the patients were classified as low responders (n = 28; anti-SARS-CoV-2 antibody level, 50-1830 AU/mL) and responders (n = 52; anti-SARS-CoV-2 antibody level > 1830 AU/mL).
• Data on laboratory values, dialysis parameters, history of kidney disease, chronic heart failure, and immunosuppressive treatments were extracted from medical records.
• The primary endpoint was the humoral immune response, evaluated using the SARS-CoV-2 antibody level at 3 months after the third dose.

TAKEAWAY:

• Low responders were more likely to have chronic heart failure (P < .00001), worse functional abilities and well-being (P = .004), hypoalbuminaemia (P < .001), lymphopenia (P = .003), rhesus status positivity (P = .02), and no response to a hepatitis B virus vaccine (P = .02) than responders.
• No significant differences were observed between both groups regarding the history of kidney transplantation, use of immunosuppressive therapy, and haemodialysis parameters.
• In multivariate analysis, chronic heart failure (odds ratio [OR], 20.63; P < .0001) and lower serum albumin levels (OR, 0.63; P = .0004) were associated with a poor response to the SARS-CoV-2 mRNA vaccine.
• However, post-vaccination SARS-CoV-2 infection rates did not differ significantly between low responders and responders (P = .59).

IN PRACTICE:

“CHF [chronic heart failure], like CKD [chronic kidney disease], is also an immunocompromised condition, which could explain the reduced vaccine response,” the authors wrote.

“The French government currently recommends administering a SARS-CoV-2 vac­cine booster every six months for immunocompromised patients,” they added.

SOURCE:

This study was led by Pierre Laurent, Department of Nephrology, Dialysis, and Transplantation, University of Picardie Jules Verne, Amiens University Hospital, Amiens, France. It was published online on June 23, 2025, in BMC Nephrology.

LIMITATIONS:

The retrospective, single-centre design of the study introduced potential biases. The small patient population limited the statistical power for group comparisons and restricted the number of variables that could be included in the analysis. Moreover, the study included only patients who received SARS-CoV-2 mRNA vaccines, excluding those who initially received viral-vector-based vaccines.

DISCLOSURES:

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.