• José Jesús Broseta, Diana Rodríguez-Espinosa, Néstor Rodríguez, María Del Mar Mosquera, María Ángeles Marcos, Natalia Egri, Mariona Pascal, Erica Soruco, José Luis Bedini, Beatriu Bayés, and Francisco Maduell.
• Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain. Electronic address: jjbroseta@clinic.cat.
• Am. J. Kidney Dis. 2021 Oct 1; 78 (4): 571-581.

Rationale & ObjectivePatients with kidney failure who are receiving maintenance dialysis have a higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and worse clinical outcomes after coronavirus disease 2019 (COVID-19) than the general population. Therefore, immunization against SARS-CoV-2 with effective vaccines is an important component of health-maintenance strategies for these patients. This study evaluated the humoral and cellular responses to messenger RNA (mRNA) SARS-CoV-2 vaccines in this population.Study DesignObservational prospective multicenter cohort study.Setting & Participants205 patients treated at 3 dialysis units at the Hospital Clínic of Barcelona (Spain) were vaccinated from February 3 to April 4, 2021, and followed until April 23, 2021.ExposureImmunization with either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 mRNA vaccine.OutcomeSeroconversion, defined as the detection of IgG antibodies to the receptor-binding domain of the S1 spike antigen of SARS-CoV-2 (anti-S1-RBD IgG), and the identification of activated CD4+T cells 3 weeks after completing vaccination. Anti-S1-RBD IgG levels were also analyzed as a secondary outcome.Analytical ApproachUnivariate and multivariable logistic and multiple linear regression models were used to evaluate the associations between vaccination and study outcomes.ResultsWe found that 97.7% of 175 vaccinated patients who were seronegative at baseline developed a response (humoral, cellular, or both); 95.4% of these patients seroconverted, while 62% of those tested for cellular immunity had a positive response. Greater age and immunosuppressive treatment were associated with lower antibody levels.LimitationsMandatory vaccine administration by health authorities. Anti-S1-RBD IgG levels were reported up to 150U/mL and cellular immune responses were characterized qualitatively. Antibody assay and cellular response assessment may not be comparable with previously published laboratory approaches.ConclusionsImmunization with mRNA vaccines generated a humoral and cellular immune response in a high proportion of patients with kidney failure receiving maintenance dialysis. These findings as well as the high risk of infection and poor clinical outcomes among these patients make their vaccination a health priority.Copyright © 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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