Research Letter

Antibody Response to mRNA-1273 SARS-CoV-2

Vaccine in Hemodialysis Patients with and without
Prior COVID-19
Lili Chan,1,2 Nicholas Fuca,1 Etti Zeldis,1,3 Kirk N. Campbell,1 and Aisha Shaikh,1,3
CJASN 16: 1258–1260, 2021. doi: https://doi.org/10.2215/CJN.04080321
1
Division of
Nephrology, Icahn
School of Medicine at
Patients on maintenance hemodialysis (HD) are highly to their first vaccine dose, and two patients were diag- Mount Sinai, New York,
susceptible to severe acute respiratory syndrome coro- nosed with COVID-19 1 week after the first vaccine New York
2
navirus 2 (SARS-CoV-2) infection (1). Work by us and dose. Patient characteristics by COVID-19 status at the Charles Bronfman
others shows that patients on maintenance HD mount time of first vaccine dose are presented in Figure 1A. Institute of Personalized
Medicine, Icahn School
an antibody (Ab) response following SARS-CoV-2 Prevaccine median anti-N IgG Ab titer was 3.98 of Medicine at Mount
infection, but the Ab titers decline over time (2,3). The (interquartile range [IQR], 0.71–5.05) and anti-RBD Sinai, New York, New
mRNA-1273 SARS-CoV-2 vaccine (Moderna) is IgG titer was 8.35 (IQR, 0.99–18.29) in patients with York
3
directed against the spike protein of SARS-CoV-2 and prior COVID-19. Prevaccine median anti-N IgG Ab Division of
Nephrology, James J.
elicits an Ab response to the receptor binding domain titer was 0.03 (IQR, 0.02–0.05) and anti-RBD IgG titer Peters Veterans Affairs
(RBD) of the spike protein, which has neutralizing was 0.03 (IQR, 0.03–0.05) in patients without prior Medical Center, Bronx,
properties (4). COVID-19. The change in the anti-N IgG Ab titer was New York
We collected data on IgG Ab response to the Mod- not significant at any time point following the vaccine
erna vaccine in patients on maintenance HD in the out- administration, except in two patients who developed Correspondence:
Dr. Aisha Shaikh,
patient dialysis unit at the James J. Peters Veterans COVID-19 1 week after the first vaccine dose.
James J. Peters
Affairs (VA) Center located in New York City. Of 79 eli- In patients with prior COVID-19, the median anti- Veterans Affairs
gible patients, 61 patients received the two-dose Mod- RBD IgG Ab titers were 33.33, 52.65, 51.85, and 56.40 Medical Center, 130
erna vaccine series at the HD unit and were included in at 1, 2, 4, and 5 weeks following the first vaccine dose, West Kingsbridge
the study. Patients with a positive SARS-CoV-2 RNA on respectively. This group received the second vaccine Road, Suite 4B-11,
Bronx, NY 10468.
nasal or nasopharyngeal specimen were diagnosed with at 4 weeks (2860.6 days) after the first vaccine dose, Email: Shaikha3@
coronavirus disease 2019 (COVID-19; Cepheid, Abbot, and the 4-week Ab titer was done immediately before mskcc.org
or Roche SARS-CoV-2 RNA assay). SARS-CoV-2 RNA the second vaccine dose administration (Figure 1B).
tests were performed on patients who presented with The median Anti-RBD IgG Ab titers rose significantly
symptoms suggestive of COVID-19 or as part of routine at 1 week after the first vaccine dose (8.35 versus
surveillance every 2 weeks on all patients on HD. 33.33; P,0.001). Anti-RBD IgG Ab titers at 5 weeks
SARS-CoV-2 IgG Ab test (Abbot IgG Nucleocapsid were significantly higher than at 1 week following the
assay, anti-N IgG, .1.39 considered positive, 100% first vaccine dose (33.33 versus 56.4; P,0.001).
sensitivity, 100% specificity; Beckman Coulter IgG In patients without prior COVID-19, the median
Receptor Binding Domain assay, anti-RBD IgG, $1.0 anti-RBD IgG Ab titers were 0.03, 0.4, 2.18, and 29.91 at
considered positive, 97% sensitivity, 100% specificity) 1, 2, 4, and 5 weeks, respectively. This group received
was performed on patients 4 weeks prior to the first the second vaccine dose at 4 weeks (2963.9 days) after
vaccine dose administration (mean of 2966 days the first vaccine dose, and the 4-week Ab titer was
before vaccine administration) and then serially at 1, 2, done immediately before the second vaccine dose
4, and 5 weeks after the first vaccine dose. Comparison administration. The anti-RBD IgG Ab titer did not
of Ab titers was done using the Wilcoxon rank sum for begin to increase until 4 weeks after the first vaccine
comparison of patients with and without prior dose (0.03 versus 2.18; P,0.001). The median anti-RBD
COVID-19 and the Wilcoxon signed rank test for com- IgG Ab titer rose significantly at 5 weeks after the first
parison of Ab titers across time frames. This project vaccine dose (0.03 versus 29.91; P,0.001) (Figure 1B).
was part of a quality improvement project with Twenty patients had prior COVID-19 before their
approval from the James J. Peters VA Quality Improve- first vaccine dose, and the median time from COVID-19
ment committee and was granted institutional review infection to first vaccine dose administration was 253
board exemption. days (IQR, 38–284 days). There was no correlation
The mean age of the cohort was 70611 years, 95% between days from COVID-19 infection and 1-week
were men, and 85% were Black patients. Twenty of the anti-RBD IgG Ab titer (Pearson correlation of 0.45;
61 patients (31%) were diagnosed with COVID-19 prior P50.05).

1258 Copyright © 2021 by the American Society of Nephrology www.cjasn.org Vol 16 August, 2021
CJASN 16: 1258–1260, August, 2021 SARS-CoV-2 Vaccine Response in Patients on Hemodialysis, Chan et al. 1259

A
COVID-19 Positive (N=20) COVID-19 Negative (N=41)

100% Male, n (%) 93%

Race, n (%)

90% Black 83%

10% White 15%

0% Asian 2%

15% Hispanic, n (%) 22%

Comorbidities, n (%)

75% Diabetes Mellitus 49%

95% Hypertension 100%

55% Coronary Artery Disease 37%

0% Asthma 7%

10% Chronic Obstructive Pulmonary Disease 24%

5% Current smoker 7%

40% Prior smoker 68%

Dialysis Access, n (%)

55% Arteriovenous Fistula 54%

20% Arteriovenous Graft 22%

25% Tunneled Catheter 24%

COVID-19 negative
B
COVID-19 positive

No. of participants 40 19 39 19 39 20 37 19 39 20
100
1st dose 2nd dose
80
Anti-RBD IgG titer

60

40

20

0
Prevaccine Week 1 Week 2 Week 4 Week 5
COVID-19 Status Neg Pos Neg Pos Neg Pos Neg Pos Neg Pos

Median 0.03 8.35 0.03 33.33 0.40 52.65 2.18 51.85 29.91 56.40

IQR 0.03-0.05 0.99-18.29 0.02-0.04 12.58-49.49 0.11-2.69 35.54-60.71 0.50-5.60 43.77-62.07 9.25-40.96 48.23-60.53

Figure 1. | Patient characteristics and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antireceptor binding domain
(anti-RBD) IgG antibody titer following SARS-CoV-2 mRNA-1273 vaccine administration. (A) Butterfly plot of patient characteristics in
patients on hemodialysis who tested positive (Pos) or negative (Neg) for coronavirus disease 2019 (COVID-19) prior to vaccination. (B)
Results of SARS-CoV-2 anti-RBD IgG antibody titer results before and after SARS-CoV -2 mRNA-1273 vaccine administration. “Prevaccine”
antibody titers were measured 4 weeks prior to first vaccine dose administration. Week-1 and week-2 antibody titers were measured 1
and 2 weeks after the first vaccine dose administration, respectively. The second vaccine dose was administered 4 weeks after the first vac-
cine dose, and week-4 antibody titers were done immediately before the second vaccine dose administration. Week-5 antibody titers were
done 1 week after the second vaccine dose administration. IQR, interquartile range.
1260 CJASN

No patient was diagnosed with COVID-19 after 34 days Educational and Communication Committee of the American Soci-
(IQR, 34–35) following the second vaccine dose. Three of 61 ety of Diagnostic and Interventional Nephrology. All remaining
patients (5%) failed to mount an anti-RBD IgG Ab response authors have nothing to disclose.
at 1 week following the second vaccine dose, and one of
these patients was receiving rituximab and prednisone dur- Funding
ing the time of vaccine administration. None of these three None.
patients had prior COVID-19.
In this report, 95% patients on HD mounted an anti-RBD References
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Disclosures Hamburger JZ, Jiang K, Kleiner G, Jurczyszak D, Matthews JC,
K.N. Campbell reports consultancy agreements with Calliditas, Mendez WA, Nabeel I, Mulder LCF, Raskin AJ, Russo KT, Salim-
Goldfinch Bio, Mallinckrodt Pharmaceuticals, Travere, and Vertex; bangon AT, Saksena M, Shin AS, Singh G, Sominsky LA, Stadl-
bauer D, Wajnberg A, Simon V: Antibody responses in
receiving research funding from Goldfinch Bio and Mallinckrodt
seropositive persons after a single dose of SARS-CoV-2 mRNA
Pharmaceuticals; and serving as a scientific advisor or member of vaccine. N Engl J Med 384: 1372–1374, 2021
the Medical Advisory Board, National Kidney Foundation of
Greater New York, Nephcure Foundation. L. Chan reports consul- Received: March 23, 2021 Accepted: April 22, 2021
tancy agreements with Vifor Pharma, Inc.; receiving research fund-
ing from the National Institutes of Health; and receiving honoraria Published online ahead of print. Publication date available at
from Fresenius. A. Shaikh reports serving as a member of the www.cjasn.org.