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Clinical efficacy of the fourth dose of the BNT162b2 vaccine in maintenance dialysis patients   

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Abstract

Background and objectives

Highly effective vaccines against severe acute respiratory syndrome virus 2 have been developed and administered worldwide. However, protection from coronavirus disease 2019 is not absolute and an optimal vaccination regimen needs to be established. This study assessed the clinical efficacy of the coronavirus disease 2019 vaccine among dialysis patients receiving 3 or 4 doses of vaccine.

Design, setting, participants, and measurements

This retrospective study was conducted using the electronic database of Clalit Health Maintenance Organization in Israel. Chronic dialysis patients treated with either hemodialysis or peritoneal dialysis during the coronavirus disease 2019 pandemic were included. We compared clinical outcomes of patients who had received three or four doses of the severe acute respiratory syndrome virus 2 vaccine.

Results

This study included 1,030 patients on chronic dialysis, with a mean age of 68 ± 13 years. Among them, 502 patients had received 3 doses of the vaccine and 528 received 4 doses. Severe acute respiratory syndrome virus 2 infection rates, severe COVID-19 that resulted in hospitalizations, COVID-19–related mortality and all-cause mortality rates were lower among chronic dialysis patients who received a fourth dose of vaccine as compared to those who received only 3 doses (after controlling for age, sex and comorbidities). Despite lower mortality rates observed with the Omicron variant, the fourth dose was significantly associated with reduced COVID-19-related mortality (1.7% vs. 3.8%, p = 0.04). Odds ratio for COVID-19-related mortality was 0.44 with 95% CI 0.2–0.98.

Conclusions

As seen in the general population and with previous vaccine boosters, the fourth dose of the BNT162b2 vaccine reduced rates of severe COVID-19-related hospitalization and mortality among chronic dialysis patients. Further studies are needed to establish the optimal regimens of vaccination for patients on chronic dialysis.

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References

  1. Hsu CM, Weiner DE, Aweh G et al (2021) COVID-19 among US dialysis patients: risk factors and outcomes from a national dialysis provider. Am J Kidney Dis. https://doi.org/10.1053/j.ajkd.2021.01.003

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hilbrands LB, Duivenvoorden R, Vart P et al (2020) Erratum: COVID-19–related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration. Nephrol Dial Transplant 35(11):1973–1983. https://doi.org/10.1093/ndt/gfaa261

    Article  CAS  PubMed  Google Scholar 

  3. Wand O, Nacasch N, Fadeela A et al (2022) Humoral response and breakthrough infections with SARS-CoV-2 B.1.617.2 variant in vaccinated maintenance hemodialysis patients. J Nephrol 35(5):1479–1487. https://doi.org/10.1007/s40620-022-01245-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Nacasch N, Cohen-Hagai K, Tayar N et al (2022) Humoral response to hepatitis B and COVID-19 vaccine among maintenance hemodialysis patients. Vaccines (Basel). https://doi.org/10.3390/vaccines10101670

    Article  PubMed  Google Scholar 

  5. Grupper A, Sharon N, Finn T et al (2021) Humoral response to the pfizer bnt162b2 vaccine in patients undergoing maintenance hemodialysis. Clin J Am Soc Nephrol 16:1037–1042. https://doi.org/10.2215/CJN.03500321

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Nacasch N, Erez D, Lishner M et al (2022) Long-term antibody response to the BNT162b2 vaccine among maintenance hemodialysis patients. Am J Kidney Dis 79(1):137–139

    Article  CAS  PubMed  Google Scholar 

  7. Shashar M, Nacasch N, Grupper A et al (2022) Humoral response to Pfizer BNT162b2 vaccine booster in maintenance hemodialysis patients. Am J Nephrol. https://doi.org/10.1159/000521676

    Article  PubMed  Google Scholar 

  8. Bar-On YM, Goldberg Y, Mandel M et al (2022) Protection by a fourth dose of BNT162b2 against Omicron in Israel. N Engl J Med. https://doi.org/10.1056/nejmoa2201570

    Article  PubMed  PubMed Central  Google Scholar 

  9. Magen O, Waxman JG, Makov-Assif M et al (2022) Fourth dose of BNT162b2 mRNA Covid-19 vaccine in a nationwide setting. N Engl J Med. https://doi.org/10.1056/NEJMOA2201688/SUPPL_FILE/NEJMOA2201688_DISCLOSURES.PDF

    Article  PubMed  PubMed Central  Google Scholar 

  10. Einbinder Y, Perl J, Nacasch N et al (2022) Humoral response and SARS-CoV-2 infection risk following the third and fourth doses of the BNT162b2 vaccine in dialysis patients. Am J Nephrol 53:586–590. https://doi.org/10.1159/000525309

    Article  CAS  PubMed  Google Scholar 

  11. Housset P, Kubab S, Hanafi L et al (2022) Humoral response after a fourth “booster” dose of a Coronavirus disease 2019 vaccine following a 3-dose regimen of mRNA-based vaccination in dialysis patients. Kidney Int 101:1289–1290. https://doi.org/10.1016/J.KINT.2022.04.006

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. COVID-19 Treatment guidelines. https://www.covid19treatmentguidelines.nih.gov/. Accessed 27 Nov 2022

  13. Goldberg Y, Mandel M, Bar-On YM et al (2021) Waning immunity after the BNT162b2 vaccine in Israel. N Engl J Med. https://doi.org/10.1056/NEJMOA2114228

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chemaitelly H, Tang P, Hasan MR et al (2021) Waning of BNT162b2 vaccine protection against SARS-CoV-2 infection in Qatar. medRxiv. https://doi.org/10.1101/2021.08.25.21262584

    Article  Google Scholar 

  15. Syed AM, Ciling A, Taha TY et al (2022) Omicron mutations enhance infectivity and reduce antibody neutralization of SARS-CoV-2 virus-like particles. Proc Natl Acad Sci U S A. https://doi.org/10.1073/pnas.2200592119

    Article  PubMed  PubMed Central  Google Scholar 

  16. Callaway E (2022) Why does the Omicron sub-variant spread faster than the original? Nature. https://doi.org/10.1038/d41586-022-00471-2

    Article  PubMed  PubMed Central  Google Scholar 

  17. Panizo N, Albert E, Giménez-Civera E et al (2022) Dynamics of SARS-CoV-2-Spike-reactive antibody and T-cell responses in chronic kidney disease patients within 3 months after COVID-19 full vaccination. Clin Kidney J 15:1562–1573. https://doi.org/10.1093/CKJ/SFAC093

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Barh D, Tiwari S, Rodrigues Gomes LG et al (2022) SARS-CoV-2 variants show a gradual declining pathogenicity and pro-inflammatory cytokine stimulation, an increasing antigenic and anti-inflammatory cytokine induction, and rising structural protein instability: a minimal number genome-based approach. Inflammation. https://doi.org/10.1007/S10753-022-01734-W

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Faye Schreiber, MS for editing the manuscript. She is an employee of Meir Medical Center.

Funding

This article did not receive any financial support.

Author information

Authors and Affiliations

  1. Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel

    Keren Cohen-Hagai, Sydney Benchetrit, Naomi Nacasch & Yael Einbinder

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Keren Cohen-Hagai, Sydney Benchetrit, Naomi Nacasch, Ayelet Grupper & Yael Einbinder

  3. Data Research Department, Meir Medical Center, Kfar Saba, Israel

    Tzipi Hornik-Lurie

  4. Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Ayelet Grupper

  5. Department of Pulmonology, Barzilai University Medical Center, Ashkelon, Israel

    Ori Wand

  6. Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel

    Ori Wand

  7. Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel

    Moshe Shashar

  8. Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA

    Moshe Shashar

Authors
  1. Keren Cohen-Hagai
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  2. Tzipi Hornik-Lurie
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  3. Sydney Benchetrit
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  4. Naomi Nacasch
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  5. Ayelet Grupper
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  6. Yael Einbinder
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  7. Ori Wand
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  8. Moshe Shashar
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Contributions

Research area and study design: KC-H, TH-L, SB, MS; Data acquisition: NN, SB, KC-H; Data analysis and interpretation: KC-H, TH-L, YE, AG, SB, KC-H; Statistical analysis: KC-H, TH-L; Supervision or mentorship: OW, SB, KC-H, MS. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual’s own contributions.

Corresponding author

Correspondence to Moshe Shashar.

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Conflict of interest

The authors have no financial or other conflicts of interest to declare.

Ethical approval

The study was approved by the Ethics Committee and Institutional Review Board of Meir Medical Center (MMC 220–21). The committee waived the requirement for informed consent due to the retrospective nature of the study. The study was performed in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines.

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Cohen-Hagai, K., Hornik-Lurie, T., Benchetrit, S. et al. Clinical efficacy of the fourth dose of the BNT162b2 vaccine in maintenance dialysis patients   . J Nephrol 36, 1957–1964 (2023). https://doi.org/10.1007/s40620-023-01667-z

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  • DOI: https://doi.org/10.1007/s40620-023-01667-z

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