Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Bachler, B.
Retrospektive Quantifikation der Anti-SARS-CoV-2 Antikörperantwort nach mRNA COVID-19 Impfung bei Patienten unter Peritonealdialyse
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2022. pp. 61
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Kirsch Alexander
- Kolland Michael
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- Abstract:
- Introduction Patients undergoing renal replacement therapy are a collective with an increased risk of contracting and subsequently dying from COVID-19. In fighting the COVID-19 pandemic, vaccination is one of the most important tools to decrease mortality. Patients undergoing renal replacement therapy have, in the past, exhibited an inferior ability to mount a sufficient antibody response to vaccines, such as the Hepatitis B or Influenza vaccine. Antibody titers in dialysis patients were found to have lower peaks and be shorter-lived, compared to control groups. Most studies in this field have focused on the hemodialysis population, but only limited information is available on the growing number of patients undergoing peritoneal dialysis. Therefore, it is of the utmost importance to investigate the response to the relatively new mRNA COVID-19 vaccines in this population. Methods We performed a single-center, non-invasive, retrospective study, where the final analysis included 31 patients of the peritoneal dialysis department of the Medical University of Graz. Patients underwent their routinely scheduled vaccinations and blood for antibody titers was drawn at routine visits, also. Data was gathered in a retrospective chart review. Our primary endpoint was the serologic response 28 days after the first vaccination. We also included the antibody titers after the second dose and after a follow-up period. We explored how certain patient characteristics were associated with the dynamics of the antibody titers. Results Four weeks after the first dose, 80.6% of patients showed reactive antibody assays. A serologic response (defined as BAU ≥15/mL), was found in 38.7% of patients. Twenty- eight days after the second shot, 93.3% of patients had reactive assays, while also 93.3% showed a serologic response. At follow-up after a mean of 202.5 days, 94.7% of assays were reactive. All of those 94.7% reached the threshold of serologic response. When utilizing a cut-off of 2000 BAU/mL, which has been suggested to enhance the positive predictive value for protection against severe disease, only 40% reached the threshold 28 days after the first dose and none at follow-up. Non-responders were significantly more likely to be treated with ESAs and had a lower residual renal function compared to responders. Significantly lower geometric mean ratios of SARS-CoV-2-antibodies were observed in patients treated with immunosuppressive drugs or erythropoiesis stimulating agents, for HBV-vaccine low or non-responder and frail patients. Conclusion We were able to show, that peritoneal dialysis patients are able to mount a good serologic response to the COVID-19 mRNA vaccine mRNA-1273 . Further, we were able to identify patient characteristics, which were associated with a weaker antibody response. This knowledge may be helpful for identifying candidates in need of increased medical attention or alternative vaccination strategies.