Humoral response after the fourth dose of the SARS-CoV-2 vaccine in the CKD spectrum: a prespecified analysis of the SENCOVAC study
Borja Quiroga, María José Soler, Alberto Ortíz, Carlos Jesús Jarava Mantecón, Virginia Olinda Gómez Pérez, A. Bordils, José Luis Lacueva, Antonio Franco, Pablo Delgado Conde, Patricia Muñoz Ramos, Carmen Calderón González, Juan Manuel Cazorla López, Jinny Sánchez-Rodríguez, Ana Sánchez Horrillo, Tania Monzón, Alba Leyva, José Antonio Muñoz Rojas, Ron T. Gansevoort, Patricia de Sequera, SENCOVAC collaborative network, Maria Teresa Jaldo Rodríguez, Rafael Lucena Valverde, Marta Puerta Carretero, Mayra Ortega Díaz, Daniel Gaitán Tocora, Esther Rodriguez Suárez, Alfredo José Sáenz Santolaya, Patricia Arribas Cobo, Tamar Talavan, Raquel Cerrajero Calero, Carolina Gracia-Iguacel, Emilio González‐Parra, Mônica Corso Pereira, Catalina Martín-Cleary, Ana Ramos-Verde, Martín Giorgi, Carmen Sánchez, Yohana Gil Giraldo, Ana Sánchez Horrillo, Pablo Ruano Suárez, Antonio Fernández Perpén, Andrés Fernández-Ramos, Laura Salanova Villanueva, Alejandra Cortiñas, Pablo A Díez Arias, Alicia Cabrera Cárdenas, Antonio de Santos, Almudena Hernández Núñez, Guillermina Barril, Loreto Mariscal de Gante, Raquel Repollet, Concepción Redondo Polo, Francesc Moreso, María Azancot, Natàlia Ramos, Oriol Bestard Nestor Toapanta, Ignacio Cidraque, Sheila Bermejo, Irene Agraz, Oreto Prat, Carlota Medina, Emma Pardo, Oreto Prat, A. Sáiz, María Antonia Munar Vila, Secundino Cigarrán, Nicolás Menéndez Granados, María Jesús Corton Cabo, Walter López Alarcón, Soledad Pizarro Sánchez, Simona Alexandru, Laura García Puente Suarez, Saúl Pampa Saico, Marisol Poma Tapia, Rocío Zamora, Rosa Sánchez Hernández, Laura Rodríguez Osorio, Nuria Garcı́a-Fernández, Paloma Leticia Martin Moreno, Noelia Ania González, Ana Sabalza Ortiz, María Nieves Bastida Iñarrea, Sagrario Soriano Cabrera, Raquel Ojeda López, Cayetana Moyano Peregrí, Maria Luisa Agüera Morales, M.D. Navarro Cabello, Auxiliadora Mazuecos, Teresa Garcı́a, Carlos F. Narváez, Cristhian Orellana, Marı́a Gabriela Márquez, Carolina Lancho Novillo, Pedro Luis Quirós Ganga, Fernando Vallejo Carrión, Antonio Luis García Herrera, Natalia Blanco Castro, Rosa María Ruiz-Calero Cendrero, María Victoria Martín Hidalgo-Barquero, Román Hernández Gallego
Abstract
BACKGROUND: There is scarce evidence on the fourth dose of severe acute respiratory syndrome coronavirus 2 vaccines in chronic kidney disease (CKD) patients. We evaluated the humoral response and effectivity of the fourth dose in the CKD spectrum: non-dialysis CKD (ND-CKD), haemodialysis (HD), peritoneal dialysis (PD) and kidney transplant (KT) recipients. METHODS: This is a prespecified analysis of the prospective, observational, multicentric SENCOVAC study. In patients with CKD who had received a complete initial vaccination and one or two boosters and had anti-Spike antibody determinations 6 and 12 months after the initial vaccination, we analysed factors associated with persistent negative humoral response and higher anti-Spike antibody titres as well as the efficacy of vaccination on coronavirus disease 2019 (COVID-19) severity. RESULTS: Of 2186 patients (18% KT, 8% PD, 69% HD and 5% ND-CKD), 30% had received a fourth dose. The fourth dose increased anti-Spike antibody titres in HD (P = .001) and ND-CKD (P = .014) patients and seroconverted 72% of previously negative patients. Higher anti-Spike antibody titres at 12 months were independently associated with repeated exposure to antigen (fourth dose, previous breakthrough infections), previous anti-Spike antibody titres and not being a KT recipient. Breakthrough COVID-19 was registered in 137 (6%) patients, 5% of whom required admission. Admitted patients had prior titres <620 UI/ml and median values were lower (P = .020) than in non-admitted patients. CONCLUSIONS: A fourth vaccine dose increased anti-Spike antibody titres or seroconverted many CKD patients, but those with the highest need for a vaccine booster (i.e. those with lower pre-booster antibody titres or KT recipients) derived the least benefit in terms of antibody titres. Admission for breakthrough COVID-19 was associated with low anti-Spike antibody titres.