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

Background Little is known regarding the dynamics of antibody and T-cell responses in chronic kidney disease (CKD) following COVID-19 vaccination. Material and methods Prospective observational cohort study including 144 participants on hemodialysis (HD) (n = 52), peritoneal dialysis (PD) (n = 14), kidney transplantation (KT) (n = 30) or advanced chronic kidney disease not on dialysis (ACKD), and healthy controls (n = 18). Anti-Spike(S) antibody and T-cell responses were assessed at 15 days (15D) and 3 months (3M) after complete vaccination schedule. HD, PD and KT patients received mRNA vaccines (mRNA-123 and BNT162b2). Most ACKD patients received BNT162b2 (n = 23), or Ad26.COV.2.S (4). Most controls received BNT162b2 (n = 12), or Ad26.COV.2.S (n = 5). Results Anti-S antibodies at 15D and 3M were detectable in 95% (48/50)/98% (49/50) of HD patients, 93% (13/14)/100% of PD patients, 67% (17/26)/75% (21/28) of KT patients and 96% (25/26)/100% (24/24) of ACKD patients. Rates for healthy controls were 81% (13/16)/100% (17/17). Previous SARS-CoV-2-S infection was documented in 4 (7,7%) HD patients, 2 (14,3%) PD patients, 2 (6,7%) KT patients, 1 (5,55%) healthy controls and in no ACKD patient. Antibody levels decreased at 3M in HD (p = 0.04), PD (p = 0.008), and ACKD patients (P = 0.0009). In KT patients levels increased (P = 0.04) between 15D and 3M,  although they were low at both time points. T-cell responses were detected in HD patients in 37 (80%) at baseline, 35 (70%) at 15 days and 41 (91%) at 3 months. In PD patients, T-cell responses appeared in 8 (67%) at baseline, 13 (93%) at 15 days and 9 (100%) at 3 months. In KT patients, T-cell responses were detected in 12 (41%) at baseline, 22 (84%) at 15 days and 25 (96%) at 3 months.In ACKD patients, T-cell responses were detected in 13 (46%) at baseline, 20 (80%) at 15 days and 17 (89%) at 3 months. None of healthy controls showed T-cell response at baseline, 10 (67%) at 15 days and 8 (89%) at 3 months. Conclusions Most HD, PD and ACKD patients develop SARS-CoV-2-S antibody responses comparable to that of healthy controls, in contrast to KT recipients. Antibody waning at 3M was faster in HD, PD, ACKD patients. No differences in SARS-CoV-2 T-cell immunity responses were noticed across study groups.