Humoral Response to the Pfizer BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis

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Figure 1.
Patients on dialysis develop a lower IgG antisevere acute respiratory syndrome coronavirus 2 spike antibodies level compared with controls (P<0.001). Two patients from the dialysis group had undetectable antibody levels defined as <50 arbitrary units per milliliter (AU/ml).
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Figure 2.
Mean antibody level in different age ranges was lower in dialysis compare to control group. Ends of the boxes are the upper and lower quartiles. The medians are marked by horizontal lines inside the boxes. Every dot represents one participant’s level of antibodies. Error bars represent the range between minimal and maximal points. The top eight whiskers in plot age <59 (all subjects from the control group) are beyond the range of the y axis (range, 23,177–40,000 AU/ml). It was done in order to provide a greater resolution to the age >70 group (P=0.003 for age <60, P=0.007 for age 60–70, and P=0.20 for age >70 for study group versus control group).

Table 1.

Characteristics of patients on dialysis and control subjects who received the Pfizer BNT162b2 vaccine

Factor	Dialysis Group, n=56	Control Group, n=95
Age, yr	74 (11)	57 (9)
Sex, women, n (%)	14 (25)	69 (73)
BMI, kg/m²	27.2 (4)
Diabetes mellitus, n (%)	35 (63)	6 (6)
Immunosuppression medication, n (%)	1 (2)	4 (4)
Kidney failure etiology, diabetes or nephrosclerosis, n (%)	41 (72)
Transplantation candidate (%)	13 (23)
Dialysis vintage, mo	38 (37)
Dialysis access, AVF, n (%)	42 (74)
Mean Kt/V	1.33 (0.23)
Days after first dose, median (IQR)^a	53 (42–56)	52 (41–60)
Days after second dose, median (IQR)^b	30 (27–34)	30 (26–34)
White blood cell count, 10 e³/µl	7.9 (3.1)
Polymorphonuclears count, 10 e³/µl	5.5 (2.4)
Lymphocyte count, 10 e³/µl	1.5 (0.6)
Serum albumin, g/dL	4.0 (0.35)

Values are mean (SD), unless otherwise stated. BMI, body mass index; AVF, arteriovenous fistula; IQR, interquartile range.
↵a Range is 34–60 days for the study group and 35–67 days for the control group.
↵b Range is 12–34 days for the study group and 14–34 days for the control group.

Table 2.

Clinical factors associated with low humoral response to the Pfizer BNT162b2 vaccine among patients on hemodialysis

Variable	Adjusted Odds Ratio (95% Confidence Interval)	P Value
Age per 1 yr	1.2 (1.1 to 1.6)	0.03
Dialysis vintage per 1 yr	1.1 (0.9 to 1.4)	0.19
Kt/V per 1 U	0.9 (0.7 to 1.9)	0.43
Diabetes mellitus	1.4 (0.8 to 2.5)	0.58
Lymphocyte count per 10 e³/µl	0.8 (0.6 to 0.9)	0.04

Low humoral response was defined as below the 25th percentile of antibody concentration. Covariates included in the analysis are age, dialysis vintage, Kt/V, lymphocyte count, and diagnosis of diabetes mellitus.