Seroresponse to SARS-CoV-2 Vaccines among Maintenance Dialysis Patients over 6 Months

Caroline M. Hsu, Daniel E. Weiner, Harold J. Manley, Gideon N. Aweh, Vladimir Ladik, Jill Frament, Dana Miskulin, Christos Argyropoulos, Kenneth Abreo, Andrew Chin, Reginald Gladish, Loay Salman, Doug Johnson, Eduardo K. Lacson

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background and objectives Although most patients receiving maintenance dialysis exhibit initial seroresponse to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, concerns exist regarding the durability of this antibody response. This study evaluated seroresponse over time. Design, setting, participants, & measurements This retrospective cohort study included patients on maintenance dialysis, from a midsize national dialysis provider, who received a complete SARS-CoV-2 vaccine series and had at least one antibody titer checked after full vaccination. IgG spike antibodies (anti-spike IgG) titers were assessed monthly with routine laboratory tests after vaccination; the semiquantitative assay reported a range between zero and $20 Index. Descriptive analyses compared trends over time by history of coronavirus disease 2019 (COVID-19) and vaccine type. Time-to-event analyses examined the outcome of loss of seroresponse (anti-spike IgG,1 Index or development of COVID-19). Cox regression adjusted for additional clinical characteristics. Results Among 1870 patients receiving maintenance dialysis, 1569 had no prior COVID-19. Patients without prior COVID-19 had declining titers over time. Among 443 recipients of BNT162b2 (Pfizer), median (interquartile range) anti-spike IgG titer declined from $20 (5.89 to $20) in month 1 after full vaccination to 1.96 (0.60–5.88) by month 6. Among 778 recipients of mRNA-1273 (Moderna), anti-spike IgG titer declined from $20 (interquartile range, $20 to $20) in month 1 to 7.99 (2.61 to $20) by month 6. The 348 recipients of Ad26.COV2.S (Janssen) had a lower titer response than recipients of an mRNA vaccine over all time periods. In time-to-event analyses, recipients of Ad26.COV2.S and mRNA-1273 had the shortest and longest time to loss of seroresponse, respectively. The maximum titer reached in the first 2 months after full vaccination was associated with durability of the anti-spike IgG seroresponse; patients with anti-spike IgG titer 1–19.99 had a shorter time to loss of seroresponse compared with patients with anti-spike IgG titer $20 (hazard ratio, 15.5; 95% confidence interval, 11.7 to 20.7). Conclusions Among patients receiving maintenance dialysis, vaccine-induced seroresponse wanes over time across vaccine types. Early titers after full vaccination are associated with the durability of seroresponse.

Original languageEnglish (US)
Pages (from-to)403-413
Number of pages11
JournalClinical Journal of the American Society of Nephrology
Issue number3
StatePublished - Mar 2022
Externally publishedYes


  • Chronic hemodialysis
  • COVID-19
  • COVID-19 vaccines
  • End-stage renal disease
  • Maintenance
  • Peritoneal dialysis
  • SARS-CoV-2

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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