Frailty and Immunogenicity Following COVID-19 Vaccination Among Patients Undergoing Hemodialysis

ABSTRACT

Background: Patients with end-stage kidney disease who are undergoing dialysis have reduced immune responses to COVID-19 vaccination. Frailty is extremely common among dialysis patients and may contribute to the impaired immune responses. However, little is known about its effects on the immunogenicity following COVID-19 vaccination in the dialysis population. Method(s) Adult hemodialysis patients without prior SARS-CoV-2 infection who received one dose of the ChAdOx1 nCoV-19 vaccine were assessed for eligibility. Participants were categorized as robust, pre-frail, or frail using the Fried frailty criteria. Humoral responses were assessed at 28 days after vaccination by measuring titers of IgG antibody to the receptor-binding domain of SARS-CoV-2 spike protein. Seroconversion was defined as antibody levels >= 50 AU/mL. Multivariate logistic regression analyses compared humoral responses of frail or pre-frail participants with robust participants. Result(s) A total of 206 participants were included in the study, of whom 50 (24.3%) were considered frail, 86 (41.7%) pre-frail, and 70 (34.0%) robust. Compared with robust patients, a significantly smaller proportion of pre-frail and frail patients developed antispike antibody seroconversion (87.1%, 66.3%, and 40.0%, respectively;P <0.001). Frailty was associated with the absence of humoral responses after adjustment for confounders including age, sex, body mass index, diabetes, coronary artery disease, serum albumin, and lymphocyte count (odds ratio, 0.25;95% CI, 0.08-0.80;P for trend = 0.025). Conclusion(s) Frailty is independently associated with impaired humoral responses following COVID-19 vaccination in hemodialysis patients. Whether repeated booster vaccination may improve the immunogenicity in frail hemodialysis patients needs further research.