Systematic Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients with Chronic Kidney Disease.

Introduction: The effects of the coronavirus disease 19 (COVID-19) pandemic in particular affect those with chronic kidney disease (CKD), who commonly have defects in humoral and cellular immunity, and the efficacy of vaccinations against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is uncertain. Methods: To inform public health and clinical practice, we synthesized published studies and preprints evaluating surrogate measures of immunity after SARS-CoV-2 vaccination in patients with CKD including those receiving dialysis or with a kidney transplant. Results: We found 35 studies (28 published, 7 preprints), sample size from 23 to 1140 patients, and follow-up from one week to 1 month after vaccination. 17 of the 35 studies enrolled a control group. In the 22 studies of patients receiving dialysis, the development of antibodies was observed in 18 to 53% after one dose, and in 70 to 96% after two doses of mRNA vaccine. In the 14 studies of transplant recipients, 3% to 59% mounted detectable humoral or cellular responses after 2 doses of mRNA vaccine. After vaccination, there are a few reported cases of relapse or de novo glomerulonephritis, and acute transplant rejection suggesting ongoing surveillance is important. Conclusion: Studies are needed to better evaluate the effectiveness of SARS-CoV-2 vaccination in these populations. Rigorous surveillance for long-term adverse effects in patients with autoimmune disease and transplant recipients is required. For transplant recipients and those with suboptimal immune responses, alternate vaccination platforms and strategies should be considered. As additional data arise, the NephJC COVID-19 page will be updated (http://www.nephjc.com/news/covid-vaccine).