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The Medical Science Function Laboratory of Experimental Teaching Center of Basic Medicine, School of Basic Medical Science, Guizhou Medical University, Guiyang, China
The authors reported a meta-analysis describing the outcomes of hemodialysis patients infected with COVID-19 after SARS-CoV-2 double vaccination. They found that two doses of SARS-CoV-2 vaccination was associated with reduced mortality and need for oxygen supplementation in hemodialysis patients with COVID-19.
Peritoneal dialysis (PD) patients are another group of immunocompromised patients. They are vulnerable to COVID-19 infection like hemodialysis patients due to their immunocompromised state. They are also at increased risk of developing serious complications if they contract the virus. COVID-19 vaccine can contribute to reduce the risk of infection of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, it is well recognized that chronic kidney disease patients have reduced vaccine response. Hence, meta-analysis of the antibody response and safety of COVID-19 vaccine in patients with PD is of great significance.
An extensive literature search was performed in PubMed, Web of Science, and EMBASE to find all relevant studies published from January 1, 2020, to October 05, 2022. We screened the references of the retrieved studies and restricted the language of the search to English. The following keywords were used in the search: COVID-19 vaccines (SARS-CoV-2 vaccines, SARS2 vaccines, SARS Coronavirus 2 vaccines, Coronavirus Disease 2019 vaccines, 2019-nCoV vaccine, and 2019 Novel Coronavirus vaccines) and peritoneal dialysis. The inclusion criteria included: (1) patients diagnosed with chronic kidney disease patients receiving PD and receiving COVID-19 vaccines, and (2) English article. The exclusion criteria were as follows: (1) irrelevant to the research direction, (2) no relevant data, (3) case reports, (4) repeated articles, and (5) review papers.
The analysis was conducted using Review Manager statistical software, version 5.3. A binary controlled study was used to calculate the number of positive rates of anti-SARS-CoV-2 spike protein IgG or adverse events. Odds ratio (OR) and 95% confidence interval (CI) were used to assess the effect in a whole random-effects meta-analysis model. The I2 and P value was used to quantify the heterogeneity of the effects among the included studies.
A total of eighteen studies involving 4434 patients were identified in the final analysis, and the details of the included studies are listed in Table 1.
Immunogenicity of a first dose of mRNA- or vector-based SARS-CoV-2 vaccination in dialysis patients: a multicenter prospective observational pilot study.
Waning of SARS-CoV-2 vaccine-induced immune response over 6 months in peritoneal dialysis patients and the role of a booster dose in maintaining seropositivity.
Local and systemic immunity are impaired in end-stage-renal-disease patients treated with hemodialysis, peritoneal dialysis and kidney transplant recipients immunized with BNT162b2 Pfizer-BioNTech SARS-CoV-2 vaccine.
Eighteen studies showed that the overall OR of positive rates of anti-SARS-CoV-2 spike protein IgG following COVID-19 vaccination in PD patients vs. healthy control subtyped for dose of vaccine was 0.36 (95% CI, 0.16−0.83, P = 0.02), the single dose vaccine was 0.44 (95% CI, 0.09−2.16, P = 0.31), and the double dose vaccine was 0.36 (95% CI, 0.13−0.98, P = 0.04) (Fig. 1). The positive rate in PD patients were significantly lower than that in healthy group, especially the double doses vaccine.
Table 1Baseline characteristics of the included studies.
Immunogenicity of a first dose of mRNA- or vector-based SARS-CoV-2 vaccination in dialysis patients: a multicenter prospective observational pilot study.
Waning of SARS-CoV-2 vaccine-induced immune response over 6 months in peritoneal dialysis patients and the role of a booster dose in maintaining seropositivity.
Local and systemic immunity are impaired in end-stage-renal-disease patients treated with hemodialysis, peritoneal dialysis and kidney transplant recipients immunized with BNT162b2 Pfizer-BioNTech SARS-CoV-2 vaccine.
Fig. 1Positive rates of anti-SARS-CoV-2 spike protein IgG following COVID-19 vaccination in patients with PD and healthy control subtyped for dose of vaccine.
In sixteen studies, we found that the overall OR of positive rate of anti-SARS-CoV-2 spike protein IgG following COVID-19 vaccination in PD vs. hemodialysis patients subtyped for dose of vaccine was 1.64 (95% CI, 1.09−247, P = 0.02), the single dose vaccine was 2.43 (95% CI, 1.24−4.73, P = 0.009), and the double dose vaccine was 1.12(95% CI, 0.72−1.73, P = 0.62) (Fig. 2). The positive rate in PD patients were higher than that in hemodialysis patients. However, there was no significant difference in positive rate between PD patients and hemodialysis patients following the double dose COVID-19 vaccine.
Fig. 2Positive rates of anti-SARS-CoV-2 spike protein IgG following COVID-19 vaccination in patients with PD and hemodialysis subtyped for dose of vaccine.
In four studies, we found that the overall OR of adverse events following COVID-19 vaccine in PD patients vs. healthy control was 0.42 (95% CI, 0.15−1.13, P = 0.09), the OR of local adverse events was 0.52 (95% CI, 0.15−1.73, P = 0.28), and the OR of systemic adverse events was 0.32 (95% CI, 0.05−2.04, P = 0.23) Fig. 3. There was no significant difference in local and systemic adverse events in PD patients and healthy persons following COVID-19 vaccination.
Fig. 3Local adverse events and systemic adverse events following COVID-19 vaccination in patients with PD.
In conclusion, our research showed that PD patients produced lower levels of anti-SARS-CoV-2 spike protein IgG after two doses of COVID-19 vaccine in comparison to healthy persons. However, our study also showed that the positive rate in PD patients were higher than hemodialysis patients. Hence, we think COVID-19 vaccine may serve as a sufficient protective role in reducing the severity of disease and likelihood of overall mortality in PD patients like hemodialysis patients. In addition, the current COVID-19 vaccine for patients with PD was safe. Future studies should determine adverse events of each vaccine type and critically identify mechanisms of severe adverse events following vaccination in PD patients.
Declaration of Competing Interest
All authors report that they have no potential conflicts of interest.
Funding
This work was supported by National Natural Science Foundation of China (No. 81860248; No. 81960224); and Science and Technology Fund of Guizhou Health Commission (No. gzwjkj2020–2–005, No. gzwkj2021–024); Cultivation project of National Natural Science Foundation of China (No. 19NSP051); the cultivate project 2021 for National Natural Science Foundation of China, Affiliated Hospital of Guizhou Medical University (No. gyfynsfc-2021–14); and the Guiyang Sci-Tech Plan Projects (No. [2022]−4–14–4).
References
Ao G.
Li A.
Wang Y.
Tran C.
Gao M.
Chen M.
The effect of SARS-CoV-2 double vaccination on the outcomes of hemodialysis patients with COVID-19: a meta-analysis.
Immunogenicity of a first dose of mRNA- or vector-based SARS-CoV-2 vaccination in dialysis patients: a multicenter prospective observational pilot study.
Waning of SARS-CoV-2 vaccine-induced immune response over 6 months in peritoneal dialysis patients and the role of a booster dose in maintaining seropositivity.
Local and systemic immunity are impaired in end-stage-renal-disease patients treated with hemodialysis, peritoneal dialysis and kidney transplant recipients immunized with BNT162b2 Pfizer-BioNTech SARS-CoV-2 vaccine.
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