Frontiers in Nephrology

SARS-CoV-2 neutralizing antibody response after three doses of mRNA1273 vaccine and COVID-19 in hemodialysis patients

Xiaoling Wang, Maggie Han, Lemuel Rivera Fuentes, Ohnmar Thwin, Nadja Grobe, null, Yuedong Wang, Peter Kotanko


Background: In hemodialysis patients, a third vaccination is frequently administered to augment protection against coronavirus disease 2019 (COVID-19). However, the newly emerged B.1.1.159 (Omicron) variant may evade vaccinal protection more easily than previous strains. It is of clinical interest to better understand the neutralizing activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants after booster vaccine or COVID-19 infection in these mostly immunocompromised patients.

Methods: Hemodialysis patients from four dialysis centers were recruited between June 2021 and February 2022. Each patient provided a median of six serum samples. SARS-CoV-2 neutralizing antibodies (nAbs) against wild type (WT) or Omicron were measured using the GenScript SARS-CoV-2 Surrogate Virus Neutralization Test Kit.

Results: Forty-two patients had three doses of mRNA1273. Compared to levels prior to the third dose, nAb-WT increased 18-fold (peak at day 23) and nAb-Omicron increased 23-fold (peak at day 24) after the third dose. Peak nAb-WT exceeded peak nAb-Omicron 27-fold. Twenty-one patients had COVID-19 between December 24, 2021, and February 2, 2022. Following COVID-19, nAb-WT and nAb-Omicron increased 12- and 40-fold, respectively. While levels of vaccinal and post-COVID nAb-WT were comparable, post-COVID nAb-Omicron levels were 3.2 higher than the respective peak vaccinal nAb-Omicron. Four immunocompromised patients having reasons other than end-stage kidney disease have very low to no nAb after the third dose or COVID-19.

Conclusions: Our results suggest that most hemodialysis patients have a strong humoral response to the third dose of vaccination and an even stronger post-COVID-19 humoral response. Nevertheless, nAb levels clearly decay over time. These findings may inform ongoing discussions regarding a fourth vaccination in hemodialysis patients.

About the Contributors

Xiaoling Wang, PhD

Senior Research Scientist

Xiaoling joined RRI in 2019. She received her PhD in biochemistry and structural biology  at Stony Brook University. Prior to joining RRI, she had years of postdoctoral experiences at Rockefeller University studying transcriptional regulation in vitro and in vivo. Xiaoling brings her extensive biochemistry, molecular and cell biology experiences to RRI. At RRI, Xiaoling is involved in many ongoing research projects and would also like to explore new projects

Maggie Han, MSc

Research Scientist

Maggie has a bachelor’s degree from New York University, where she studied economics and has a master’s degree in health sciences from Pontifícia Universidade Católica do Paraná. She is the executive assistant to Dr. Peter Kotanko, Research Director. In addition to her administrative duties, she is also very active in research. Her work is mainly focused on pervasive sensing techniques, wearables, and study of physical activity, sleep, and patient-reported outcomes in chronic kidney disease patients.

Nadja Grobe, MS, PhD

Supervisor, Laboratory Research

Nadja received her MS and PhD in biochemistry from the Martin Luther University Halle-Wittenberg, Germany. Prior to joining RRI in 2017, she gained more than 10 years of experience in guiding and implementing chemistry, biochemistry, and biomedical-focused research teams in nonprofit, academia, and government. Her previous research has been funded by the American Heart Association, the National Institutes of Health, and the American Society of Nephrology.

Dr. Peter Kotanko, MD

RRI Research Director

SVP, Corporate Research & Development

Peter Kotanko, MD, is Research Director at the Renal Research Institute (RRI), New York. Prior to joining RRI, from 1997 to 2007 he served as vice chair of a department of internal medicine at an academic teaching hospital in Graz, Austria. Prior to moving to Graz in 1989, he worked from 1982 to 1989 in the Department of Physiology and the University Clinic of Internal Medicine in Innsbruck, Austria. From 1995 to 1996 he trained in nephrology at the Hammersmith Hospital, London, United Kingdom.