Response to “Impact of Prolonged SARS-CoV-2 Dosing Interval in Hemodialysis Patients”

We read the study submitted by Lamarche et al., which emphasized an impact of a shortened interval between COVID-19 vaccination doses on seroconversion rate among hemodialysis patients. The KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease(CKD) recommended a vaccination program for CKD patients to protect against infections (1Kidney Disease: Improving Global Outcomes CKDWGKDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.Kidney Int. 2024; 105: S117-S314PubMed Google Scholar). However, CKD and dialysis patients are considered as immunocompromised population which have inadequate immune response following vaccination (2Naqvi S.B. Collins A.J. Infectious complications in chronic kidney disease.Adv Chronic Kidney Dis. 2006; 13: 199-204Abstract Full Text Full Text PDF PubMed Scopus (175) Google Scholar). According to Krueger et al, higher dose and increase frequency of vaccine appeared to be effective strategies to enhance efficacy and durability of vaccine (3Krueger K.M. Ison M.G. Ghossein C. Practical Guide to Vaccination in All Stages of CKD, Including Patients Treated by Dialysis or Kidney Transplantation.Am J Kidney Dis. 2020; 75: 417-425Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar). In the case of the COVID-19 vaccination, previous studies had shown increasing seroconversion rate in CKD patients and kidney transplant recipients receiving booster doses (4Mallah N. Pardo-Seco J. Lopez-Perez L.R. Gonzalez-Perez J.M. Roson B. Otero-Barros M.T. et al.Effectiveness of COVID-19 vaccine booster in the general population and in subjects with comorbidities. A population-based study in Spain.Environ Res. 2022; 215114252PubMed Google Scholar) (5Phirom S. Phannajit J. Jantarabenjakul W. Paitoonpong L. Kitrungphaiboon T. Choktaweesak N. et al.Comparison of the Immune Response After an Extended Primary Series of COVID-19 Vaccination in Kidney Transplant Recipients Receiving Standard Versus Mycophenolic Acid-sparing Immunosuppressive Regimen.Transplant Direct. 2022; 8: e1393Crossref PubMed Scopus (1) Google Scholar). Lamarche, et al. drew the conclusion that shorter interval between COVID-19 vaccine doses improve seroconversion rate in hemodialysis patients aligning with our study. However, the result from both studies needs to be interpreted with caution. We designed an accelerated hepatitis B vaccination regimen which elicited higher seroconversion rate at 12 weeks compared to the standard regimen. This result was owing to higher numbers of vaccine dose prior to measurement of immune response (4 vs. 3 doses). While the seroconversion rate at 28 and 52 weeks were similar between 2 groups when both completed 4-dose course of vaccination. On the other hand, the study conducted by Lamarche, et al. demonstrated lower seroconversion in patients received vaccination interval ≥ 8 weeks. This finding was more pronounce in non-responder following the first dose. Therefore, the effect of seroconversion was not solely related with the interval between vaccination. Nevertheless, this study conveyed an interesting concept that we may be able to enhance immunologic response of vaccine non-responder using early boosted dose. Impact of prolonged SARS-CoV-2 dosing interval in hemodialysis patientsKidney International ReportsPreviewIn their cohort study, Kittrakulrat et al. reported that in patients with advanced chronic kidney disease (CKD), a shorter interval between HBV vaccination doses led to a significantly higher seroconversion rate 1. This finding is in line with our findings on the response rate to SARS-CoV-2 vaccinations in patients receiving hemodialysis. We conducted a prospective cohort study of chronic hemodialysis patients without prior SARS-CoV-2 infection from 7 centers. Patients received two doses of SARS-CoV-2 mRNA vaccine at variable dosing intervals (21 to 113 days) (Figure 1A). Full-Text PDF Open Access