# Cellular and humoral response to SARS-CoV-2 vaccine BNT162b2 in adults with Chronic Kidney Disease G4/5

## TL;DR

This study examines how adults with advanced kidney disease respond to the BNT162b2 vaccine compared to healthy individuals.

## Contribution

The study reveals that CKD patients have similar blood antibody responses to the vaccine as healthy controls but show weaker mucosal and T-cell immunity.

## Key findings

- CKD patients showed similar anti-Spike and anti-RBD IgG levels in plasma as healthy controls.
- CKD patients had lower anti-Spike IgG in saliva and fewer Spike-specific CD8+ T-cells in blood.
- Vaccination before kidney replacement therapy was found to be efficient in inducing serological responses in CKD patients.

## Abstract

The mRNA vaccines have proven to be very effective in preventing severe disease and death from SARS-CoV-2 in the general population. However, in patients with chronic kidney disease (CKD) in dialysis or with kidney transplants (KT) the vaccine responses vary, with severe breakthrough infections as a consequence. In this intervention study we investigated the magnitude and quality of the responses to mRNA vaccination administered prior to kidney replacement therapy (KRT). Twenty patients with CKD G4/5 and nine healthy controls were followed for 12 months after receiving two doses of BNT162b2 four weeks apart and a booster dose after 3–6 months. Induction of anti-Spike and anti-RBD IgG in plasma followed the same kinetics in CKD patients and controls, with a trend towards higher titers in controls. In accordance, there was no differences in the establishment of Spike-specific memory B-cells between groups. In contrast, the CKD patients showed lower levels of anti-Spike IgG in saliva and Spike-specific CD8+ T-cells in blood, possibly influencing the capacity of viral clearance which can contribute to an elevated risk of severe breakthrough infections. In conclusion, we found that CKD patients, despite having a reduced mucosal and cytotoxic immunity to BNT162b2, demonstrated a serological response in plasma similar to healthy controls. This suggests that immunization prior to RRT is efficient and motivated. (EudraCT-nr 2021-000988-68).