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Frailty and Humoral Immune Responses Following COVID-19 Vaccination among Patients Undergoing Hemodialysis

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Background

Patients with end-stage kidney disease who are undergoing dialysis have reduced immune responses to COVID-19 vaccination. Frailty is extremely common among dialysis patients and may contribute to the impaired immunogenicity. This study aimed to determine the association between frailty and humoral immune responses following COVID-19 vaccination in hemodialysis patients.

Design, Setting, Participants

Adult hemodialysis patients without prior SARS-CoV-2 infection who received a priming dose of ChAdOx1 nCoV-19, an adenovirus-vectored vaccine, were assessed for eligibility. Participants were categorized as robust, pre-frail, or frail using the Fried frailty criteria. Humoral responses were assessed 28 days after vaccination by measuring titers of anti-spike IgG antibodies. The primary outcome was anti-spike antibody seroconversion, defined as antibody levels ≥50 AU/mL. Multivariable-adjusted logistic regression models were used to assess the association between frailty status and the primary outcome.

Results

A total of 206 participants (mean age 67 ± 13 years, 50% women) were included in the study, of whom 50 (24%) were characterized as frail, 86 (42%) were characterized as pre-frail, and 70 (34%) were characterized as robust. Anti-spike antibody levels were progressively lower with more advanced stages of frailty (P <0.001). Compared with robust patients, a significantly smaller proportion of pre-frail and frail patients developed anti-spike antibody seroconversion (87%, 66%, and 40%, respectively; P <0.001). Frailty was associated with the absence of humoral responses after adjustment for age, sex, body mass index, diabetes, coronary artery disease, serum albumin, and lymphocyte count (OR=0.25; 95% CI, 0.08–0.80).

Conclusions

Frailty is independently associated with impaired humoral responses following COVID-19 vaccination among hemodialysis patients. Strategies aimed at preventing or attenuating frailty in the dialysis population are warranted.

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Acknowledgments

The authors appreciate the assistance of the Biobank of Taipei Tzu Chi Hospital for the collection and processing of clinical specimens.

Funding

Funding Sources: This work is supported by grants from Research Projects MOST 111231443-303-009, MOST 111-2314-B-303-032, MOST 112-2314-B-303-014, and MOST 112-2314-B-303-009-MY3 from the National Science and Technology Council, Taiwan and Research Projects TCRD-TPE-109-RT-2, TCRD-TPE-111-03, TCRD-TPE-111-05, and TCMF-CP 111-02 from Taipei Tzu Chi Hospital, Taiwan.

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Authors and Affiliations

  1. Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan

    T.-Y. Lin & Szu-Chun Hung

  2. Division of Nephrology, Taipei Tzu Chi Hospital, 289, Jianguo Road, Xindian District, New Taipei City, 231, Taiwan

    Szu-Chun Hung

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  1. T.-Y. Lin
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Correspondence to Szu-Chun Hung.

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Ethical standards: This study was approved by the Institutional Review Board of Taipei Tzu Chi Hospital (IRB 10-XD-117).

Conflict of Interest: There are no conflicts of interest.

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Lin, TY., Hung, SC. Frailty and Humoral Immune Responses Following COVID-19 Vaccination among Patients Undergoing Hemodialysis. J Nutr Health Aging 27, 980–986 (2023). https://doi.org/10.1007/s12603-023-1994-x

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  • DOI: https://doi.org/10.1007/s12603-023-1994-x

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