Vaccination in patients with kidney failure: lessons from COVID-19

被引:73
作者
Babel, Nina [1 ,2 ,3 ,4 ,5 ,6 ,7 ,8 ]
Hugo, Christian [9 ]
Westhoff, Timm H. [1 ]
机构
[1] Ruhr Univ Bochum, Univ Hosp, Marien Hosp Herne, Med Dept 1, Herne, Germany
[2] Ruhr Univ Bochum, Univ Hosp, Marien Hosp Herne, Ctr Translat Med, Herne, Germany
[3] Ruhr Univ Bochum, Univ Hosp, Marien Hosp Herne, Immune Diagnost Lab, Herne, Germany
[4] Charite Univ Med Berlin, Berlin, Germany
[5] Free Univ Berlin, Berlin, Germany
[6] Humboldt Univ, Berlin, Germany
[7] Berlin Ctr Adv Therapies BeCAT, Berlin, Germany
[8] Berlin Inst Hlth, Berlin, Germany
[9] Tech Univ Dresden, Univ Klinikum Carl Gustav Carus, Med Klin & Poliklin 3, Dresden, Germany
基金
英国科研创新办公室;
关键词
RNA-POLYMERASE-III; T-CELL RESPONSE; TRANSPLANT RECIPIENTS; BNT162B2; VACCINE; SARS-COV-2; MYCOPHENOLIC-ACID; ANTIBODY-RESPONSE; B-CELLS; HEMODIALYSIS; VARIANTS;
D O I
10.1038/s41581-022-00617-5
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Infection is the second leading cause of death in patients with chronic kidney disease (CKD). Adequate humoral (antibody) and cellular (T cell-driven) immunity are required to minimize pathogen entry and promote pathogen clearance to enable infection control. Vaccination can generate cellular and humoral immunity against specific pathogens and is used to prevent many life-threatening infectious diseases. However, vaccination efficacy is diminished in patients with CKD. Premature ageing of the immune system and chronic systemic low-grade inflammation are the main causes of immune alteration in these patients. In the case of SARS-CoV-2 infection, COVID-19 can have considerable detrimental effects in patients with CKD, especially in those with kidney failure. COVID-19 prevention through successful vaccination is therefore paramount in this vulnerable population. Although patients receiving dialysis have seroconversion rates comparable to those of patients with normal kidney function, most kidney transplant recipients could not generate humoral immunity after two doses of the COVID-19 vaccine. Importantly, some patients who were not able to produce antibodies still had a detectable vaccine-specific T cell response, which might be sufficient to prevent severe COVID-19. Correlates of protection against SARS-CoV-2 have not been established for patients with kidney failure, but they are urgently needed to enable personalized vaccination regimens. Effective vaccination strategies are crucial to mitigate the high risk of infection-associated morbidity and mortality in patients with kidney failure. Here, the authors examine vaccine-induced immunity in these patients, in particular their responses to COVID-19 vaccination, in the context of the immune impairment induced by kidney dysfunction and the use of immunosuppressive medications.
引用
收藏
页码:708 / 723
页数:16
相关论文
共 192 条
[1]   Dendritic cell tolerogenicity: a key mechanism in immunomodulation by vitamin D receptor agonists [J].
Adorini, Luciano ;
Penna, Giuseppe .
HUMAN IMMUNOLOGY, 2009, 70 (05) :345-352
[2]   Update on Inflammation in Chronic Kidney Disease [J].
Akchurin, Oleh M. ;
Kaskel, Frederick .
BLOOD PURIFICATION, 2015, 39 (1-3) :84-92
[3]   Antibody Response to a Fourth Dose of a SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: A Case Series [J].
Alejo, Jennifer L. ;
Mitchell, Jonathan ;
Chiang, Teresa P. -Y. ;
Abedon, Aura T. ;
Boyarsky, Brian J. ;
Avery, Robin K. ;
Tobian, Aaron A. R. ;
Levan, Macey L. ;
Massie, Allan B. ;
Garonzik-Wang, Jacqueline M. ;
Segev, Dorry L. ;
Werbel, William A. .
TRANSPLANTATION, 2021, 105 (12) :E280-E281
[4]   Mechanisms of action of mycophenolate mofetil [J].
Allison, AC .
LUPUS, 2005, 14 :S2-S8
[5]  
Anand S, 2021, J AM SOC NEPHROL, V32, P2435, DOI [10.1681/ASN.2021050611, 10.1101/2021.05.06.21256768]
[6]   The intestinal microbiota, a leaky gut, and abnormal immunity in kidney disease [J].
Anders, Hans-Joachim ;
Andersen, Kirstin ;
Stecher, Baerbel .
KIDNEY INTERNATIONAL, 2013, 83 (06) :1010-1016
[7]   COVID-19-Induced ARDS Is Associated with Decreased Frequency of Activated Memory/Effector T Cells Expressing CD11a++ [J].
Anft, Moritz ;
Paniskaki, Krystallenia ;
Blazquez-Navarro, Arturo ;
Doevelaar, Adrian ;
Seibert, Felix S. ;
Holzer, Bodo ;
Skrzypczyk, Sarah ;
Kohut, Eva ;
Kurek, Julia ;
Zapka, Jan ;
Wehler, Patrizia ;
Kaliszczyk, Sviatlana ;
Bajda, Sharon ;
Thieme, Constantin J. ;
Roch, Toralf ;
Konik, Margarethe Justine ;
Berger, Marc Moritz ;
Brenner, Thorsten ;
Kolsch, Uwe ;
Meister, Toni L. ;
Pfaender, Stephanie ;
Steinmann, Eike ;
Tempfer, Clemens ;
Watzl, Carsten ;
Dolff, Sebastian ;
Dittmer, Ulf ;
Abou-El-Enein, Mohamed ;
Westhoff, Timm H. ;
Witzke, Oliver ;
Stervbo, Ulrik ;
Babel, Nina .
MOLECULAR THERAPY, 2020, 28 (12) :2691-2702
[8]   Clinical effectiveness of COVID-19 vaccination in solid organ transplant recipients [J].
Aslam, Saima ;
Adler, Eric ;
Mekeel, Kristin ;
Little, Susan J. .
TRANSPLANT INFECTIOUS DISEASE, 2021, 23 (05)
[9]   p-Cresyl sulfate affects the oxidative burst, phagocytosis process, and antigen presentation of monocyte-derived macrophages [J].
Azevedo, M. L. V. ;
Bonan, N. B. ;
Dias, G. ;
Brehm, F. ;
Steiner, T. M. ;
Souza, W. M. ;
Stinghen, A. E. M. ;
Barreto, F. C. ;
Elifio-Esposito, Selene ;
Pecoits-Filho, R. ;
Moreno-Amaral, A. N. .
TOXICOLOGY LETTERS, 2016, 263 :1-5
[10]   Immunizations in Chronic Kidney Disease and Kidney Transplantation [J].
Babu, Tara M. ;
Kotton, Camille N. .
CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES, 2021, 13 (02) :47-65