Patients with kidney failure receiving hemodialysis (HD) mount a lower antibody response to the COVID-19 vaccine than healthy individuals without kidney failure, a new study finds.

Investigators compared immune response to 2 doses of the Pfizer-BioNTech (BNT162b2) vaccine in 56 patients on maintenance HD and a control group of 95 healthcare workers without kidney disease.

At a median 30 days after the second dose, 54 patients in the dialysis group displayed an antibody response and 2 did not, whereas all of the control group mounted a response, Moshe Shashar, MD, of Laniado Hospital in Netanya, Israel, and colleagues reported in the Clinical Journal of the American Society of Nephrology. The 2 patients with no serologic response were a 75-year-old man with long-term immunosuppression, diabetes, and hypertension and a 90-year-old man with diabetes.

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More importantly, IgG levels in the dialysis group were significantly lower than in the control group: median 2900 vs 7401 AU/mL. Compared with the control group, the dialysis group had significant 2.7-fold increased odds of an antibody response in the lower 25th percentile of IgG levels.

Each 1-year increase in age also was significantly associated with 1.1- and 1.2-fold increased odds of low humoral IgG response overall and in the dialysis group, respectively, compared with the control group. Conversely, higher lymphocyte count in patients on dialysis significantly correlated with 17% decreased odds of a low humoral response per 10 e3/µL increment.

Patients with chronic kidney disease, and especially those treated with maintenance HD tend to have a reduced immune response to infection or vaccination.

“Our major finding is that the majority of patients on maintenance HD developed a substantial humoral response following the two vaccine doses; however, it was significantly lower than controls,” Dr Shashar’s team stated.

The investigators believe the findings should prompt further research and consideration for changing the dose and/or schedule of COVID-19 vaccinations for patients on maintenance HD as has been done with some previous vaccines.


Grupper A, Sharon N, Finn T, et al. Humoral response to the Pfizer BNT162b2 vaccine in patients undergoing maintenance hemodialysis. Published online April 6, 2021. Clin J Am Soc Nephrol. doi:10.2215/CJN.03500321