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Abstract: FR-PO1103

Longitudinal SARS-CoV-2 Antibody and T-Cell Immune Responses in Patients on Hemodialysis During the Omicron Era

Session Information

  • COVID-19 - II
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)


  • Karaba, Andrew H., Johns Hopkins University, Baltimore, Maryland, United States
  • Xue, Jiashu, Johns Hopkins University, Baltimore, Maryland, United States
  • Johnston, Trevor Scott, Johns Hopkins University, Baltimore, Maryland, United States
  • Traut, Caroline, Johns Hopkins University, Baltimore, Maryland, United States
  • Blankson, Joel, Johns Hopkins University, Baltimore, Maryland, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
  • Ray, Stuart C., Johns Hopkins University, Baltimore, Maryland, United States

Individuals receiving renal replacement therapy via hemodialysis (HD) are at high risk for severe outcomes from COVID-19, have attenuated responses to the original COVID-19 vaccine series, and are at increased risk for contracting SARS-CoV-2 due to frequent healthcare exposures. How immunity to SARS-CoV-2, and risk for severe disease, evolve with episodes of infection and additional booster vaccinations in this vulnerable population has not been described.


An observational multicenter cohort of 55 HD patients (>90% received at least two doses of mRNA COVID-19 vaccine, 56% female, 47% with diabetic kidney disease, age [med, IQR] 67, 58-74 years) were followed for 24 weeks between Dec 2021 and Nov 2022 and provided blood samples at enrollment (week 0), 8 weeks, and 24 weeks. Plasma was tested for anti-SARS-CoV-2 IgG and ACE2 inhibition (surrogate neutralization; 0-100% with >25% consistent with neutralizing antibody) against ancestral, Beta, Delta, and Omicron subvariants using the MSD platform. T cell responses to SARS-CoV-2 spike and nucleocapsid were assessed via ELISpot. Changes in antibody and T cell responses were assessed by paired Wilcoxon rank-sum testing. Additionally, responses were compared to boosted healthy controls (HC) (n=11).


Antibody responses against ancestral virus remained relatively constant in the HD cohort (p = 0.9). Neutralization of BA.5 remained low throughout with 48% of participants below the 25% threshold associated with live-virus neutralization. While ACE2 inhibition was similar to HCs (Figure), the proportion of HD participants above the 25% threshold for BA.5 was significantly lower than HCs (p = 0.004). Neutralizing capacity of BA.5 among HD patients with a history of COVID-19 was not greater than those with no history of COVID-19. Spike specific T cell responses increased in HD patients over time.


Original vaccine formulations are insufficient to induce reliable Omicron subvariant neutralization in HD patients.


  • Commercial Support – This work was supported by Fresenius Medical Care