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Abstract: FR-PO1102

Immune Response After the Fourth COVID-19 Vaccine Dose in Hemodialysis Patients

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)


  • Alejos, Belen, Fresenius Medical Care, Bad Homburg, Germany
  • Braun, Jennifer, Fresenius Medical Care, Bad Homburg, Germany
  • Rincón, Abraham, Fresenius Medical Care, Madrid, Spain
  • Croft, Kaitlyn, Fresenius Medical Care, Bad Homburg, Germany
  • Stauss-Grabo, Manuela, Fresenius Medical Care, Bad Homburg, Germany
  • Winter, Anke, Fresenius Medical Care, Bad Homburg, Germany
  • Stuard, Stefano, Fresenius Medical Care, Bad Homburg, Germany
  • Baro, Maria Eva, Fresenius Medical Care, Madrid, Spain
  • Arkossy, Otto, Fresenius Medical Care, Bad Homburg, Germany

Hemodialysis (HD) patients have shown a suboptimal immune response to COVID-19 vaccines, and it remains unclear whether current vaccination schemes are suitable for these patients. We assessed humoral and cellular responses after the administration of the 4th dose of mRNA-based COVID-19 vaccine in HD patients.


We included HD patients from a NephroCare clinic in Spain who were vaccinated with three doses of an mRNA-based COVID-19 vaccine and scheduled to receive the 4th dose. Humoral response was assessed at T0 (max. 4 weeks before 4th dose) and T1 (1 month post 4th dose) using a Bioplex IgG antibody panel. IFN-g released by S1 protein stimulated T-cells was used to assess cellular response in a subsample of 5 patients.


Twenty patients (80% males and median age 76.3 (IQR: 65.2; 84.2) years) were analyzed. Immune response was measured at T0 in a median period of 158 days after the 3rd dose and 100% patients maintained Anti-RBD and Anti-Spike 1 IgGs above the protective level. At T1, all humoral response markers significantly increased and cellular response was positive in 80% (4/5) patients. Anti-Nucleocapsid IgG, detecting contact with the virus, were positive in 3 (15%) patients at T0 and 4 (20%) at T1 but no COVID-19 infection was reported in the study period (figure 1).


Our study suggests that HD patients maintain a reasonable immune protection after three doses of an mRNA COVID-19 vaccine that further increases after the 4th dose.
The first and second authors contributed equally to this work.

Figure 1: Humoral and cellular immune levels before and after the fourth COVID-19 vaccine dose in HD patients.


  • Commercial Support – Fresenius Medical Care