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Abstract: FR-PO1098

Malnutrition Is a Risk Factor for Lower Humoral Immune Response After Anti-SARS-CoV-2 Vaccination in Patients on Hemodialysis: A Multi-Center Clinical Study

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)


  • Toro, Luis, Hospital Clinico Universidad de Chile, Santiago, Chile
  • Clavero, Rene, Hospital Gustavo Fricke, Valparaiso, Chile

Malnutrition is frequent in patients with end-stage renal disease (ESRD). This condition is an independent risk factor for developing adverse events, including severe infections and infection-related deaths. Previous studies have shown that patients with malnutrition, both in the general population and ESRD patients, have an impaired immune response. Currently, there is little data on malnutrition's effects on the induction of the immune response to anti-SARS-CoV-2 vaccination. Therefore, our objective was to evaluate the impact of malnutrition on the humoral immune response after anti-SARS-CoV-2 vaccination in ESRD patients on hemodialysis.


Prospective cohort of ESRD patients on chronic hemodialysis who received a three-dose anti-SARS-CoV-2 immunization schedule between 2021 and 2022. We measured the plasma levels of anti-SARS-CoV-2 IgG antibodies before vaccination, four months after doses 2,3 and 4. Based on anthropometric parameters and subjective global assessment (SGA), we stratified patients according to their baseline nutritional status. In addition, we evaluated potential predictors of humoral response using multivariate analysis.


214 patients were evaluated in four hemodialysis centers. Age: 63.7 ± 16.3 years, men: 116 (54.2%). 41 patients (19.1%) were diagnosed with malnutrition. Malnourished patients had a lower humoral response after anti-SARS-CoV-2 vaccination compared to those without malnutrition (4 months after the second dose: 61.3% vs. 79.4%, p<0.01; 4 months after the third dose: 78.3% vs 93.1%, p<0.01. Figures 1 and 2). Multivariate analysis indicated that malnutrition is an independent risk factor for a decreased humoral immune response after vaccination (OR: 3.1, [1.5-9.9], p=0.01).


Our results suggest malnutrition is a risk factor for a lower humoral response after anti-SARS-CoV-2 vaccination in ESRD patients on hemodialysis. These data suggest that improving nutritional status can improve the post-vaccination immune response, which should be evaluated in future studies.
Study supported by FONDECYT Regular 1221571.


  • Government Support – Non-U.S.