Kidney Week

Abstract: SA-PO0536

Nasal Antibody Responses to the 20-Valent Pneumococcal Conjugate Vaccine (PCV20) in Patients with CKD and Patients on Dialysis

Session Information

• CKD: Clinical - Therapies, CKM Health, Special Populations, and More
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Jain, Swati, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Swati Jain, PhD

• Wills, Kelly M., VA Eastern Colorado Health Care System, Aurora, Colorado, United States

Kelly M. Wills, RN

• Silveira, Lori, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Lori Silveira, PhD

• Nicholson, Lindsay K., VA Eastern Colorado Health Care System, Aurora, Colorado, United States

Lindsay K. Nicholson, MD

• Janoff, Edward N., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Edward N. Janoff, MD

• Jani, Alkesh, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Alkesh Jani, MD

Background

Mucosal immunity plays a central role in protection against pneumococcal colonization and respiratory infection. While pneumococcal conjugate vaccines induce robust systemic antibody responses, their ability to generate mucosal antibodies in the upper respiratory tract remains less well defined. This question is particularly relevant in chronic kidney disease (CKD) and dialysis populations, who are at increased risk of pneumococcal disease. Data on mucosal antibody responses following PCV-20, especially across CKD severity stages, is limited.

Methods

Previously-vaccinated adults >50 years with CKD stage III/IV (n=37), stage V and on dialysis (n=10) and control subjects without CKD (n=34) received PCV-20. Nasopharyngeal samples were collected at baseline and week 4 post-vaccination. We measured both total and specific IgA and IgG against selected pneumococcal capsular polysaccharide serotypes (PPS) that were locally prevalent in Colorado (serotypes 3, 4, and 12F), that elicited the most robust serum responses in these groups (serotypes 7F, 14, and 10A) and serotype 19F which met both criteria.

Results

Levels of total nasal IgA exceeded IgG in all groups (median ~74% vs ~24%, respectively). Baseline PPS-specific nasal IgA and IgG levels were low and variably detectable across groups. Following vaccination, no significant increase in nasal PPS-IgA or -IgG was observed for any of the evaluated serotypes in CKD II/IV, CKD V/dialysis or healthy control groups. This pattern was consistent across both locally prevalent and immunogenic serotypes. No consistent differences were observed between CKD stages, dialysis, or controls.

Conclusion

PCV-20 does not induce measurable nasal IgA or IgG responses to pneumococcal capsular antigens in previously-vaccinated CKD, dialysis, or healthy individuals, even for serotypes with strong systemic immunogenicity or regional prevalence. These findings suggest that systemic vaccination does not translate into detectable mucosal antibody boosting in the upper respiratory tract of adults across CKD severity stages.

Funding

• Veterans Affairs Support