Response to three doses of the Pfizer/BioNTech BNT162b2 COVID-19 vaccine: a retrospective study of a cohort of haemodialysis patients in France.

BACKGROUND: The mortality rate associated with coronavirus disease 2019 (COVID-19) is high among haemodialyzed patients. We sought to describe the serological status of haemodialysis patients having received up to three doses of BNT162b2 mRNA vaccine, and to identify factors associated with a poor humoral response. METHODS: We performed a retrospective, observational study of patients attending a dialysis centre in Antibes, France. One or two of each patient's monthly venous blood samples were assayed for anti-spike (S1) immunoglobulin G (IgG). RESULTS: We included 142 patients, of whom 124 remained COVID-19-negative throughout the study. Among these COVID-19-negative patients, the humoral immune response rate (defined as an anti-S1 IgG titre ≥1.2 U/ml) was 82.9% after two injections and 95.8% after three injections, and the median [interquartile range] titre increased significantly from 7.09 [2.21; 19.94] U/ml with two injections to 93.26 [34.25; 176.06] U/ml with three. Among patients with two injections, the mean body mass index and serum albumin levels were significantly higher in responders than in non-responders (26.5 kg/m2 vs. 23.2 kg/m2, p = 0.0392; and 41.9 g/l vs. 39.0 g/l, p = 0.0042, respectively). For the study population as a whole at the end of the study, a history of COVID-19, at least two vaccine doses, and being on the French national waiting list for kidney transplantation were the only factors independently associated with the anti-S1 IgG titre. CONCLUSIONS: Dialysis patients vaccinated with two doses of BNT162b2 might not be sufficiently protected against SARS-CoV-2 and so should receive a third (booster) dose. TRIAL REGISTRATION: The present retrospective study of clinical practice was not interventional and so was not registered.

Patients with ANCA-associated vasculitis admitted to the intensive care unit with acute vasculitis manifestations: a retrospective and comparative multicentric study.

PURPOSE: Data for ANCA-associated vasculitis (AAV) patients requiring intensive care are scarce. METHODS: We included 97 consecutive patients with acute AAV manifestations (new onset or relapsing disease), admitted to 18 intensive care units (ICUs) over a 10-year period (2002-2012). A group of 95 consecutive AAV patients with new onset or relapsing disease, admitted to two nephrology departments with acute vasculitis manifestations, constituted the control group. RESULTS: In the ICU group, patients predominantly showed granulomatosis with polyangiitis and proteinase-3 ANCAs. Compared with the non-ICU group, the ICU group showed comparable Birmingham vasculitis activity score and a higher frequency of heart, central nervous system and lungs involvements. Respiratory assistance, renal replacement therapy and vasopressors were required in 68.0, 56.7 and 26.8% of ICU patients, respectively. All but one patient (99%) received glucocorticoids, 85.6% received cyclophosphamide, and 49.5% had plasma exchanges as remission induction regimens. Fifteen (15.5%) patients died during the ICU stay. The following were significantly associated with ICU mortality in the univariate analysis: the need for respiratory assistance, the use of vasopressors, the occurrence of at least one infection event in ICU, cyclophosphamide treatment, sequential organ failure assessment at admission and simplified acute physiology score II. After adjustment on sequential organ failure assessment or infection, cyclophosphamide was no longer a risk factor for mortality. Despite a higher initial mortality rate of ICU patients within the first hospital stay (p < 0.0001), the long-term mortality of hospital survivors did not differ between ICU and non-ICU groups (18.6 and 20.4%, respectively, p = 0.36). Moreover, we observed no renal survival difference between groups after a 1-year follow-up (82.1 and 80.5%, p = 0.94). CONCLUSION: This study supports the idea that experiencing an ICU challenge does not impact the long-term prognosis of AAV patients.