Immunogenicity Rates After SARS-CoV-2 Vaccination in People With End-stage Kidney Disease: A Systematic Review and Meta-analysis | Chronic Kidney Disease | JN Learning | AMA Ed Hub [Skip to Content]
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Immunogenicity Rates After SARS-CoV-2 Vaccination in People With End-stage Kidney DiseaseA Systematic Review and Meta-analysis

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To identify the key insights or developments described in this article
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Key Points

Question  What are the immunogenicity rates in people with end-stage kidney disease receiving SARS-CoV-2 vaccines?

Findings  This systematic review and meta-analysis of 32 studies found that patients receiving dialysis had lower immunogenicity rates after first and second vaccine doses than those not receiving dialysis. Prevalence of diabetes had an inverse linear association with immunogenicity rate.

Meaning  These findings suggest that the immunogenicity rate after vaccination was lower in patients receiving dialysis and that diabetes might be a risk factor for nonresponse to vaccination.


Importance  Adults receiving dialysis treatment have a higher likelihood of death when infected with SARS-CoV-2 than adults not receiving dialysis treatment. To date, the immune response of people receiving dialysis after SARS-CoV-2 vaccination has not been systematically discussed.

Objective  To assess immunogenicity rates in people with end-stage kidney disease (ESKD) receiving SARS-CoV-2 vaccines, explore postvaccination potential risk factors for nonresponse, and assess whether receiving dialysis is associated with different antibody response rates compared with the nondialysis population.

Data Sources  This systematic review and meta-analysis used articles from PubMed, Medline, and Embase published before July 30, 2021, as well as articles in the medRxiv preprint server.

Study Selection  Studies that evaluated the immunogenicity rate according to the postvaccine antibody response rate in patients with ESKD receiving dialysis were selected.

Data Extraction and Synthesis  The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A random-effects model was used. Two independent reviewers conducted the literature search and extracted the data.

Main Outcomes and Measures  The primary outcome was the pooled antibody postvaccine response rates in individuals with ESKD. The secondary outcomes were pooled response rates in individuals receiving and not receiving dialysis. Subgroup analysis and meta-regression were conducted to identify the sources of heterogeneity.

Results  A total of 32 studies were included. The overall immunogenicity rate of the dialysis group was 86% (95% CI, 81%-89%). Meta-regression showed a significant difference was detected in the postvaccine response rate on the basis of prevalence of diabetes (regression coefficient, −0.06; 95% CI, −0.10 to −0.02; P = .004). Compared with nondialysis controls, patients in the dialysis group had a lower response rate after the first (relative risk [RR], 0.61; 95% CI, 0.47-0.79; I2 = 70.2%) and second (RR, 0.88; 95% CI, 0.82-0.93; I2 = 72.2%) doses, with statistically significantly increased RR between first and second doses (P = .007).

Conclusions and Relevance  These findings suggest that the immunogenicity rate among patients receiving dialysis was 41% after the first dose and 89% after the second dose. Diabetes might be a risk factor for nonresponse in the dialysis population. Patients receiving dialysis had a poorer antibody response rate than did individuals not receiving dialysis, particularly after the first dose.

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Article Information

Accepted for Publication: August 27, 2021.

Published: October 28, 2021. doi:10.1001/jamanetworkopen.2021.31749

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Chen JJ et al. JAMA Network Open.

Corresponding Author: Chih-Hsiang Chang, MD, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan (

Author Contributions: Drs Chang and Chen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Chen, T.H. Lee, Tian, Chang.

Acquisition, analysis, or interpretation of data: Chen, C.-C. Lee, Fan, Chang.

Drafting of the manuscript: Chen.

Critical revision of the manuscript for important intellectual content: T.H. Lee, Tian, C.-C. Lee, Fan, Chang.

Statistical analysis: Chen, Fan, Chang.

Obtained funding: Fan, Chang.

Administrative, technical, or material support: T.H. Lee, Fan, Chang.

Supervision: Tian, C.-C. Lee.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by grant No. CMRPG5K0141 from Chang Gung Memorial Hospital, and Dr Chang was supported by grant No. 109-2314-B-182A-124 from the Ministry of Science and Technology.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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