Anand S, Montez-Rath ME, Han J, et al. (881K) GUID:?F7B98D7A-EE0D-4A0D-A240-96D0406F7D3D 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. Abstract 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 8-Gingerol meta-analysis used articles from PubMed, Medline, and Embase published before July 30, 2021, as well as articles in the 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 8-Gingerol 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; server included statistic was used to assess the heterogeneity of the pooled estimate, where a value greater than 0.5 was considered substantially heterogenous. To explore the potential source of heterogeneity, we conducted several subgroup analyses using mixed effects models, including (1) incomplete, complete, or booster vaccination protocols; (2) populations with prior SARS-CoV-2 infection or without prior SARS-CoV-2 infection; and (3) kidney replacement therapy modality, including hemodialysis or peritoneal dialysis. We also performed univariate random-effects meta-regression analysis using the following study-level explanatory variables: mean age, the proportion of women, mean dialysis vintage, and the prevalence of diabetes. Of note, all subgroup analysis (except regarding SARS-CoV-2 infection status) and meta-regression were 8-Gingerol performed in the selected studies that enrolled SARS-CoV-2Cnaive populations with complete vaccine protocols. In addition, the preprinted articles were excluded to assess the robustness of the overall result in sensitivity analysis. The secondary outcome, immunogenicity rates of patients receiving dialysis compared with individuals not receiving dialysis, was summarized as the pooled relative risk using the DerSimonian-Laird random-effects model. The pooled estimate of secondary outcomes between the studies with complete and those with incomplete protocols was further compared using the mixed effects model. Finally, using the overall analysis of primary outcome, publication bias was assessed using visual check by funnel plot and formal statistical test by the Egger intercept test. All analyses were conducted using Comprehensive Meta-Analysis Software version 3.3.070 (Biostat). values were 2-sided, and statistical significance was set at server, 184 potentially eligible preprint studies were recognized. After the titles and abstracts were screened, the full texts were examined to further determine study eligibility. After the exclusion of irrelevant studies, including studies not dealing with the outcome of interest and studies only based on ESKD with kidney transplant human population, 32 studies,5,6,7,8,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31 including 6 preprint content articles,32,33,34,35,36,37 were included in the meta-analysis (eFigure 1 in the Product). The extracted data are summarized in Table 1 and Table 2. Table 1. Characteristics, Vaccine Type, and Vaccine Protocols of Included Studies server and another 5 studies from enrolled studies only reported the immunogenicity rates of individuals receiving dialysis who did not total the vaccination protocol (ie, those who received only 1 1 dose of the BNT162b, AZD1222, or mRNA-1273 vaccines).7,11,12,13,37 Other articles reported an antibody response rate after the second dose with or without reporting the response rate after the first dose. Three Rabbit Polyclonal to DGKI studies discussed immunogenicity rates after the booster shot.14,15,16 The mean age of the participants ranged from 60.5 to 76 years (Table 1). Hemodialysis was the predominant kidney alternative therapy modality. Five studies enrolled people receiving combined peritoneal dialysis and hemodialysis,12,16,17,18,34.