SARS-CoV-2 vaccine effectiveness and breakthrough infections in maintenance dialysis patients

Among patients receiving maintenance dialysis with a national US dialysis provider, fully vaccinated dialysis patients were significantly less likely to be diagnosed with COVID-19 or be hospitalized than unvaccinated patients. Ad26.COV2.S/Janssen vaccine had significantly worse outcomes, and mRNA-1273/Moderna the best. Among the 27 patients with breakthrough COVID-19 and anti-spike IgG antibodies measured, 23/27 (85%) breakthrough COVID-19 cases occurred at titers <2 U/L (lower limit of a positive response); 14 of these patients never developing Ab titers above 2 U/L. Only 3/27 were receiving immunosuppression. The potential use of antibody titers to guide vaccinations should be explored.