Kidney Week

Abstract: TH-PO1149

Vaccination Strategies in Patients Receiving Dialysis: Should We Watch the Clock?

Session Information

• COVID-19
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Coronavirus (COVID-19)

• 000 Coronavirus (COVID-19)

Authors

• Subramanian, Nivetha, Stanford Medicine, Stanford, California, United States

Nivetha Subramanian, MD

• Yu, Xue, Stanford Medicine, Stanford, California, United States

Xue Yu, MS

• Varkila, Meri, Stanford Medicine, Stanford, California, United States

Meri Varkila, MD

• Block, Geoffrey A., US Renal Care Inc, Decatur, Georgia, United States

Geoffrey A. Block, MD, FASN

• Parsonnet, Julie, Stanford Medicine, Stanford, California, United States

Julie Parsonnet, MD

• Chertow, Glenn M., Stanford Medicine, Stanford, California, United States

Glenn M. Chertow, MD, MPH, FASN

• Anand, Shuchi, Stanford Medicine, Stanford, California, United States

Shuchi Anand, MD, MS

• Montez-Rath, Maria E., Stanford Medicine, Stanford, California, United States

Maria E. Montez-Rath, PhD

Background

Previous studies reported that early morning vaccination was associated with a more robust antibody response than late afternoon or evening vaccination. Circadian changes in the immune system may yield better immunogenicity in the morning than later in the day. We examined peak and longitudinal SARS-CoV-2 antibody response by vaccine timing in a nationwide cohort of patients on hemodialysis.

Methods

Patients were documented in the electronic medical record to have received at least 1 dose of mRNA vaccine at the dialysis facility during their assigned shift and had available data on antibody indices after 1^st dose (n=1229). Using a semiquantiative Siemens RBD IgG assay and quantile regression, we estimated unadjusted and adjusted median RBD IgG indices over time by dialysis shift.

Results

The mean age of patients receiving vaccine in the early morning (~530 am) shift was younger than those in the mid-day (~10 am) or late afternoon (~2 pm) shifts: 60(SD 13), versus 66(13) and 62(15) years, respectively. Patients in the early morning shift were more likely to receive the BNT162b.2 vaccine than those who dialyzed in mid-day or late afternoon shifts (57% versus 52% and 42%, respectively). A larger proportion of patients who dialyzed in early morning (19%) had detectable RBD IgG indices prior to vaccine compared with patients in mid-day (12%) and late afternoon (14%) shifts. In unadjusted analyses, the early morning cohort had higher RBD IgG indices 30-60 days post-vaccine. Adjusting for age, diabetes, years on dialysis, type of vaccine, and baseline IgG eliminated difference by shift (Fig1).

Conclusion

In this nationwide cohort of patients receiving dialysis and mRNA vaccines, we found that early morning vaccination did not yield a better immunogenicity as measured by antibody response. Prior analyses reporting an association of vaccine timing with immune response may not have accounted for prior SARS-CoV-2 infection or other relevant differences in patient characteristics.

Funding

• Other NIH Support