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Immune Response to Vaccines in Dialysis Patients: Covid-19 and Beyond

Patients on dialysis have often shown an impaired response to different vaccines, whose mechanism has not been fully elucidated. However, Covid-19 vaccines have provided a unique opportunity to deeply analyze the immune response in this population. Most recent data indicate that seroconversion rates may not reflect the real neutralizing activity of vaccine-induced antibodies. Therefore, continuous immune monitoring with proper serological tests is crucial to adopt the best prevention and therapeutic strategy.

Patients with end-stage kidney disease (ESKD) are highly predisposed to infections, which are the major causes of morbidity and the second cause of mortality in this vulnerable population. Many studies showed an overall reduced response to different vaccines, including those against Influenza virus and HBV. It has long been established that uraemia is associated with an acquired immunodeficiency state induced by dysregulation of the immune system. Although not completely elucidated, complex and multifactorial causes, including dysfunction in neutrophils, macrophages, B cells, T cells and in complement activation are involved in the immune dysregulation observed in ESKD. Paradoxically, concomitant signs of activation of immune cells have been described in dialysis patients, which are further accentuated rather than corrected by renal replacement treatments.1 Nevertheless, a delayed and impaired antibody response and rapid waning of immunity to different vaccines, including those against HBV, suggests the importance of continuous immune monitoring and specific booster protocols in these patients.

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