Dialysis patients remain vulnerable to Omicron as England scraps Plan B measures
• Patients on in-hospital dialysis were found to have low antibody levels against Omicron two doses of the vaccine
• A third dose improved the response but a substantial fraction of dialysis patients will remain vulnerable to Omicron infection
• Evidence arrives as England scraps Plan B measures including mask mandates and vaccine passports
• Research suggests that a fourth dose of the Covid-19 vaccine may be required for kidney patients to provide sufficient protection
• Dialysis patients continue to remain vulnerable to the virus, and are regularly exposed to clinical environments while receiving life-saving treatment
London 21 January 2022: As the government in England relax the latest set of Covid restrictions, new data from researchers at the Francis Crick Institute raise concern of the impact on dialysis patients. Published as a research letter in The Lancet, the results show that, even after third doses of vaccination, a significant fraction of patients receiving in-hospital dialysis treatment appear to remain at risk from the Omicron variant.
The ongoing NAOMI study, funded by a coalition of kidney charities including Kidney Research UK, the National Kidney Federation, Kidney Wales, the PKD Charity and several Kidney Patient Associations, showed that the variant continues to pose a risk to kidney disease patients on dialysis despite them having received a second or even third dose of the vaccine.
Researchers showed that after three vaccine doses, patients had lower levels of neutralising antibodies- antibodies that are able to block entry of the virus into cells- against Omicron when compared to Delta. Additionally, patients who received just two doses of the vaccine were also less likely to show a detectable antibody response to Omicron than Delta. With two doses of the Oxford/AstraZeneca vaccine, antibody levels were too low to detect for both variants in most patients. This is important because neutralising antibodies are a crucial component of the protection afforded by vaccination.
Patients who had received the Oxford/AstraZeneca vaccine for their first two doses were less likely to have detectable levels of antibodies able to neutralise Omicron. Only 48% of this group had detectable neutralising antibody levels after 3 doses, compared to 72% of patients who had the Pfizer-BioNTech mRNA vaccine for their first two doses.
The majority of kidney patients on dialysis are currently only eligible for two primary doses of the vaccine as well as a booster. The results of this latest study reveal that kidney patients on in-hospital dialysis remain vulnerable to the latest dominant variant, and also suggest that they may require a fourth dose of the Covid-19 vaccine to ensure adequate protection from Omicron.
Dr Aisling McMahon, Executive director of Research, Innovation and Policy at Kidney Research UK, said: “As the pandemic continues, it is extremely important that we continue to monitor how well the vaccines are protecting kidney patients. These findings clearly show that many patients on dialysis are still vulnerable to Covid-19 infection, particularly the Omicron variant, even after three vaccine doses. We believe this study provides strong evidence that patients who travel to hospital for dialysis should receive a fourth vaccine dose to ensure they have the best protection possible.”
The research team measured the levels of neutralising antibodies against the Omicron and Delta variants in 98 patients who travel to hospital for dialysis sessions. All patients studied had received at least their second or even third dose of the Covid-19 vaccine.
Rupert Beale, head of the Crick’s Cell Biology of Infection Laboratory, said: “New variants will continue to arise as the pandemic evolves, and for vulnerable patients, it’s especially important to assess the specific risks. We’ve shown that Omicron has raised the threshold for effective protection and that patients undergoing dialysis shouldn’t assume protection after three doses. Our study suggests four doses of vaccine would benefit dialysis patients.”
Edward Carr, postdoctoral clinical fellow in the Crick’s Cell Biology of Infection Laboratory, said: “Patients in need of kidney dialysis treatment are making regular visits to hospital and are also more vulnerable to severe COVID-19 infection. Some of these patients are considered to be immunocompromised because of the medication they’re taking or their comorbidities. Currently, just these patients – and not all dialysis patients – are automatically offered a fourth vaccine dose.
“Our data supports fourth doses for all kidney dialysis patients to maximise levels of protection in this group.”
Researchers are continuing to monitor both the impact of new variants and the number of vaccines needed to offer sufficient protection to those in the most vulnerable categories. The results of this most recent study add to the existing evidence for the Joint Committee on Vaccination and Immunisation to consider recommending a fourth dose for kidney patients on dialysis.
About the study:
The team from the Francis Crick Institute measured the levels of neutralising antibodies against the Omicron and Delta variants in 98 patients who travel to hospital for dialysis sessions at around 158 days after their second dose of vaccine and at around 27 days after their third vaccine dose. The patients’ first and second doses were either Pfizer/BioNTech or Oxford/AstraZeneca. All patients received the Pfizer/BioNTech vaccine for their third dose.
The NAOMI study is funded by Kidney Research UK, NKF, PKD charity, Kidney Wales and several Kidney Patient Associations [Exeter, North Staffs and South Cheshire, Northamptonshire, South Eastern and Wessex], the MRC and core funding from the Francis Crick Institute, which receives its funding from Cancer Research UK, the UK Medical Research Council, and the Wellcome Trust.
About Kidney Research UK
As the largest kidney research charity in the UK, nothing is going to stop us in our urgent mission to end kidney disease. We’re here to be heard, to make a difference, to change the future. This is a disease that ruins and destroys lives. It must be stopped.
Over the past 60 years, our research has made an impact. But kidney failure is rising, as are the factors contributing to it, such as diabetes and obesity.
Today, we are more essential than ever.
Kidney disease affects three million people in the UK, treatments can be gruelling and currently there is no cure. Only research will end this.
About the Francis Crick Institute
The Francis Crick Institute is a biomedical discovery institute dedicated to understanding the fundamental biology underlying health and disease. Its work is helping to understand why disease develops and to translate discoveries into new ways to prevent, diagnose and treat illnesses such as cancer, heart disease, stroke, infections, and neurodegenerative diseases.
An independent organisation, its founding partners are the Medical Research Council (MRC), Cancer Research UK, Wellcome, UCL (University College London), Imperial College London and King’s College London.
The Crick was formed in 2015, and in 2016 it moved into a brand new state-of-the-art building in central London which brings together 1500 scientists and support staff working collaboratively across disciplines, making it the biggest biomedical research facility under a single roof in Europe.