Longitudinal dynamics of humoral immune responses following serial COVID-19 vaccinations and breakthrough infections in dialysis patients

Sep 16, 2025Human vaccines & immunotherapeutics

Changes in antibody responses over time after multiple COVID-19 vaccines and infections in dialysis patients

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Abstract

Seroprotection rates reached nearly 100% in dialysis patients after the third and subsequent COVID-19 vaccine doses.

  • Initial seroprotection was low, with only 16% achieving neutralizing inhibition and 2% anti-RBD seroprotection after the first vaccine dose.
  • Neutralizing inhibition increased significantly from 5% after the first dose to approximately 90% after doses four to six.
  • Anti-RBD antibody levels declined substantially, by 66%-85% after 6 months and over 90% by 12-15 months.
  • Younger age, receipt of a fourth dose, and the type of vaccine were identified as significant predictors of higher neutralizing antibody titers.
  • Breakthrough infections resulted in higher and more sustained anti-RBD antibody levels, especially in patients with .
  • Patients exhibiting stronger immunity reported fewer symptoms following COVID-19 infection.

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Key numbers

~100%
Increase in Neutralizing Antibody Seroprotection
Seroprotection rates after the third vaccine dose
>90%
Decline in Anti- Titers
Decline observed by 12-15 months post-vaccination
67%
Higher Anti- Titers Post-Breakthrough Infection
Decline in anti- titers at 6 months post-infection followed by vaccination

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