Comparison of immunogenicity of mRNA and protein subunit SARS-CoV-2 vaccines in dialysis patients: a multicenter study.

Patients on maintenance hemodialysis (HD) have impaired immune function and are at high risk of severe COVID-19; however, comparative data on immunogenicity and vaccine choice behavior between mRNA and protein subunit SARS-CoV-2 vaccines remain limited. In this observational study, 227 participants (202 patients on HD and 25 non-dialysis individuals) received either an mRNA vaccine (BNT162b2) or a protein subunit vaccine (NVX-CoV2373) in 2024 vaccination season. Anti-SARS-CoV-2 spike antibody levels were assessed at weeks 0, 4, and 24, with week 4 defined as the primary outcome and week 24 as a secondary time point for longer-term persistence; the association between previous adverse events and vaccine choice was evaluated. At week 4, BNT162b2 induced significantly higher antibody levels than NVX-CoV2373 in patients on HD. BNT162b2 also induced significantly higher antibody levels than NVX-CoV2373 in non-dialysis individuals. Antibody levels declined by week 24 in both vaccine groups, although differences in antibody levels were observed up to week 24. Previous adverse events did not deter selection of BNT162b2 (OR 8.08, 95% CI 0.98-66.5), although this association may reflect participant perceptions or other unmeasured factors. Non-dialysis subgroup with limited number of patients also showed higher antibody levels in the BNT162b2 group. These findings suggest that BNT162b2 is associated with higher anti-spike antibody levels at predefined post-vaccination time points in patients on HD. However, these findings should be interpreted cautiously because clinical outcomes and formal antibody decay modeling were not evaluated.