On Thursday 17 June, kidney doctors and scientists gathered online to share and discuss the very latest research working out how best to protect kidney patients from Covid-19.
At the webinar, hosted by the UK Kidney Association, the British Transplant Society, the Royal Society of Medicine and Kidney Research UK, experts presented very early results from lab studies investigating how well vaccines work in kidney patients, whether patients are still becoming ill with Covid-19, and outlined clinical trials investigating alternative ways of providing protection. The webinar was aimed at a professional audience and included a lot of complex information.
We’ve summarised the information here, including when we can expect results from studies, and explain what it means for you.
1. Covid-19 vaccines work in most people – so please get both vaccines
According to research studies abroad, around 80% of people on haemodialysis are generating antibodies against Covid-19 around four weeks after their second dose. Dr Ed Carr presented very early data that is emerging from the first study in patients in the UK – a multi-centre vaccine response study that we are helping to fund.
These early results suggest that dialysis patients are responding to the first dose of the vaccine and mount a promising immune response, which is encouraging news. The research team will now follow what happens after a second dose.
These results collectively confirm that as far as we know, vaccines are the best way to protect yourself as much as you can from Covid-19. Having a second dose strengthens immunity against the virus even more than the first dose. Only re-consider having a second dose if you had a serious side effect from the first one, and your doctor advises against it.
This means the advice has not changed – it is recommended that you and your families have the vaccine when you are offered it.
2. Covid-19 vaccines do not work as well for some immunosuppressed patients
At the event, Dr Michelle Willicombe from Imperial College London summarised research from around the world studying how well vaccines work in people who are immunosuppressed. You can also read Ed Carr's blog, which explains this in much more detail.
These studies are more difficult to compare, for several reasons. First, immunosuppression medications vary between centres – it’s possible a centre reports low numbers of antibodies because they use stronger immunosuppression. Or there might be something else that is different about their patients – for example their group of patients are younger than the others.
In the biggest single study, kidney transplant patients who are immunosuppressed don’t respond as well to the vaccine as other groups, with just over half of these people developing antibodies to the virus after a second vaccine dose. At this webinar, Michelle presented some early results from her research – the first study testing this in the UK population. Although early data, it backs up the findings from international studies that not all kidney transplant patients develop antibodies. However, there is encouraging data from the US, that immune responses can be detected after three vaccine doses.
Further, it is believed that the degree of immunosuppression someone receives may determine their immune response (amongst other things like their age and whether they have had a Covid-19 infection before vaccination). In general, stronger immunosuppression treatment means you are less likely to be able to develop antibodies to Covid-19 than someone else whose treatment is less strong. For example, if you have had a liver transplant you need less immunosuppression, so liver transplant recipients as a group are more likely to develop antibodies than people who have had a kidney transplant.
It’s really important to highlight here that antibodies don’t tell the full story – our immune systems are complex. We know the most about antibodies after Covid-19 vaccination because they are the easiest part of the immune system to measure. But these are only one element of the immune system. Antibodies are the first line of defence the vaccine provides if you encounter the virus, but the vaccines also stimulate immune cells called T cells. We don’t yet know much about how T cells behave after the Covid-19 vaccines as they are more difficult to study. There are studies happening now to find out more about T cells and also B cells (that make the antibodies) that will tell us more.
The OCTAVE study in the UK is likely to report on T cells, and antibodies, later in 2021. It’s also important to remember that people on immunosuppressants sometimes don’t respond to other vaccines too, such as the flu vaccine, for the same reason – their immune systems cannot always mount a strong response. But people are still advised to have those vaccines, because, as before, some protection from these conditions is better than none.
Read on to find out what the studies tell us about the protection the vaccines might give kidney patients.
3. Immunosuppressed patients should continue to be cautious
There is no simple way to know if the vaccine will protect you completely from disease, particularly if a new variant of the virus emerges that ‘looks’ different enough to be missed by the vaccine response.
The studies happening now will give us lots of information about how kidney patients are responding. But because the studies described above are beginning to suggest that vaccines don’t work for everyone, immunosuppressed patients should be alert and continue to take precautions and protect themselves as much as they can.
One way to protect yourselves is to ensure your household members are fully vaccinated, so you are less likely to be exposed to the virus. In March 2021, the JCVI recommended that over 16s who share a household with severely immunosuppressed patients are offered COVID-19 vaccination as this may reduce the risk of infection in immunosuppressed groups.
Social distancing and avoiding crowded places, avoiding travelling to high-risk countries, only meeting others outside, and always wearing a face mask remain important. These are even more important if cases creep up and as lockdown restrictions are rolled back. You can also access free, twice-weekly lateral flow tests on the NHS, so kidney patients and members of their households could do this now. We know this is once again a worrying time for patients in this group. Just as the country appears to be ‘opening up’ again, uncertainties and worry remain for you.
You may be asked to return to work, so check out Government guidelines about staying safe at work. Studies are now beginning to report that having a third dose could help to boost immunity further. The Government has already been discussing third doses for all over-50s in the UK later in 2021. Some really encouraging news is coming from a very recent study, which although it has only tested 30 patients, suggests a third dose can benefit patients who have had an organ transplant of any type (not just kidneys).
There are also ongoing trials (not in kidney patients) looking at whether switching between vaccines can help to give immunity to Covid-19. Some countries have already decided to give a third dose to kidney transplant patients. It’s a little different in the UK, so we need the UK data to come in for the JCVI to give a view. It may turn out that a third dose is recommended for transplant patients.
4. More treatments are now available, should you catch Covid-19
Thanks to research across the world, there are far more tools in our armoury should people catch the virus and become ill with it. There’s a good summary of these in a recent article in the British Medical Journal. This means kidney patients now have access to a greater number of treatments should they become infected with Covid-19. We hope that despite some of the uncertainty about the vaccine and the protection it provides, the fact we now have more treatments means if you do catch the virus, you are much less likely to become seriously ill or die from it.
5. Vaccines might not be the only way to protect kidney patients
Researchers are now exploring more ways to protect kidney and immunosuppressed patients from Covid-19, over and above vaccinations. This includes the work that Dr Rona Smith presented at the webinar about the PROTECT-V trial, which our research partners, Kidney Research UK, are helping to fund.
This exciting platform trial, which now has urgent public health badging from the Government, is testing whether a drug usually used to treat tapeworm, called niclosamide, can protect kidney patients from developing Covid-19 when delivered as a nasal spray. The trial began in Cambridge in February 2021 and is now rolling out fast across the country, recruiting patients through several renal centres across the UK. If you are interested in taking part, talk to your kidney doctor to see if you are eligible.
Making sense of this information
There was a lot of complex information presented in this seminar, so we have tried to translate this above. There are a few important points to bear in mind:
- The dialysis data is very early stage and will need to be clarified before we make any conclusions about what it means for patients
- While the international data is already published on people who are immunosuppressed, the UK data is still early stage. This needs to be confirmed and we need to see what happens after further vaccine doses
- While antibody tests are important, they don’t provide the full picture of how our immune systems protect us from Covid-19, as we have explained above.
- We need to ensure antibody tests reflect what we see in the clinic. Dr Rommel Ravanan from NHS Blood & Transplant described how we are seeing fewer people who have had transplants becoming ill or dying from Covid-19 infections after vaccines, which is reassuring, but this needs to be correlated with the antibody tests.
Messages to take away
Just to summarise the messages we have heard:
- Covid-19 vaccines work in most people – so get both vaccines (and get your families vaccinated too)
- Covid-19 vaccines do not work as well for some immunosuppressed patients, although the early data needs to be confirmed Immunosuppressed patients should continue to be cautious
- More treatments are now available, should you catch Covid-19 Vaccines might not be the only way to protect kidney patients - researchers are exploring additional ways that could help
The kidney charities and professional organisations are now urgently working together to plan how to use this information to help patients.
Find out more
Visit Covid-19 and Polycystic Kidney Disease to find out more about Covid-19 vaccines and the latest guidelines for PKD patients and their families to stay safe during these challenging times.
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