RECOVAC - Long Term Efficacy and Safety of COVID-19 (SARS-CoV-2) Vaccination in Kidney Disease Patients

Covid19 Clinical Trial

— LESS CoV-2  

Official title:

The RECOVAC LESS CoV-2 Study - Long Term Efficacy and Safety of SARS-CoV-2 Vaccination in Patients in Patients With Chronic Kidney Disease Stage G4-G5, on Dialysis or After Kidney Transplantation

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04841785
• Other study ID #: NL76839.042.21
• Status: Completed
• Start date: April 22, 2021
• Est. completion date: December 18, 2023

Study information

• Verified date: March 2024
• Source: University Medical Center Groningen
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Rationale: COVID-19 is associated with severely increased morbidity and mortality in patients with chronic kidney disease stage G4-G5 and patients on dialysis or after kidney transplantation. Therefore, effective SARS-CoV-2 vaccination would be of great clinical importance in these patients. However, SARS-CoV-2 vaccination studies have excluded these patients so-far. Literature data indicate that vaccination may be less effective in these patient groups. Objective: To assess the efficacy and safety of SARS-CoV-2 vaccination in patients with chronic kidney disease stage G4-G5, patients on dialysis or after kidney transplantation during two years follow-up after vaccination. Study design: prospective single center observational cohort study. Study population: - all Dutch patients on dialysis with data registered in the Dutch Dialysis registry (RENINE) - all Dutch patients after kidney transplantation with data registered in the Dutch national kidney transplant registry (NOTR). - All Dutch patients with chronic kidney disease stage G4-G5 registered in the Santeon hospitals. Intervention: After SARS-CoV-2 vaccination according to standard of care, blood will be drawn for antibody response measurements at day 28 and month 6 after 2nd vaccination at by mailer-based finger-prick in 3400 hemodialysis patients, 600 peritoneal dialysis patients, 4000 patients after kidney transplantation and 4000 patients with chronic kidney disease stage G4-G5. Patients who will undergo a 3rd SARS-CoV-2 vaccination via the national vaccination program for immunocompromised patients will be asked to carry out the mailer-based finger-prick 28 days after the 3rd SARS-CoV-2 vaccination, instead of the antibody measurement 6 months after the 2nd SARS-CoV-2 vaccination. Main study parameters/endpoints: The primary endpoint is efficacy of SARS-CoV-2 vaccination determined as: - the incidence of COVID-19 after vaccination. Secondary endpoints are - mortality - adverse events of specific interest according to (inter)national authorities in collaboration with LAREB - presence of HLA-antibodies in dialysis patients on the waiting list for a first kidney transplantation - acute rejection and graft failure in patients after kidney transplantation In a subset of patients additional secondary endpoints will be assessed - the antibody based immune response at 28 days after completion of SARS-CoV-2 vaccination. - the durability of antibody based immune response at 6 months compared to at 28 days after having received two subsequent SARS-CoV-2 vaccinations, in patients that have not received a 3rd SARS-CoV-2 vaccine. - the antibody based immune response at 28 days after having received the 3rd SARS-CoV-2 vaccination. The incidence of these endpoints will be compared, if applicable, to those: - in the general population who are vaccinated - in patients on dialysis or after kidney transplant who are not vaccinated Within these patient groups endpoints will be compared between recipients of different vaccines.

Description:

1. OBJECTIVES Primary objective: To assess the efficacy of SARS-CoV-2 vaccination by the incidence of COVID-19 in patients with chronic kidney disease stage G4-G5, on dialysis and patients after kidney transplantation who received SARS-CoV-2 vaccination Secondary Objectives: - To assess the safety of vaccination In a subgroup of participants: - To assess the level of antibody response at 28 days and 6 months after SARS-CoV-2 vaccination - To assess durability of the antibody response at 6 months after having received two subsequent SARS-CoV-2 vaccinations, in a subset of patients that have not received a 3rd SARS-CoV-2 vaccine - the antibody based immune response at 28 days after having received the 3rd SARS-CoV-2 vaccination. Exploratory Objectives: - The vaccination coverage rate - The severity of COVID-19 in case of infection - The influence of vaccination on health-related quality of life by patient reported outcome measures (PROMs) in patients on dialysis. - The SARS-CoV-2 genotype in patients with COVID-19 In a subgroup of participants: - To assess the level of antibody response after vaccination between patients with COVID-19 and without COVID-19 at: - 28 days after the 2nd SARS-CoV-2 vaccination - 28 days after the 3rd SARS-CoV-2 vaccination - 6 months after the 2nd SARS-CoV-2 vaccination in patients who have not received a 3rd vaccine. - To assess change in behaviour towards measures against COVID-19 before and after vaccination If data are available and applicable, outcomes in vaccinated patients on dialysis or after kidney transplantation will be compared: - with outcomes in the general population - with outcomes in patients with severely impaired kidney function (CKD stages G4/5), on dialysis or with a kidney transplant who are not vaccinated. - according to the type of vaccination they received 2. STUDY DESIGN This is a prospective observational registry-based cohort study to evaluate the long-term efficacy and safety after SARS-CoV-2 vaccination on clinically important outcomes in patients with chronic kidney disease stage G4-G5, on dialysis or after kidney transplantation. All participants will receive vaccination against COVID-19 via the national vaccination program and according to the manufacturer's instructions. To assess the immune response after vaccination, blood samples will be collected at 28 days after the 2nd SARS-CoV-2 vaccination, 28 days after the 3rd SARS-CoV-2 vaccination, and 6 months after the 2nd SARS-CoV-2 vaccination in patients who have not received a 3rd vaccination. In total a maximum of 1 ml blood will be drawn. Data of the following cohorts will be analyzed in this study. - Patiens with chronic kidney disease stage G4-G5, data to be derived from the Santeon hospitals. - Patients on hemodialysis and peritoneal dialysis, data to be derived from the existing national registry RENINE - Kidney transplant recipients, data to be derived from the existing national registry NOTR - Patients on dialysis or after kidney transplantation with COVID-19 disease, data to be derived from the ERACODA database. 3. METHODS Main study parameter/endpoint: The primary endpoints is the incidence of COVID-19 in a two years period after SARS-CoV-2 vaccination in patients with chronic kidney disease stage G4-G5, on dialysis or after kidney transplantation. Secondary study parameters/endpoints: Safety in all patients: - Incidence of mortality - Incidence of adverse events of specific interest as defined by (inter)national authorities in collaboration with LAREB - Incidence of a combined endpoint of acute rejection or graft failure in patients after kidney transplantation - Incidence of HLA antibodies defined as calculated Panel Reactivity Antibodies (cPRA) > 5% in patients on the waiting list for their first kidney transplantation Efficacy in a subgroup of patients: - The antibody response against the SARS-CoV-2 Receptor Binding Domain at 28 days after the final SARS-CoV-2 vaccination. - The antibody response against the SARS-CoV-2 Receptor Binding Domain at 28 days after the 3rd SARS-CoV-2 vaccination. - The durability of antibody based immune response against SARS-CoV-2 Receptor Binding Domain at 6 months compared to 28 days after completion of SARS-CoV-2 vaccination in patients who did not receive a 3rd SARS-CoV-2 vaccination. Exploratory study parameters: - Vaccination coverage rates - Disease severity in patients who develop COVID-19, assessed as - Hospitalization - ICU admission - Mechanical ventilation - Mortality - The influence of vaccination on health-related quality of life by patient reported outcome measures (PROMs) in dialysis patients - SARS-CoV-2 genotype in patients with COVID-19 In a subgroup of participants: - To assess the level of SARS-CoV-2 Receptor Binding Domain antibody response after vaccination between patients with COVID-19 and without COVID-19 at: - 28 days after the 2nd SARS-CoV-2 vaccination - 28 days after the 3rd SARS-CoV-2 vaccination - 6 months after the 2nd SARS-CoV-2 vaccination in patients who have not received a 3rd vaccine. - To assess change in behaviour towards measures against COVID-19 before and after vaccination These data collected after SARS-CoV-2 vaccination in patients with chronic kidney disease stage G4-G5, on dialysis and after a kidney transplantation will (if applicable data are available) be compared: - to those obtained in the general population - to those obtained in patients with chronic kidney disease stage G4-G5, on dialysis or with a kidney transplant who are not vaccinated - according to the type of vaccination received These comparisons will allow us to analyze whether SARS-CoV-2 vaccination offers efficacy to prevent COVID-19 and sufficient safety in patients with chronic kidney disease stage G4-G5, dialysis and kidney transplant patients when compared to non-vaccinated patients with chronic kidney disease stage G4-G5, dialysis and kidney transplant patients, whether the efficacy is similar as in the general population, and whether there are differences in the risk-benefit ratio between the various vaccines.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 4868
• Est. completion date: December 18, 2023
• Est. primary completion date: November 30, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Eligible for COVID-19 vaccination as described by the instructions of the manufacturer.

2. Age of 18 years or older

3. Capable of understanding the purpose and risks of the study, fully informed and given written informed consent (signed informed consent form has been obtained)

4. Either

• eGFR < 30 ml/min/1.73m2 but not on dialysis or with a kidney transplant
• Hemodialysis, or peritoneal dialysis
• Kidney Transplant recipient at least 6 weeks after transplantation

Exclusion Criteria:

• History of severe adverse reaction associated with a vaccine and/or severe allergic reaction (e.g. anaphylaxis) to any component of the study intervention(s).
• Patients who opted out for research in the Santeon, RENINE and NOTR registries.
• Patients who participate in the RECOVAC-IR study.
• Of note, patients will be eligible whether or not they have a history of COVID-19. Analyses will be performed in the overall population, but also shown separately for those without and with a history of COVID-19.

Related Conditions & MeSH terms

• Chronic Kidney Diseases
• COVID-19
• Covid19
• Kidney Diseases
• Renal Insufficiency, Chronic
• SARS-CoV Infection
• Severe Acute Respiratory Syndrome

Intervention

Diagnostic Test:
• mailer-based finger-prick
All participants in the antibody measurement study will be sent a mailer-based finger-prick set. The sets will be sent to the home address of the patient, including a return envelope. After collecting and returning the samples SARS-CoV-2 antibodies will be analysed quantitatively at the laboratory.

Locations

Country	Name	City	State
Netherlands	University Medical Center Groningen	Groningen

Sponsors (1)

Lead Sponsor	Collaborator
University Medical Center Groningen

Country where clinical trial is conducted

Netherlands, 

References & Publications (19)

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ERA-EDTA Council; ERACODA Working Group. Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA. Nephrol Dial Transplant. 2021 Jan 1;36(1):87-94. doi: 10.1093/ndt/gfaa314. — View Citation

Gansevoort RT, Hilbrands LB. CKD is a key risk factor for COVID-19 mortality. Nat Rev Nephrol. 2020 Dec;16(12):705-706. doi: 10.1038/s41581-020-00349-4. — View Citation

Gezondheidsraad. Strategieën voor COVID-19-vaccinatie. Den Haag: Gezondheidsraad, 2020; publicatienr. 2020/23

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Katerinis I, Hadaya K, Duquesnoy R, Ferrari-Lacraz S, Meier S, van Delden C, Martin PY, Siegrist CA, Villard J. De novo anti-HLA antibody after pandemic H1N1 and seasonal influenza immunization in kidney transplant recipients. Am J Transplant. 2011 Aug;11 — View Citation

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Noordzij M, Duivenvoorden R, Pena MJ, de Vries H, Kieneker LM; collaborative ERACODA authors. ERACODA: the European database collecting clinical information of patients on kidney replacement therapy with COVID-19. Nephrol Dial Transplant. 2020 Dec 4;35(12 — View Citation

Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, Perez Marc G, Moreira ED, Zerbini C, Bailey R, Swanson KA, Roychoudhury S, Koury K, Li P, Kalina WV, Cooper D, Frenck RW Jr, Hammitt LL, Tureci O, Nell H, Schaefer A, Unal S, Tre — View Citation

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van Besouw NM, Yan L, de Kuiper R, Klepper M, Reijerkerk D, Dieterich M, Roelen DL, Claas FHJ, Clahsen-van Groningen MC, Hesselink DA, Baan CC. The Number of Donor-Specific IL-21 Producing Cells Before and After Transplantation Predicts Kidney Graft Rejec — View Citation

van der Willik EM, Meuleman Y, Prantl K, van Rijn G, Bos WJW, van Ittersum FJ, Bart HAJ, Hemmelder MH, Dekker FW. Patient-reported outcome measures: selection of a valid questionnaire for routine symptom assessment in patients with advanced chronic kidney — View Citation

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* Note: There are 19 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Vaccination coverage rate	Percentage of patients vaccinated	two years
Other	SARS-CoV-2 genotype	In patients with active COVID-19 infection	two years
Other	Level of SARS-CoV-2 Receptor Binding Domain antibody in patients with and without COVID-19	level of SARS-CoV-2 Receptor Binding Domain antibody response at 28 days and 6 months after the second SARS-CoV-2 vaccination (in patients who did not receive a third vaccination) or 28 days after the third SARS-CoV-2 vaccination between patients who develop COVID-19 and who do not develop COVID-19 after vaccination	two years
Other	Disease severity of COVID-19 in case of infection assessed by ICU admission	Number of ICU admissions with COVID-19 after vaccination	two years
Other	Disease severity of COVID-19 in case of infection assessed by mechanical ventilation	Number of cases with mechanical ventilation because of COVID-19 after vaccination	two years
Other	Disease severity of COVID-19 in case of infection assessed by mortality	Number of deaths due to COVID-19 after vaccination	two years
Other	Disease severity of COVID-19 in case of infection assessed by hospitalization	Number of hospital admissions with COVID-19 infection after vaccination	two years
Other	Influence of vaccination on health related quality of life - SF-12	Measured by Patient Reported Outcome Measures (PROMs). This is a questionnaire consisting of two parts. The first part includes the 12 items Short Form (SF-12) health survey to monitor physical and mental quality of life (with a score on 8 categories ranging from 0-100; with a higher score defined as a higher quality of life). Scores before and after vaccination will be compared.	two years
Other	Influence of vaccination on health related quality of life - DSI	Measured by Patient Reported Outcome Measures (PROMs). This is a questionnaire consisting of two parts. The second part includes the Dialysis Symptom Index (DSI) questionnaire to monitor disease specific burden from the perspective of patients (with a score ranging from 0-30, with a higher score defined as a higher disease burden). Scores before and after vaccination will be compared.	two years
Other	Change in behaviour towards measures against COVID-19	Estimated by questionnaires, created by the studyteam in collaboration with the Dutch patient association. This questionnaire is focused on mental aspect of COVID-19 measures and whether certain measures, results or extra vaccinations influence behaviour of patients	two years
Primary	The incidence of COVID-19	After SARS-CoV-2 vaccination in patients with chronic kidney disease stage G4-G5, on dialysis or after kidney transplantation.	two years after SARS-CoV-2 vaccination
Secondary	Incidence of mortality	Incidence of mortality in patients with chronic kidney disease stage G4-G5, on dialysis or after kidney transplantation.	two years after SARS-CoV-2 vaccination
Secondary	Incidence of adverse events	Incidence of adverse events of specific interest as defined by (inter)national authorities in collaboration with LAREB	two years after SARS-CoV-2 vaccination
Secondary	Incidence of acute rejection or graft failure in kidney transplant recipients	Incidence of a combined endpoint of acute rejection or graft failure in patients after kidney transplantation	two years after SARS-CoV-2 vaccination
Secondary	Incidence of HLA antibodies measured in blood	Incidence of HLA antibodies defined as calculated Panel Reactivity Antibodies (cPRA) > 5% in patients on the waiting list for their first kidney transplantation	two years after SARS-CoV-2 vaccination
Secondary	The antibody level against the SARS-CoV-2 Receptor Binding Domain measured in blood	The antibody response against the SARS-CoV-2 Receptor Binding Domain	28 days after second SARS-CoV-2 vaccination.
Secondary	The antibody level against SARS-CoV-2 Receptor Binding Domain measured in blood	The antibody based immune response against SARS-CoV-2 Receptor Binding Domain at 6 months compared to 28 days after completion of SARS-CoV-2 vaccination in patients without a third vaccination.	6 months after second SARS-CoV-2 vaccination
Secondary	The antibody level against SARS-CoV-2 Receptor Binding Domain measured in blood	The antibody based immune response against SARS-CoV-2 Receptor Binding Domain at 28 days after a third vaccination	28 days after third SARS-CoV-2 vaccination