The Longitudinal Evolution of Post-COVID-19 Outcomes Among Hemodialysis Patients in Turkey.

Introduction: Hemodialysis (HD) patients have increased risk for short-term adverse outcomes of COVID-19. However, complications and survival at the post-COVID-19 period have not been published extensively. Methods: We conducted a national, multicenter observational study that included adult maintenance HD patients recovered from confirmed COVID-19. A control HD group without COVID-19 was selected from patients in the same center. We investigated the characteristics and outcomes in the follow-up of HD patients and compare them with the non-COVID-19 group. Results: A total of 1223 patients (635 patients in COVID-19 group, 588 patients in non-COVID-19 group) from 47 centers were included in the study. The patients' baseline and HD characteristics were almost similar. The 28th-day mortality and mortality between 28th day and 90th day were higher in the COVID-19 group than non-COVID-19 group (19 [3.0%] patients vs. none [0%]; 15 [2.4%] patients vs. 4 [0.7%] patients, respectively). The presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection, and arteriovenous (AV) fistula thrombosis was significantly higher in the COVID-19 group in both the first 28 days and between 28 and 90 days. In the multivariable analysis, age (odds ratio [OR] [95% CI]: 1.029 [1.004-1.056]), group (COVID-19 group vs. non-COVID-19 group) (OR [95% CI]: 7.258 [2.538-20.751]), and vascular access type (tunneled catheter/AV fistula) (OR [95% CI]: 2.512 [1.249-5.051]) were found as independent parameters related to 90-day mortality. Conclusion: In the post-COVID-19 period, maintenance HD patients who have had COVID-19 have increased rehospitalization, respiratory problems, vascular access problems, and high mortality compared with the non-COVID-19 HD patients.

Antibody response to two doses of inactivated SARS-CoV-2 vaccine (CoronaVac) in kidney transplant recipients.

BACKGROUND: Coronavirus Disease-19 (COVID-19) has high mortality in kidney transplant recipients (KTR), and vaccination against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is vital for this population. Although the humoral response to messenger RNA vaccines was shown to be impaired in KTR, there is a lack of data regarding the antibody response to inactivated vaccines. We investigated the antibody response to two consequent doses of the inactivated SARS-CoV-2 vaccine (CoronaVac; Sinovac Biotech, China). METHODS: A total of 118 patients from two centers were included. The levels of anti-SARS-CoV-2 immunoglobulin-G antibodies against the nucleocapsid and spike antigens were determined with enzyme immunoassay (DIA.PRO; Milano, Italy) before the vaccine and one month after the second dose of the vaccine. Thirty-three patients were excluded due to antibody positivity in the serum samples obtained before vaccination. RESULTS: Eighty-five patients, 47 of whom were female, with a mean age of 46 ± 12, were included in the statistical analysis. The maintenance immunosuppressive therapy comprised tacrolimus (88.2%), mycophenolate (63.6%), and low-dose steroids (95.3%) in the majority of the patients. After a median of 31 days following the second dose of the vaccine, only 16 (18.8%) patients developed an antibody response. The median (IQR) antibody level was 52.5 IU/ml (21.5-96). Age (48 vs. 38, p = .005) and serum creatinine levels (1.14 vs. 0.91, p = .04) were higher in non-responders and were also found to be independently associated with the antibody response (odds ratio (OR): 0.93, p = 0.012 and 0.15, p = 0.045, respectively) in multivariate analysis. CONCLUSION: In this study, we found the antibody response to the inactivated vaccine to be considerably low (18.8%) in KTR. Increased age and impaired renal function were associated with worse antibody response. Based on the knowledge that mRNA vaccines yield better humoral responses, this special population might be considered for additional doses of mRNA vaccination.

Comparison of Remote Controlled Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis During COVID-19 Pandemic

Objectives: We aimed to show the possible effect of the peritoneal dialysis (PD) modality on the mood and clinical outcomes of the patients during the first official quarantine period applied to control the Coronavirus disease-2019 (COVID-19) in Turkey. Materials and Methods: With the start of quarantine, in our center, we started doing the patient visits by phone. At the end of the quarantine, the patients were asked to complete a questionnaire in order to reveal whether they felt safe or alone, their anxiety status, and their preferred method of communicating with the team. In addition, volume status, biochemical parameters, blood pressure and medications in December 2019 were reviewed and compared with those in June 2020. Results: A total of 60 patients, 32 of whom were female, with a mean age of 53.4±16 years were included in the study. While there were 24 (40%) patients who underwent remote controlled outpatient peritoneal dialysis (RK-APD), there were 36 (60%) patients who underwent continuous APD (CAPD). According to the survey results, 15 (25%) patients did not experience any anxiety, while 45 patients stated that they had varying degrees of anxiety. 85% of the patients reported that they were very pleased that they could continue their dialysis treatment at home. While 69.4% of the patients who underwent CAPD were worried that they could not be followed as closely during the quarantine, 70.8% of the patients who underwent RK-APD stated that they felt safe because their treatment was monitored by the team through the system. While there was only an increase in the daily amount of ultrafiltration in RK-APD patients (December 2019 and June 2020;1,365 vs 1,514 mL, p=0.026), no difference was observed in CAPD patients. CAPD patients tended to communicate with nurses more frequently. While these interviews were done frequently via WhatsApp messages in CAPD patients (20, 37% vs 5, 18.5%;p=0.008), they were in the form of audio phone calls (22, 81%) in APD patients. Conclusion: In conclusion, during the COVID-19 outbreak, maintaining dialysis with PD treatment at home, regardless of the modality, is a safe and effective method and has positive effects on patient satisfaction.