ABSTRACT
Background: Hemodialysis (HD) patients are at higher risk for SARS-CoV-2 infection and its severe complications compared to the general population. Several studies examined the effectiveness of COVID-19 vaccines in this highly vulnerable population but showed mixed results. The aim of this study was to determine the effectiveness of mRNA vaccines against confirmed SARS-CoV-2 infection in HD patients in the State of Qatar. Method(s): We used a test-negative case-control design to determine the effectiveness of vaccination in HD patients > 14 days after the second dose. Ninetyfive patients had positive SARS-CoV-2 PCR (cases), while 884 patients had negative PCR (controls). Vaccine effectiveness was determined using the following formula [Vaccine effectiveness = 1 - Odds (T+ vaccinated) /Odds (T+ non-vaccinated)]. Result(s): Thirty out of 691 vaccinated HD patients had positive SARS-CoV-2 PCR versus 65 out of 288 non-vaccinated patients (4% vs. 23%, P<0.0001). Patients were more likely to have positive PCR if they were females (P<0.0001), elderly (P=0.02), or Asians (P=0.03). The overall effectiveness of mRNA COVID-19 vaccines against confirmed SARS-CoV-2 infection was 84.5% (95% CI: 76.5-89.8;Table 1) Conclusion(s): Our data support the importance of using the mRNA COVID-19 vaccine in HD patients to prevent SARS-CoV-2 infection in such a high-risk population.
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Background: Patients on dialysis are more susceptible to COVID-19 infection, with higher mortality and morbidity. In December 2021 the state of Qatar witnessed a surge in COVID 19 cases solely due to omicron variant. We compare the effect of omicron Vs pre-omicron variants COVID infection on hemodialysis patients in terms of incidence, severity and mortality. Method(s): This is an observational, analytical, retrospective, nationwide study. COVID-19 PCR was the method of diagnosis. During the Omicron wave, Rapid Antigen Test was accepted by Ministry of Health in Qatar as a diagnostic test. Our study followed patients for duration from 3/2020 to 1/2022. All positive results from 1st of December 2021 were assigned to the omicron group as per national genomic surveillance. Cases before that were assigned to the pre-omicron group. Primary outcome was to compare the incidence of omicron infections in haemodialysis patient compared to pre-omicron era. Secondary outcomes were to assess the mortality, ICU admissions, length of stay in ICU and need for ventilatory support in omicron vs pre-omicron phase. Patient demographics and clinical features were collected from a national electronic medical record. Result(s): 274 haemodialysis patients were diagnosed with COVID-19 during the omicron wave (2 months period) vs174 patients in the pre-omicron period (21 months). The incidence in omicron wave was 30.3%, which is significantly higher than preomicron waves of 18.7% (p <0.001). Omicron variant has lower mortality rate 2.4%, compared to other variants grouped together 15.5% (p <0.001). ICU admissions rate during the omicron wave was significantly less than pre-omicron waves (4.9% Vs 26.4% (p <0.001)), and there was less need for ventilatory support (0.01% Vs 0.16% (p <0.001)). ICU length of stay was not significantly different (16.7+/-8 days Vs 14.2 +/-17.5 days (p = 0.34)). Conclusion(s): This is the 1st national study to compare the outcome of omicron vs non-omicron COVID-19 variants infection among hemodialysis patients. The incidence of omicron variant was higher than pre-omicron variants, while mortality and ICU admission were significantly lower in the omicron era compared to pre-omicron era. ICU length of stay was not significantly different.
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Purpose: Kidney transplant recipients have been shown to develop a severe form of coronavirus disease (COVID-19) that poses a significant mortality risk. The aim of this study was to evaluate risk factors associated with acquiring COVID-19 in our kidney transplant population. Methods: We retrospectively reviewed the medical records of all kidney transplant recipients in our national transplant registry. There were 249 out of 693 kidney transplant recipients who underwent SARS-CoV-2 infection testing by August 1st, 2020. All testing was done by government using RT-PCR of throat and nasal swabs. Forty-three of the tested patients had positive COVID-19 (17%), while the remaining 206 were negative. Mann-Whitney and Fisher's exact tests were used to study the different continuous and categorical variables, respectively. Results: Among patients tested for COVID-19, Asian ethnicity (37% vs. 16%, P=0.003), history of hypertensive nephropathy (23% vs. 9%, P=0.01) and deep vein thrombosis (12% vs.1%, P=0.002) were statistically significant in COVID-19 positive group compared to COVID-19 negative group. Tacrolimus trough level at the time of COVID-19 testing was also significantly higher in COVID-19 positive patients (7.7 ng/mL vs. 6.6 ng/mL, P=0.03). Recipient age, gender, year of transplant, donor type, maintenance immunosuppression, flu vaccine within 1 year and use of ACE inhibitors or ARBs were all similar in both groups. Most patients with positive COVID-19 were symptomatic at the time of testing compared to negative patients (84% vs. 18%, P=0.0001). However, close contact with positive COVID-19 people was similar in both groups (14% vs. 14%, P=1). Conclusions: Prevention and reduction of COVID-19 infection development is crucial in kidney transplant recipients to avoid unfavorable outcomes. With the widespread of COVID-19 worldwide, avoiding exposure might not be possible. Our results suggest that targeting lower tacrolimus trough levels may reduce the risk of acquiring SARS-CoV-2 infection.
ABSTRACT
Background: COVID-19 infection carries a high burden and poor outcomes in patients who are immunosuppressed like kidney transplant or on dialysis. Our study aim is to compare outcomes between dialysis and kidney transplant patients infected with COVID-19 in the State of Qatar. Methods: Retrospective cohort study reviewing medical, laboratory and radiographic data of all dialysis and kidney transplant recipients' patients in our national registry (between February and August 2020). Data collected from a national-based electronic medical record. Results: 76 patients on dialysis patients had COVID19 vs 43 kidney transplants (p=ns). Kidney transplant patients with COVID19 tended to be younger than dialysis patients (52 vs. 58 years old, p=0.007), has less hypertension and more history of deep venous thrombosis. Clinical presentation did not differ between both groups with more asymptomatic in dialysis patients compared to kidney transplant patients (14.5% versus 2.3%, p=0.03). More patients died from COVID19 in the dialysis patients vs. kidney transplant patients (11 (14.5%) vs. only 1 (2.3%), p=0.034). Inflammatory markers were significantly higher in dialysis patients (IL6 peak and Ferritin) compared to kidney transplant patients. Conclusions: Our national study showed similar incidence and severity of COVID19 in dialysis compared to kidney transplant in Qatar. Mortality and inflammatory markers were higher in dialysis patients.
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Background: Acute kidney injury among patients with COVID-19 infection is a poor prognostic indicator. There is limited evidence to guide the nephrology community if there are any risk or advantages of using sustained low-efficiency dialysis (SLED) or continuous renal replacement therapy (CRRT). We aim to evaluate the clinical outcomes of COVID-19 patients receiving renal replacement therapy in the intensive care unit (ICU). Methods: This is a retrospective chart review of adult patients with COVID-19 admitted to ICU in the state of Qatar who had 1)acute kidney injury and 2)received renal replacement therapy between February to August of 2020. We evaluated clinical characteristic, severity of illness, mortality, and renal outcomes at 30 days. Results: Among 127 patients with acute kidney injury requiring dialysis in ICU, 16 patients were on CRRT, 68 patients were on SLED, and 43 patients were on combination. We did not observe significant difference among age, gender, ethnicity or baseline creatinine. Most common indication for indication of dialysis was volume overload followed by acidosis in all three groups with serum creatinine of 264umol/L vs 499umol/L vs 351umol/L in CRRT, SLED and CRRT+SLED, respectively. Inflammatory markers, Pressore requirement and APACHE II score were similar between all groups. 30-day Survival was 23%, 50% and 9%. Among 34 patients on SLED who survived, 6 were dialysis dependent post COVID-19 infection. Conclusions: Acute kidney failure in critically ill COVID-19 patients is associated with high mortality. A lower mortality, but high morbidity is observed in patients receiving SLED in critical care setting. Further investigation of SLED in COVID-19 should be considered.
ABSTRACT
Background: Dialysis patients are considered at high risk to develop serious COVID19 complications. Taking extreme measures are necessary to prevent COVID19 transmission at the dialysis center. We are presenting outcomes of our COVID19 prevention project from our largest dialysis center in Qatar. Methods: Our project was done at FBJKC (largest dialysis center in Qatar with about 60% of all hemodialysis (HD) and 90% of all peritoneal dialysis (PD) patients in Qatar)) between March 1st and May 25th 2020. We gradually implemented a bundle of measures and algorithm (attached) to properly triage and limit COVID19 exposure inside the center. New infection control protocol with specifications to COVID19 were implemented, including a new policy for reusing N95 masks in high risk areas. We tracked number of patients and staff who were infected during that period and source of infection. Results: Our dialysis census during that period was 480 HD and 170 PD patients. Only 6 HD patients turned positive for COVID19 (0.9%) and 2 PD patients (1.2%) (compared to 1.3% general population in Qatar by May 25th). We had 3 dialysis staff infected out of 114 (2.6%). Our investigation showed that all cases of COVID19 (both in patients and staff) were likely contracted outside the center. All staff and patients exposed to positive cases of COVID19 inside the center turned out negative. Our infection control classified most exposures at low risk, especially after we fully implemented our precautions. Conclusions: Preventive actions implemented inside a large dialysis center led to prevention of COVID19 transmission. Increase positive COVID19 cases (in staff and patients) were related to countrywide growth of infection.