Effectiveness of Messenger RNA Vaccines against SARS-CoV-2 Infection in Hemodialysis Patients: A Case-Control Study.

Patients with end-stage kidney disease (ESKD) are at increased risk for SARS-CoV-2 infection and its complications compared with the general population. Several studies evaluated the effectiveness of COVID-19 vaccines in the dialysis population but showed mixed results. The aim of this study was to determine the effectiveness of COVID-19 mRNA vaccines against confirmed SARS-CoV-2 infection in hemodialysis (HD) patients in the State of Qatar. We included all adult ESKD patients on chronic HD who had at least one SARS-CoV-2 PCR test done after the introduction of the COVID-19 mRNA vaccines on 24 December 2020. Vaccinated patients who were only tested before receiving any dose of their COVID-19 vaccine or within 14 days after receiving the first vaccine dose were excluded from the study. We used a test-negative case−control design to determine the effectiveness of the COVID-19 vaccination. Sixty-eight patients had positive SARS-CoV-2 PCR tests (cases), while 714 patients had negative tests (controls). Ninety-one percent of patients received the COVID-19 mRNA vaccine. Compared with the controls, the cases were more likely to be older (62 ± 14 vs. 57 ± 15, p = 0.02), on dialysis for more than one year (84% vs. 72%, p = 0.03), unvaccinated (46% vs. 5%, p < 0.0001), and symptomatic (54% vs. 21%, p < 0.0001). The effectiveness of receiving two doses of COVID-19 mRNA vaccines against confirmed SARS-CoV-2 infection was 94.7% (95% CI: 89.9−97.2) in our HD population. The findings of this study support the importance of using the COVID-19 mRNA vaccine in chronic HD patients to prevent SARS-CoV-2 infection in such a high-risk population.

National response to the COVID-19 Omicron variant crisis in the ambulatory hemodialysis service in the State of Qatar.

The coronavirus disease (COVID-19) pandemic has had a significant worldwide impact since its emergence in 2019. End-stage kidney disease patients have been among the most vulnerable population affected and have a higher risk of acquiring infection and developing more severe disease. We have encountered three major COVID-19 waves in Qatar and they have required different strategies to overcome. The most recent wave was due to the Omicron variant characterized by higher transmissibility. The monthly incidence of COVID-19 infection during the Omicron wave in patients with end-stage renal disease peaked at 256 patients compared to 35 and 39 patients during the first and second waves, respectively. In addition, more than one-third of our dialysis staff became infected during this wave. Unlike the previous two waves, COVID-19 due to the Omicron variant was less severe with only 5% of hemodialysis patients requiring admission to the intensive care unit compared to 25% during the previous waves. The Omicron variant wave resulted in a crisis in our country due to the high number of non-hospitalized COVID-19 hemodialysis patients and the severe staff shortage. Several measures were taken to overcome the crisis, such as designating one facility to dialyze all COVID-19 ambulatory patients, reducing dialysis sessions to 3 hours, and introducing a fourth dialysis shift. This article describes the challenges we faced in the ambulatory hemodialysis service during the Omicron wave and the measures taken in the COVID-19 and non-COVID-19 designated facilities to combat the crisis.

Effects of COVID-19 on Mineral and Bone Disease Outcomes in Hemodialysis Patients: A Retrospective Study From Qatar

BACKGROUND AND AIMS Management of end-stage renal disease (ESRD) on dialysis has been challenging during the COVID19 epidemic. Staff illness led to a shortage of manpower that affected patient care. We established a specialty nursing management for mineral and bone disease (MBD) in the ambulatory dialysis service in Qatar in 2016. We are presenting a retrospective study about the effects of the COVID-19 epidemic on MBD outcomes in ambulatory dialysis patients in the State of Qatar. METHOD A retrospective cohort study in all adult patients with ESRD on chronic hemodialysis therapy (>1 month) in ambulatory dialysis clinics in the State of Qatar. Data collected were patient's characteristics, laboratory and diagnostic investigations for each patient through our electronic data system (nationwide). We focused on parathyroid hormone (PTH), calcium and phosphorus levels done routinely on monthly basis. The study duration was 31 months (January 2019–September 2021). RESULTS We included 623 patients. Age was 56 ± 11 years old and 61% were male. The main comorbidities were diabetes mellitus (63%), hypertension (92%) and cardiovascular disease (22%). The percentage of patients with PTH levels within targets ranged from 63 to 74%. It was stable before and during the first wave of COVID-19 in Qatar (March–June 2020) then dropped afterward briefly for 3 months (October–December 2020) (74% versus 63% respectively P = 0.0003). PTH level in target improved afterward and also during the second wave of COVID-19 (February–May 2021) but then dropped again for 3 months (July–September 2021) [72% versus 66% respectively P = 0.02 (graph below with details)]. Patients with phosphorus and calcium in the target were mostly stable [79% (77–83%) and 76% (74–79%), respectively]. CONCLUSION Our retrospective study regarding the effect of the COVID-19 epidemic on MBD outcomes in hemodialysis (HD) showed a temporary drop in PTH level in the target without affecting calcium and phosphorus targets. The delayed drop after COVID-19 waves in PTH in target could be related to the routine quarterly measurement of PTH. We think that establishing a solid management system for MBD led to reasonably stable outcomes despite all challenges during the COVID-19 epidemic.

Minimal change disease following the Moderna COVID-19 vaccine: first case report.

BACKGROUND: There have been cases of minimal change disease (MCD) reported following previous vaccines. During the COVID-19 era, only 3 cases of new-onset MCD and a case of MCD relapse were reported following the Pfizer-BioNTech COVID-19 vaccine. We herein report the first case of MCD after receiving the Moderna COVID-19 vaccine. CASE PRESENTATION: A 43-year-old man presented to hospital 3 weeks after receiving the first dose of the Moderna vaccine, with both bilateral lower extremities and scrotal edema. He initially developed a sudden-onset bilateral lower extremities swelling on day 7 post-vaccine. He, then, developed dyspnea and scrotal swelling over a time span of 2 weeks. On physical examination, his blood pressure was 150/92 mmHg. There was a decreased air entry at lung bases, bilateral lower extremities and scrotal edema. Labs revealed hypoalbuminemia, hyperlipidemia and 15 g of proteinuria. His immunologic and serologic work up was negative. Renal biopsy showed concomitant MCD and IgA nephropathy. Patient was treated with oral steroids and had a good response; his edema resolved, serum albumin improved, and proteinuria decreased to 1 g within 2 weeks of treatment. CONCLUSIONS: To the best of our knowledge, MCD has not been previously reported after receiving the Moderna COVID-19 vaccine. It remains unclear whether the COVID-19 mRNA vaccines are associated with the development of MCD, or it coincided with the mass vaccination. Further studies are needed to determine the incidence of MCD post COVID-19 vaccines and the underlying pathophysiology of glomerular injury post vaccination.

Kidney Transplant Recipients Infected With Coronavirus Disease 2019: Retrospective Qatar Experience.

BACKGROUND: This study aimed to evaluate the incidence of coronavirus disease 2019 (COVID-19) infection on kidney transplant, mortality, and risk factors associated with infection acquisition and severe illness in kidney transplant recipients with COVID-19. METHODS: Of 693 kidney transplant recipients who reported to our center, 249 were tested for COVID-19 by throat and nasal swab reverse transcription polymerase chain reaction. Of these, 43 recipients tested positive and 206 recipients tested negative. Among the 43 positive recipients, 9 were treated within an isolation facility, 25 were admitted to the hospital, and 9 were admitted to the intensive care unit (ICU). Risk factors associated with positive results and ICU admission were evaluated. RESULTS: COVID-19 was found in 6% of transplant recipients. Asian ethnicity (p = .003), history of hypertensive nephropathy (p = .01), AB blood group (P = .04), and higher tacrolimus trough levels (P = .007) were more frequent in the COVID-19 positive than in the COVID-19 negative group. ICU admission was more frequent in recipients presenting with fever, shortness of breath, and acute allograft dysfunction. Renal replacement therapy was required in 3 (7%) of 43 recipients, and mortality was reported in 1 (2.3%) recipient. Acute allograft dysfunction was an independent risk factor for severe COVID-19 (odds ratio, 93.7; 95% confidence interval, 2.37-3710.94; P = .02). CONCLUSIONS: Higher tacrolimus targets may be associated with COVID-19 development. Acute kidney injury during the COVID-19 course may be a sign of severe disease. Prognostication of COVID-19 severity in kidney transplant recipients is crucial for early recognition of critical illness and may ensure early intervention.

Restructuring nephrology services to combat COVID-19 pandemic: Report from a Middle Eastern country.

Coronavirus disease 2019 has spread across the world and has been classified as a pandemic. It has overwhelmed the healthcare systems. Specifically, it has overstretched the intensive care units and renal replacement therapy services in many countries. In this paper, we discuss the reconfiguration of nephrology services in the State of Qatar during the current pandemic. We highlight the key strategies that have been implemented to ensure that renal replacement therapy capacity is not constrained in either the intensive care or ambulatory setting. Some innovative approaches for the safe delivery of ambulatory care to dialysis and kidney transplant patients are also discussed.