ABSTRACT
BACKGROUND AND AIMS: As COVID-19 related mortality is higher in haemodialysis patients than in the general population, proper vaccination strategies against the SARS-CoV-2 virus have utmost importance. It has been previously shown that mRNA vaccines (e.g. BNT162b2) can generate >95% of seropositivity in haemodialysis patients [1]. On the other hand, the seropositivity rate reached by the inactivated vaccine (CoronaVac ® ) was around 80%. In this study, we aimed to analyse the persistence of SARS-CoV-2 antibodies in haemodialysis patients for 6 months and compare it with the healthy controls. METHOD: Haemodialysis patients who were vaccinated either by BNT162b2 or CoronaVac ® and who continued their regular controls for 6 months were involved in the study. Those who had previous or active SARS-CoV-2 infection, who had malignancies and those who had received immunosuppressive drugs in the previous 12 month were excluded from the study. SARS-CoV-2 IgG levels were measured by a commercial test after the first doses of the vaccines and at the end of the sixth month. Healthy healthcare workers who were vaccinated with similar vaccine schemes were taken as the control group. RESULTS: We recruited 85 haemodialysis patients who had received their first doses of either vaccine. Of them, 4 patients died;3 patients were hospitalized because of COVID-19 infection during the follow-up;9 patients missed at least one of their regular controls;and 2 patients were diagnosed with malignancy. A total of 26 patients experienced asymptomatic or mild COVID-19 infection during the follow-up period. SARS-CoV-2 IgG levels were measured at the end of the sixth month for the remaining 41 patients. Sero-positivity significantly decreased at the end of the sixth month for both vaccines, but the BNT162b2 group (n = 22) still had better seropositivity than CoronaVac ® (n = 19) group (81% versus 50%;P = .03). In contrast, the seropositivity of healthy controls, even with the inactivated vaccine, was 96%. When one booster dose was applied, 90% of seropositivity could be maintained in the BNT162b2 group at the sixth month. CONCLUSION: BNT162b2 vaccine generates more persistent antibodies than inactivated vaccines in haemodialysis patients. However, when compared with the healthy controls at the end of the sixth month, antibody titers decrease more profoundly in haemodialysis patients. The booster dose can maintain the antibody levels and should be applied at least every 6 months.
ABSTRACT
BACKGROUND AND AIMS: Although existing data suggest an increased mortality rate, data about the course of coronavirus disease 2019 (COVID-19) in peritoneal dialysis (PD) patients, its short-and long-term effects on the patient and technique survival are limited. Moreover, specific factors associated with increased risk of death have not been clearly defined yet. Therefore, we aimed to study the characteristics of PD patients with COVID-19, determine the short-term mortality and other medical complications, and delineate the factors associated with COVID-19 outcome. METHOD: This national multicenter study included all PD patients who had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive reverse transcriptase-polymerase chain reaction testing of a nasopharyngeal swab recorded in this database from the attending 27 PD centers. The demographic data, comorbidities, medications used, PD-related data were recorded as well as clinical, laboratory and radiological findings of COVID-19 and outcomes at the end of the first month were recorded. RESULTS: We enrolled 142 COVID-19 patients (median age: 52 years). A total of 58.2% of patients had mild disease at diagnosis, lung involvement was detected in 60.8% of patients. A total of 83 (58.4%) patients were hospitalized, 31 (21.8%) patients were admitted to intensive care unit and 24 needed mechanical ventilation. A total of 15 (10.5%) patients were switched to hemodialysis and hemodiafiltration was performed for 4 (2.8%) patients. Persisting pulmonary symptoms (n = 27), lower respiratory system infection (n = 12), rehospitalization for any reason (n = 24), malnutrition (n = 6), hypervolemia (n = 13), peritonitis (n = 7), ultrafiltration failure (n = 7) and in PD modality change (n = 8) were reported in survivors. During the 1 month from the diagnosis of COVID-19, 26 patients (18.31%) died. The non-survivor group was older and comorbidities were more prevalent. Fever, dyspnea, cough, serious-vital disease at presentation, bilateral pulmonary involvement and pleural effusion were more frequent among non-survivors. Age (OR:1.102;95% CI: 1.032- 1.117;P:0.004), moderate-severe clinical disease at presentation (OR:26.825;95% CI: 4.578-157.172;P < 0.001) and CRP levels (OR:1.008;95% CI;1.000-1.016;P:0.040) were associated with increased first-month mortality in multivariate analysis. CONCLUSION: Early mortality rate and medical complications are quite high in PD patients with COVID-19. Age, clinical severity of COVID-19 and baseline CRP level are the independent parameters associated with mortality.
ABSTRACT
BACKGROUND AND AIMS: Haemodialysis (HD) patients are at increased risk for adverse short-term consequences of COVID-19. In this study, we investigated the characteristics of chronic HD patients in the post-COVID-19 period and compared them with the control group. METHOD: We conducted a national multicentre observational study involving adult chronic HD patients recovering from COVID-19. The control HD group was selected from patients with similar characteristics who did not have COVID-19 in the same center. SARS-CoV-2 RT-PCR negative patients and patients in the active period of COVID-19 were not included. RESULTS: A total of 1223 patients (635 COVID-19 groups, 588 control groups) were included in the study from the data collected from 47 centres between 21 April 2021 and 11 June 2021. The patients' baseline demographics, comorbidities, medications, HD characteristics and basic laboratory tests were quite similar between the groups (Table 1). 28th-day mortality and between 28th day and 90th day mortality were higher in the COVID-19 group than in the control group [19 (3.0%) patients and 0 (0%) patients;15 (2.4%) patients and 4 (0.7%) patients, respectively]. Presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection and A-V fistula thrombosis were significantly higher in the COVID-19 group in the first 28 days of illness and between 28 and 90 days. Mortality was significantly associated with preexisting COVID-19, age, current smoking, use of tunneled HD catheter, persistence of respiratory symptoms, rehospitalization, need for home oxygen support, presence of lower respiratory tract infection within 28 days and persistence of respiratory symptoms. CONCLUSION: In the post-COVID-19 period, mortality, rehospitalization, respiratory problems and vascular access problems are higher in maintenance HD patients who have had COVID-19 compared to control HD patients. (Table Presented).
ABSTRACT
Objectives: There is limited data about coronavirus disease-19 (COVID-19) characteristics and results in peritoneal dialysis (PD) patients. This study aimed to investigate the characteristics and outcomes among PD patients and compare them with matched hemodialysis (HD) patients and a control group without kidney disease. Methods: We included 18 PD patients and consecutive age- and gender-matched 18 HD and 18 patients without kidney disease (control group) registered into the Turkish Society of Nephrology database including 1301 COVID-19 patients. We compared demographic, clinical, radiological, laboratory data, and outcomes namely intensive care unit (ICU) admission, mechanical ventilation, mortality, and composite outcome (death and/or ICU admission). Results: ICU admission, mechanical ventilation, and mortality rates in PD patients (27.8%, 22.2%, and 22.2%, respectively) and the HD group (16.7%, 11.1%, and 16.7%, respectively) were higher than the control group (11.1%, 11.1%, and 5.6%, respectively), but intergroup comparison did not reveal difference. A total of 11 (20.3%) patients had composite outcome (6 PD patients, 3 HD patients, and 2 patients in the control group). In Cox regression analysis, higher age and higher CRP level were related to increased risk of composite outcome. Adjusted rate of composite outcome in PD group was significantly higher than the control group (P =.050). This rate was similar in HD and control groups (P =.30). Conclusions: Combined in-hospital mortality and/or ICU admission of PD patients with COVID-19 was significantly higher than the control patients. There is a need for careful surveillance of PD patients for infection signs and prompt treatment of COVID-19.
ABSTRACT
BACKGROUND AND AIMS: Kidneys are among the affected organs in COVID-19 and there may be different etiologies resulting in acute kidney injury (AKI) in different stages of the disease. There have been previous studies focusing on incidence and mortality of AKI in COVID-19 but none has made in depth analysis in relation to the background pathophysiology. Based on previous observations, we hypothesized that all AKIs seen in COVID-19 are not uniform and we aimed to analyze the etiologies and prognosis of AKI among hospitalized COVID-19 patients in relation to the time of AKI during different phases of the disease. METHOD: A total of 1056 patients were admitted to the designated COVID-19 clinics from March to July in 2020. 77 Patients who were younger than 18 years old and 7 kidney transplant patients were excluded from the study. 427 of the remaining patients were confirmed by real time polymerase chain reaction (RT-PCR) test.). As eGFR below 60 mL/min/1,73 m2 was already shown to be related to mortality, these patients (44) were also excluded. As immunologic response is generally accepted to start with the second week of COVID-19 course, patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from 7th day. Initial lymphocyte counts, creatinine levels, electrolytes, acid-base status and changes in the inflammatory markers were compared between the groups. A comparison between patients who survived and who died was also performed. RESULTS: 89 of the 383 included COVID-19 patients developed AKI. 24% of those who developed AKI died. Patients who developed AKI later had higher peak CRP and D-dimer levels with lower nadir lymphocyte counts (p=0,000, 0,004 and 0,003 respectively). Additionally, patients who died had higher initial inflammatory marker levels and lower lymphocyte counts than those who survived. Mortality of patients who had AKI on hospital admission (13%) was similar to the overall COVID-19 mortality for inpatients, however it was as high as 44% for those who developed AKI after 7th day. Early AKI was related to pre-renal causes and had a milder course. However, later AKIs were more related to immunologic response and had significantly higher mortality. Patients who died had significantly higher ferritin and d-dimer levels upon their hospital admissions (p=0,000). Electrolyte disturbances, metabolic acidosis and mortality were also higher in patients who developed AKI later. Hypernatremia (OR: 6,5, 95% CI: 3 - 13,9) and phosphorus disturbances (both hyperphosphatemia (OR: 3,3;95%CI: 1,6 - 6,9) and hypophosphatemia (OR: 3,9;95% CI: 2,0-7,9)) were related to mortality. CONCLUSION: Findings of this study suggest that AKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies.