ABSTRACT
Background: COVID-19 vaccine hesitancy has been asscociated with social deprivation and selected minority ethnic groups who are over-represented in the Renal Replacement Therapy (RRT) population. We designed a COVID-19 vaccination programme for our RRT population with the aim to increase vaccination uptake and decrease health inequalities. Method(s): Key interventions included addressing vaccine hesitancy by deploying the respective clinical teams as trusted messengers, prompt eligible patient identification and notification, deployment of resources to optimise vaccine administration in a manner convenient to patients and timely collection and analysis of local safety and efficacy data. First COVID-19 vaccination uptake data in relation to ethnicity and social deprivation, measured by the multiple deprivation index, in our RRT population were analysed and compared with uptake data in the regional total adult clinically extremely vulnerable (CEV) population in Greater Manchester (GM). Univariate logistic regression analysis was used to explore the factors associated with not receiving a vaccine. Result(s): Out of 1156 RRT patients included in this analysis (Table) 96.7% received the first dose vaccination compared to 93% in the cohort of CEV patients in the GM. Age, sex, ethnicity and index of multiple deprivation were not associated with first dose vaccine uptake. Vaccine uptake in Asian and Black RRT patients was 94.9% and 92.3% respectively compared to 93% and 76.2% for the same ethic groups in the reference CEV GM. Vaccine uptake was 96.1% of RRT patients in lowest quartile of multiple deprivation index compared to 90.5% in the GM reference population. Conclusion(s): Bespoke COVID-19 vaccination programme based on local clinical teams as trusted messengers can address vaccine hesitancy and reduce health inequalities.
ABSTRACT
BACKGROUND AND AIMS: Individuals with end-stage kidney disease (ESKD) have a greater susceptibility towards coronavirus disease 2019 (COVID-19) infection compared to those without chronic kidney disease or ESKD, and these patients are more vulnerable to poor clinical outcomes. The introduction of COVID-19 vaccination programs displayed efficacy to improving clinical outcomes. A study based in the UK reported excellent humoral responses to the Pfizer BNT162b2 vaccine, but suboptimal responses to the Oxford AstraZeneca ChAdOx1-nCoV-19(AZD1222) vaccine amongst hemodialysis patients. High rate of humoral responses to two doses of the COVID-19 vaccination has been reported within small cohorts of peritoneal dialysis (PD) patients 3 to 8 weeks post vaccination, whilst one study confirmed maintenance of significant humoral responses 6 months post vaccination with the Pfizer BNT162b2 vaccine. Our study aimed at evaluating longer-term antibody responses-6 months after a two-dose regimen of the Pfizer BNT162b2 and Oxford AstraZeneca ChAdOx1-nCoV-19 (AZD1222) vaccines in patients receiving PD. METHOD: This is a single-center observational study conducted for PD patients who were offered both doses of the COVID-19 vaccine [either Pfizer BNT162b2 or Oxford AstraZeneca ChAdOx1-nCoV-19(AZD1222)] since universal introduction of the vaccination program in our local area in December 2020. COVID-19 antibody testing was performed using the Siemens' immunoassay targeting the spike protein S1 RBD (an index ≥ 1.0 was deemed as a positive result) between October and November 2021. Demographic and baseline clinical data were collected for each patient, and analysis focused on comparing the characteristics between PD patients with positive and negative COVID-19 antibody statuses. Statistical analysis was performed using SPSS version 24. RESULTS: Eighty-six patients were included in this study. The median age was 62 years (47-71) with a predominance of males (61.6%) and Caucasian ethnicity (75.6%). The majority of patients have hypertension (84.8%) with 38% having a history of cardiovascular disease and 34% being diabetic. Ten patients (11.6%) previously received a kidney transplant with 7 patients (8.2%) currently on immunosuppressive treatment, and 15 patients (17.4%) previously receiving such treatments. A total of 81 patients received both doses of the COVID-19 vaccine, of which 57 (70.4%) received Pfizer BNT162b2, 16 (19.7%) received Oxford AstraZeneca ChAdOx1-nCoV-19 (AZD1222) and the type of vaccine was unknown in 8 patients (9.9%). A total of 72 patients were COVID-19 antibody tested between October and November 2021 in which 68 (94.4%) had a positive antibody and 4 (5.6%) had a negative antibody test. The median time between first dose of the COVID-19 vaccination and antibody testing was 9 (8.6-9.5) months and the median time between second dose of the COVID-19 vaccination and antibody testing was 6.3 (5.8-6.7) months. Comparing the demographic and clinical characteristics between patients with positive and negative antibodies, a higher proportion of patients with history of receiving immunosuppression (currently or previously;P = 0.004) had a negative antibody status despite receiving two doses of COVID-19 vaccination. There were no further significant differences observed. Full study results are presented in Tables 1 and 2. CONCLUSION: In our cohort of PD patients, detectable humoral response to COVID-19 vaccination was sustained 6 months following vaccination irrespective of the type of vaccination received. A higher proportion of patients with a history of receiving immunosuppression (current or past) had a poor antibody response following COVID-19 vaccinations, highlighting the importance of considering focused COVID-19 vaccination strategies in the context of immunosuppression.
ABSTRACT
BACKGROUND AND AIMS: Patients with transplanted kidneys are more susceptible to COVID-19 infections compared to those with native kidneys because of chronic immunosuppression and co-existing co-morbidities. A wide spectrum of renal pathologies has been reported from renal biopsies taken from patients with native kidneys following COVID-19 presentation. In comparison, biopsy-proven findings in the setting of kidney transplantation and COVID-19 diagnosis are seldom described. Our study aims to review early reported histological findings of transplant kidney biopsies from patients testing positive for COVID-19. METHOD: This is a secondary analysis of a larger study (PROSPERO registration number: CRD42020218048) which reviewed the histopathological findings of kidney biopsies in adults with concurrent COVID-19 infection. A systematic literature search was conducted independently by two authors (HW, VJ) through 'PubMed', 'Web of Science', 'Embase' and 'Medline-ProQuest' using the following keywords: 'COVID-19 AND Kidney Biopsy', 'COVID-19 AND Renal Biopsy', 'SARS-CoV-2 AND Kidney Biopsy' and 'SARS-CoV-2 AND Renal Biopsy'. Articles were screened by three authors (HW, VJ, RC) for relevance and duplicates were removed. The study selection process was carried out as per the PRISMA guideline. In this analysis, we included all research articles reporting biopsies in transplanted kidneys in adults over age > 18 who tested positive with COVID-19 following a PCR swab test. We only included articles published in the English language. All relevant articles published before November 1st 2020 were included in this review. Information regarding demographic data, comorbidities, renal presentation, renal parameters at time of COVID-19 diagnosis, management, need for renal replacement therapy and outcomes were extracted from selected articles. RESULTS: Our review identified 11 cases reporting transplant kidney biopsies in patients with positive COVID-19 status. These 11 cases were reported from 7 articles, which were either single case reports or part of a case series. Mean age of the reported cases was 43.6 years 6 10.7. Transplant kidney biopsies were taken from 4 female and 7 male patients, where 7 patients were of black ethnicity. The review involved 3 live donor and 6 deceased donor transplanted kidneys, and 2 cases did not report type of kidney transplant received. All of the documented cases presented with acute kidney injury. 9 patients have essential hypertension or hypertension secondary to other comorbidities. Biopsy findings revealed 2 cases of acute T-cell mediated and antibody mediated rejection, 2 cases of acute tubular injury, 5 cases of either FSGS or collapsing FSGS and 1 report of post-transplant kidney infarction. Acute treatment received involved different regimes. All 11 patients were eventually discharged from hospital, where 2 patients required dialysis following discharge. Table 1 describes data from the extracted cases. CONCLUSION: There are multiple histological pathologies observed amongst transplant kidney biopsies taken from patients admitted following COVID-19 diagnosis. Early results suggest aggressive medical treatment to manage inflammation, transplant rejection and co-morbidities such as hypertension may optimize general and renal-specific outcomes. Collation of further cases is required to determine a clearer association between COVID-19 and characteristics demonstrated from transplant kidney biopsies.