Prognostic Factors of Serological Response to the Sars-Cov 2 Vaccine in Peritoneal Dialysis: Our Experience

BACKGROUND AND AIMS The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic has had a massive impact in health systems worldwide, taking an important toll on dialysis patients as they are more comorbid, have higher mortality and an impaired immune system. Vaccines against SARS-Cov-2 proved to reduce mortality and hospitalization, but serological response in the dialysis population is weaker. Therefore, predictors of response would be useful to assess their level of protection and evaluate the need for further booster doses of the vaccine. METHOD - We retrospectively analysed all peritoneal dialysis (PD) patients fully vaccinated (two doses) in our PD Unit between February and June 2021. - Clinical data, vaccine brand and anti SARS-Cov-2 IgG antibodies (Ab) measured by enzyme immunoassay were recorded. - The linear correlation between Ab level and all other variables was analysed using the Pearson correlation coefficient. RESULTS - In the study period, 22 of 32 prevalent patients were fully vaccinated with two vaccine doses, 70.8% Moderna, 20.8% Pfizer/BioNTech and 8.3% AstraZeneca. A total of 50% were male and 36.4% had diabetes mellitus, with mean age 61.4 ± 12.3 years. Median time on PD was 15.6 months (IQR 4.9–25.1). Up to 22.7% were on immunosuppression (IS) after a kidney graft dysfunction (prednisolone, tacrolimus or both) and 22.7% had a previous diagnosis of coronavirus disease (COVID). - A total of 072.7% had an immediate minor adverse event after the second dose of the vaccine, mostly headache/malaise (31.8%) and puncture site pain (22.7%). - Ab levels were significantly higher in those patients with previous COVID (r = 0.452;P = 0.035). Male gender and Moderna vaccine had a positive correlation with higher Ab titers, although not statistically significant (r = 0.401, P = 0.064 and r = 0.215, P = 0.337, respectively). Those with longer duration of PD treatment before vaccination had a weaker serological response (r = −0.228, P = 0.307). Ab levels did not correlate with age (r = −0.046, P = 0.837), diabetes (r = −0.121, P = 0.600) or IS medications (r = −0.070, P = 0.756). - Shows Ab levels at 7.4 ± 4 weeks after the second dose: CONCLUSION In our experience, PD patients have an adequate serological response to the SARS-Cov-2 vaccines, being previous COVID exposure the main predictor of a good response. Conversely, longer duration of PD treatment was a prognostic factor of seroconversion failure. We believe this should be kept in mind to assess the need for booster vaccination doses in those patients.Table 1.Ab levels (AU/mL)%<1000100–100031.81001–10 00027.310 001–40 00022.7>40.00018.2

Impact of different COVID-19 waves on kidney replacement therapy epidemiology and mortality: REMER 2020.

BACKGROUND: Kidney replacement therapy (KRT) confers the highest risk of death from coronavirus disease 2019 (COVID-19). However, most data refer to the early pandemic waves. Whole-year analysis compared with prior secular trends are scarce. METHODS: We present the 2020 REMER Madrid KRT registry, corresponding to the Spanish Region hardest hit by COVID-19. RESULTS: In 2020, KRT incidence decreased 12% versus 2019, while KRT prevalence decreased by 1.75% for the first time since records began and the number of kidney transplants (KTs) decreased by 16%. Mortality on KRT was 10.2% (34% higher than the mean for 2008-2019). The 2019-2020 increase in mortality was larger for KTs (+68%) than for haemodialysis (+24%) or peritoneal dialysis (+38%). The most common cause of death was infection [n = 419 (48% of deaths)], followed by cardiovascular [n = 200 (23%)]. Deaths from infection increased by 167% year over year and accounted for 95% of excess deaths in 2020 over 2019. COVID-19 was the most common cause of death (68% of infection deaths, 33% of total deaths). The bulk of COVID-19 deaths [209/285 (73%)] occurred during the first COVID-19 wave, which roughly accounted for the increased mortality in 2020. Being a KT recipient was an independent risk factor for COVID-19 death. CONCLUSIONS: COVID-19 negatively impacted the incidence and prevalence of KRT, but the increase in KRT deaths was localized to the first wave of the pandemic. The increased annual mortality argues against COVID-19 accelerating the death of patients with short life expectancy and the temporal pattern of COVID-19 mortality suggests that appropriate healthcare may improve outcomes.

The Impact of Immunosuppression and Autoimmune Disease on Severe Outcomes in Patients Hospitalized with COVID-19.

Immunosuppression (IS) and autoimmune disease (AD) are prevalent in patients with severe coronavirus disease 2019 (COVID-19), but their impact on its clinical course is unknown. We investigated relationships between IS, AD, and outcomes in patients hospitalized with COVID-19. Data on consecutive admissions for COVID-19 were extracted retrospectively from medical records. Patients were assigned to one of four cohorts, according to whether or not they had an AD (AD and NAD) or were immunosuppressed (IS and NIS). The primary endpoint was development of severe acute respiratory distress syndrome (ARDS); secondary endpoints included death, and a composite of mechanical ventilation (MV) or death. A total of 789 patients were included: 569 (72.1%) male, 76 (9.6%) with an AD, and 63 (8.0%) with IS. Relative to the NIS-NAD cohort, patients in the IS-AD cohort had a significantly reduced risk of severe ARDS (adjusted hazard ratio [aHR] 0.42; 95% confidence interval [CI] 0.23-0.80; p = 0.008). No significant relationships between IS or AD status and either death or the composite of MV and death were identified, although a trend towards higher mortality was identified in the IS-NAD cohort (aHR vs NIS-NAD 1.71; 95% CI 0.94-3.12; p = 0.081). Patients in this cohort also had higher median serum levels of interleukin-6 compared with IS-AD patients (98.2 vs 21.6 pg/mL; p = 0.0328) and NIS-NAD patients (29.1 pg/mL; p = 0.0057). In conclusion, among patients hospitalized with COVID-19, those receiving immunosuppressive treatment for an AD may have a reduced risk of developing severe ARDS.