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.
ABSTRACT
Background: Hamad general Hospital is the main provider of (HD) in Qatar with 932 patients. We established a team from dialysis nurses under direct nephrologist supervision for management of (MBD). We introduced Etelcalcetide in Qatar in May 2021 for HD patients unable to tolerate oral cinacalcet (GIT symptoms) especially during the COVID-19 pandemic where patients had difficulties dispensing medicine and have proper follow up Methods: Our study followed patients from May 2021 till March 2022. We included HD for >6 months patients with (HPT) despite being on cinacalcet therapy. Patients recruited from all HD centers (4) in Qatar. Data collected through electronic medical records. Result(s): 50 patients fulfilled inclusion criteria and were included in study period. Median (PTH) on cinacalcet was 946 pg./ml (Mean 1123pg/ml). After conversion to Etelcalcetide, PTH median level had significant improvement to 623 pg./ml (mean 749 pg./ ml). Average improvement in PTH level was 46% (36% of patients with 50% improvement and 48% of patients with >50% improvement). The Median dose for Etelcalcetide was 21.5mg /week. (Patients with within our PTH target range (150-500pg/ml) improved from 8% in May 2021 (on cinacalcet) to 38% in March 2022 (on Etelcalcetide) p=0.0003) while patients with PTH above 800 decreased from 50% to 20% for the same period (p=0.001). Reasons for conversion from Cinacalcet to Etelcalcetide were noncompliance due to GIT side effects (with resistant elevation of PTH despite optimal dose (90% of patients) also due to the COVID-19 pandemic and its effect in following medication in the face of shortage of our nurses and physician. Conclusion(s): Our project to optimize MBD management in HD patients with uncontrolled HPT not tolerating Cinacalcet by utilizing Etelcalcetide showed significant improvement in PTH outcomes. It was well tolerated with no reported significant side effects. Utilizing MBD team proven to be a wise decision during the peak of the COVID-19 pandemic with physician shortage and service disturbances. (Figure Presented).
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.
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.