ABSTRACT
Background: Maintenance dialysis patients' SARS-CoV-2 receptor binding spike antibody (RBD s-Ab) levels decline rapidly in the months following initial vaccination. We describe the association of RBD s-Ab levels with a subsequent diagnosis of COVID-19 and COVID-related hospitalization or death. Method(s): We identified all vaccinated adult maintenance dialysis patients at Dialysis Clinic, Inc. who were diagnosed with COVID-19 between June 20, 2021 and May 8, 2022. Descriptive analyses illustrate the association of RBD s-Ab levels assessed 7-45 days prior to COVID-19 diagnosis with COVID-related hospitalization or death. Result(s): There were 340 maintenance dialysis patients with RBD s-Ab levels assessed at a median 23 [16,40] days prior to COVID diagnosis, with mean age 65+/-13 years, 51% female, 51% White, 91% HD and vintage 4.3+/-4.3 years. While COVID-19 diagnosis and COVID-related hospitalization or death events occurred across RBD s-Ab levels (Figure), 74 of 93 (80%) COVID-related hospitalizations and 24 of 25 deaths (96%) occurred at RBD s-Ab level <500 BAU/mL Conclusion(s): Maintenance dialysis patients are at risk for serious COVID events when RBD s-Ab < 500 BAU/mL. Routine RBD s-Ab measurement informing personalized vaccination strategies to keep titers above 500 BAU/mL may benefit this high-risk population.
ABSTRACT
Background: Preventing COVID-19 infection or its consequences through SARSCoV- 2 vaccination in maintenance dialysis patients, a high risk population, is imperative. We determined relative vaccine effectiveness (VE) of 1, 2, or 3 doses of an mRNA vaccine in preventing SARS-CoV-2 infection, hospitalization, and death. Method(s): All adult maintenance dialysis patients at Dialysis Clinic, Inc. offered an mRNA vaccine between 12/15/20 and 2/28/22 were included, with follow up time through 3/31/22. Using a multivariable logistic regression model, we calculated adjusted odds ratios (OR) for COVID-19 infection and associated hospitalization and death within 30 days during pre-Delta (12/15/20-6/19/21), Delta (6/20-12/18/21) and Omicron (12/19/21-2/28/22) periods. VE was calculated as (1-adjusted OR) x 100%. Patients were censored at infection, death, or transplantation. Result(s): The 17,309 maintenance dialysis patients included had mean age of 63+/-15 years, 58% male, 35% Black, 47% White, 87% HD and mean vintage 42+/-55 months. Across all three COVID-19 variant periods, VE increased with each successive mRNA dose received, improving protection against infection, hospitalization and death (Table). VE was highest among patients vaccinated with homologous mRNA-1273 regimens. Conclusion(s): Two or more SARS-CoV-2 mRNA vaccine doses exhibited VE protecting against COVID-19 related associated hospitalization and death in maintenance dialysis patients irrespective of variant era. At least 3 doses maximizes protection and may be necessary due to uremia-related mild to moderate immunodeficiency. (Table Presented).
ABSTRACT
At Dialysis Clinic Inc., a national dialysis provider, we assessed the impact of COVID-19 on delivery of care by comparing the risk of mortality and hospitalization month-over-month over three years. Monthly rates for all-cause mortality (with Poisson regression) and hospitalization (with negative binomial regression) were calculated per 1000 patient months for in-center hemodialysis (ICHD) patients for calendar months Jan-Sept for 2018, 2019 and 2020, adjusted for age and race. The analysis was repeated with and without patients with COVID-19. During Jan-Sept 2020 there were 1,743 deaths in 15,336 non-COVID-19 patients and 204 deaths in 995 COVID-19 patients. A nonsignificant increased monthly mortality rate was observed in April 2020 [15.79 (13.83, 18.02)] relative to other months in 2018, 2019 and 2020 (Figure). Excluding patients after COVID-19 diagnosis, the April 2020 monthly death rate decreased [12.16 (10.45, 14.15)] in alignment with other months/years. During Jan-Sept 2020 there were 14,531 hospitalizations in 15,336 non-COVID-19 patients and 976 hospitalizations in 995 COVID-19 patients. There was a significant decrease in monthly hospitalization rate in April 2020 [111.39 (105.08, 118.08)] (Figure) and a further significant decrease after excluding COVID-19 patients [98.07 (92.15, 104.38)] relative to other months in 2018, 2019, and 2020. During the COVID-19 pandemic ICHD patient monthly mortality rates did not differ significantly whereas hospitalization rates did decrease significantly during the month of April 2020 Despite lower hospitalization rates, outpatient care quality was sufficiently maintained to avoid increased non-COVID marginal mortality risk.
ABSTRACT
Background: The CDC recommends screening of all patients for COVID exposure history and or signs and symptoms prior to treatment. In order to limit the spread of COVID within our facilities, Dialysis Clinic Inc. screens all patients prior their in-center hemodialysis treatment or peritoneal dialysis visit consistent with recommendations. Methods: We describe the outpatient screening results of our dialysis patients having a positive screen as patients under investigation (PUI) to activate local protocols for isolation and testing. We determined the frequencies of positive screening parameters and rate of identifying COVID patients. Results: From 2/17 to 5/1, 2020, facilities screened 15,602 patients over 402,002 in-person visits, identifying 959 PUI's (6%). Among PUIs, 61 of 351 (17%) COVID+ patients were correctly triaged prior to COVID+ diagnosis. In the subset of 788 PUIs screened prior to 4/11/20 where we were able to catalogue reasons for positive screening, 149 (19%) had exposure only and 639 exhibited symptoms (81%), of which 15 had exposure;34 resided in group home (GH) and 7 had both exposure and GH residence. It was determined 41 (6.4%) were COVID+. Frequency of symptoms elicited by PUI are shown below. Conclusions: 959 PUIs were identified and isolated by our screening process, resulting in the successful preemptive triage of 61 COVID+ (6%) patients before testing positive, potentially limiting infection spread in the facility. Cough and fever were the most common reasons for positive screen, and fever was most commonly associated with COVID+ diagnosis. However, the majority (83%) of COVID+ patients were primarily asymptomatic and hence not captured by screening. (Table Presented).