ABSTRACT
BACKGROUND AND AIMS: Patients with glomerulonephritis may have an increased risk of influenza infection and morbidity, but vaccine coverage remained low with little data on acceptance in glomerulonephritis. We aimed to assess influenza vaccine awareness among patients with glomerulonephritis and identify determinants of vaccine acceptance. METHOD: Single-center cross-sectional study of patients with glomerulonephritis who completed a survey in the clinic or over the telephone between June and August 2021. Sociodemographic data, health literacy measured by HLS-EU-47 questionnaire, influenza and the coronavirus disease (COVID-19) vaccine awareness and determinants of vaccine acceptance according to the World Health Organization framework. RESULTS: Among 86 patients who completed the survey, influenza vaccine awareness was lower than COVID-19 vaccine awareness (75.6% versus 100%). After adjusting for the survey type, use of English language at home and at healthcare settings, higher income and professional or executive occupation were significantly associated with influenza vaccine awareness, while older age and lower education level were associated with reduced awareness. The healthcare provider was the most frequent information source and > 90% trusted that healthcare providers and the government considered the patients' best interests and gave correct information. Only half thought their medical condition and medications would affect their vaccine decision while a quarter to half did not understand how the vaccine worked and thought there were better ways to protect against infection. CONCLUSION: Healthcare providers can actively identify and advocate influenza vaccines to the unaware and overcome potential barriers to reduce influenza infections and morbidity in glomerulonephritis.
ABSTRACT
Introduction: Critical illness in SARS-CoV-2 (COVID-19) infection can result in acute kidney injury (AKI). Continuous renal replacement therapy (CRRT) is part of the overall supportive ICU management. Case Description: CRRT was delivered as Continuous Veno-venous Haemodiafiltration (CVVHDF) using the Prismaflex (Baxter Inc.) system with heparinbonded AN69 filter (oXiris®). The filters were electively changed every 12 hours for first 5 days to augment cytokine adsorptive capacity. Regional citrate anticoagulation (RCA) was used to ensure filter longevity. Initial citrate dose was prescribed at 3.0 mmol/L. All 3 consecutive patients were male aged 66.7 ± 6.02 years. APACHE II score was 32.7 ± 6.51 and predicted mortality was 71%. Mean initial creatinine was 264.7 μmol/L, and urine output was 6.7 mL/hour. All patients were on vasopressor support, broad spectrum antimicrobials and mechanical ventilation. 30 oXiris filters were studied in the 3 patients. 6/30 (20%) filters clotted spontaneously before scheduled change. Mean filter lifespan (24/30) was 689.6 ± 42.3 min before elective change. For the filters that clotted, mean circuit longevity was 515.7 ± 126.2 min. The observed difference was significant, p = 0.002. Importantly, filter clotting occurred despite adequate citrate dose of 3.0 mmol/L and mean post-filter ionized calcium of 0.34 ± 0.06 mmol/L. Vascular access issues were excluded by review of access, return pressures. Citrate dose was increased to 3.2 mmol/ L for all patients and this reduced the frequency of filter clotting subsequently. Two patients were extubated and had full renal recovery - mean duration of CRRT dependence was 9.5 days. However, the third patient remained CRRT dependent until demise on the 28th day of ICU stay. Discussion: Attenuation of circuit lifespan was observed despite adequately dosed RCA and heparin bonded oXiris filters. We theorize that this could be due to a procoagulant state induced by the SARS-CoV-2 infection. Possibly, higher citrate dose to target even lower post-filter ionized calcium may be required to optimise anticoagulation and filter lifespan, thereby ensuring optimal effluent dose and solute clearance, for critically ill COVID-19 patients.