ABSTRACT
Background: Hemodialysis (HD) patients have high mortality from COVID-19 and immunity following vaccination remains uncertain. This study evaluated SARS-CoV-2 antibody response in HD patients following BNT162b2 COVID-19 vaccination compared to health care workers (HCW) and convalescent serum. Methods: This single centre observational cohort study enrolled 142 HD patients and 35 HCW receiving the BNT162b2 vaccine. SARS-CoV-2 IgG antibodies to the spike protein (anti-spike), receptor binding domain (anti-RBD), and nucleocapsid protein (anti-NP) were measured in 66 HD patients receiving one vaccine dose, 76 HD patients receiving two vaccine doses, and 35 HCW receiving two vaccine doses. Results: In HD patients receiving a single BNT162b2 dose, seroconversion occurred in 53/66 (80%) for anti-spike and 35/66 (55%) for anti-RBD by 28 days post dose, but only 15/66 (23%) and 4/66 (6%), respectively attained a robust response defined as reaching the median level of anti-spike and anti-RBD in convalescent serum. In patients receiving two doses of BNT162b2 vaccine, seroconversion occurred in 69/72 (96%) for anti-spike and 63/72 (88%) for anti-RBD by 2 weeks following the second dose while 52/72 (72%) and 43/72 (60%) reached median convalescent serum levels of anti-spike and anti-RBD. In HCW, 35/35 (100%) exceeded median levels of anti-spike and anti-RBD in convalescent serum 2-4 weeks post second dose. Conclusions: This study found poor immunogenicity 28 days following a single dose of BNT162b2 vaccine in HD patients, supporting adherence to recommended vaccination schedules, and avoiding delay of the second dose in this population.
ABSTRACT
Background: Home dialysis may be able to minimize SARS-CoV2 exposure risks. The pandemic may have introduced unique challenges related to supply disruption and care delivery changes. We sought to assess the global burden of COVID-19 on peritoneal dialysis units (PD) and understand PD unit practice changes during this time. Methods: The Peritoneal Dialysis/Dialysis Outcomes and Practice Patterns Study (PDOPPS/DOPPS) and International Society of Nephrology (ISN) administered a webbased survey (1) to dialysis units selected based on a random sample stratified by region (November 2020 -March 2021), and (2) to an open invitation via ISN's membership list and social media (March 2021). Responses were compared across 10 ISN regions. Results: Returned surveys included 167 PD facilities across 52 countries. Changes in several care domains including clinic communication and frequency, labwork frequency, method of communication, masking policies, changes in handling of PD effluent among infected individuals, PD supply disruption, access to methods of PD catheter insertion and frequency of new patient training are highlighted (table). Conclusions: Variability exists in routine PD care, and the availability and use of PPE, disruption in PD supplies among the different regions reflecting the availability of the resources and infrastructure differences. LMIC tended to be more severely impacted-this gap needs to be addressed in anticipation of future pandemics for treatment continuity. Although remote technology use among PD patients to communicate with their physicians has increased during the pandemic, optimal communication frequency, methods and schedule of routine bloodwork needs to be better elucidated.
ABSTRACT
Background: The COVID-19 pandemic caused unprecedented disruption to dialysis patients care globally. Facility surveys were distributed to assess the impact of COVID-19 pandemic on hemodialysis (HD) and peritoneal dialysis (PD) practices. Methods: Medical Director (MD) and Nurse Manager (NM) Surveys (MDS, NMS) are being distributed in May/June 2020 to 723 clinics enrolled in the Dialysis (in-center HD, DOPPS) or Peritoneal (PDOPPS) Dialysis Outcomes and Practice Patterns Study in Canada, China, Japan, the United States, 7 European countries, 5 Gulf Cooperative Council countries, and China metropolitan areas (Beijing, Guangzhou, Shanghai). Surveys content includes the number of COVID-19 cases, testing, and clinical management, screening, infection control, staffing, patient transportation, and psychological support. Results: As of 27 May 2020, we have 80 MDS (China, Europe, US = 33, 38, 5) and 101 NMS (45, 46, 9) responses from DOPPS sites. The following percentages are presented sequentially for China, Europe, and US. Among MDs, 0%, 67%, 67% reported at least one confirmed COVID-19 case among dialysis patients, and 85%, 70%, 66% reported being on the late phase of the COVID-19 curve. 40%, 23%, 100% of MDs were more likely to recommend home dialysis;19%, 5%, 29% reported an increase in missed dialysis treatments;30%, 24%, 50% were more likely to prescribe potassium binders;and 75%, 68%, 43% had greater challenges obtaining vascular access interventions. Among NMs, 30%, 9%, 40% reported current limitations in access to COVID-19 testing;and 61%, 51%, 29% reported having, or risk of, shortage in staffing. Conclusions: Early results indicate many clinics in Europe and US have had COVID-19 cases, but sites in the three DOPPS-China cities have avoided COVID-19 to date. In all regions, shortages of human and medical resources were common, as were changes to dialysis delivery/practice including more skipped sessions, greater use of potassium binders, and preferentially recommending home dialysis. Over the next month, we expect hundreds more responses, and will compare approaches in PD and HD clinics. These data will inform guidance for dialysis care as the COVID-19 pandemic ensues.