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Background: Patients on hemodialysis are at high-risk for complications derived from coronavirus disease-19 (COVID-19). The present study aims to evaluate the impact of a booster vaccine dose and breakthrough SARS-CoV-2 infections on humoral immunity three months after the booster dose. Method(s): This is a multicentric and prospective study assessing anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6-and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Result(s): 711 patients (67% male, 67 [20-89] years) were included. Of them, 545 (77%) patients had received an early booster and 166 (23%) a late booster. At 6 months, 64 (9%) patients had negative humoral response (3% of early booster and 29% of late booster participants, p=0.001) and 58 (91%) of them had seroconverted at 9 months, when, 5/545 (0.9%) patients in the early booster cohort and 1/166 (0.6%) in the late booster cohort remained antibody negative (p=NS). During follow-up, 35 patients (5%) developed COVID-19. Antibody titers at 9 months were independently associated to lower time from booster (B -0.12, p=0.043), COVID-19 (B 2.29, p<0.001) and mRNA-1273 booster (B 1.17, p=0.001). Conclusion(s): In hemodialysis patients, higher rates of anti-Spike antibody development were associated to mRNA-1273 booster, lower time from booster and breakthrough SARS-CoV-2 infection.
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INTRODUCTION: Four vaccines against Covid-19 have been approved to date. Their acceptance and safety have not been addressed on healthcare workers. The aim of the present study is to evaluate vaccination rates and side effects among Spanish nephrologists. METHODS: All the Spanish nephrologists were invited to participate in this survey. Data on demographics, Covid-19 infection status, received vaccine doses and side effects were collected. Acceptance and side effects were analyzed for Covid-19 vaccination. Factors associated to vaccination were assessed and a multivariate adjusted model was constructed to determine independent predictors for Covid-19 vaccine side effects. RESULTS: A total of 708 nephrologists answered the survey (460 [65%] women, mean age 44±11 years). Six-hundred and eight (86%) had received the first dose and 513 (72%) were fully vaccinated. Most of the subjects (565, 93%) received BNT162b2 (Pfizer-BioNTech®) vaccine. Among vaccinated nephrologists, 453 (75%) presented any side effect; the most frequent was local reaction (68%), followed by myalgia (44%), tiredness (39%) and headache (34%). Age (OR 0.97, 95%CI [0.95-0.99], p<0.0001) and prior Covid-19 infection (OR 2.37, 95%CI [1.27-4.42], p=0.007) were independent predictors for developing side effects with Covid-19 vaccine. Overall side effects were similar with both vaccines, being myalgia (p=0.006) and tiredness (p=0.032) more frequent with the Pfizer-BioNTech® one. CONCLUSION: Age and prior Covid-19 infection were predictors of vaccination side effects among Spanish nephrologists.
Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , BNT162 Vaccine , Female , Humans , Middle Aged , Nephrologists , SARS-CoV-2 , Vaccination/adverse effectsABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide over the last year causing more than one million deaths. Several treatments have tried to modify the natural history of the coronavirus disease 2019 (COVID-19) but only corticosteroids have demonstrated to be effective in moderate or severe affectation. In that situation, the development of vaccines for preventing the SARS-CoV-2 infection has focused the attention of the scientific community. At present, available messenger RNA-based technology vaccines have received the approval of local and international sanitary authorities. In this position statement, the Spanish Society of Nephrology wants to state that patients with chronic kidney disease and healthcare workers are at high-risk for contagion and complications of COVID-19 so they must have priority in the vaccine administration.
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.