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Rheumatology (United Kingdom) ; 62(Supplement 2):ii48, 2023.
Article in English | EMBASE | ID: covidwho-2326724


Background/Aims The immune response to SARS-CoV-2 is known to be reduced in the immunocompromised. However, extent to which immunity is affected by immunosuppression in specific disease cohorts remains poorly characterised. Furthermore, implications of the ongoing vaccination booster programme require further study. Individuals with lupus nephritis (LN) require prolonged high-dose immunosuppression in order to maintain disease control, rendering them important to study in this context. We evaluated SARS-CoV-2 nucleocapsid and spike antibody response in this cohort during the Spring/Summer 2022 booster vaccine campaign. Nucleocapsid antibody indicates previous infection whilst spike antibody indicates previous infection and/or vaccination response. Titre of spike antibody to prevent infection is not known, but presence of antibodies is likely to protect against severe disease. Methods SARS-CoV-2 spike and nucleocapsid antibody were measured in adult patients with LN attending a tertiary centre rheumatology clinic. Data was collected retrospectively on disease, immunosuppression, vaccine status and history of natural exposure. Results 35 cases of LN were investigated, of which LN III, IV and V were predominant biopsy diagnoses. Regarding immunosuppressants, the Eurolupus Cyclophosphamide protocol had been used in the majority of patients to achieve initial control, with 3/35 patients still receiving pulsed courses at data collection. 18/35 were on Mycophenolate Mofetil;a further 13/35 had previously received this. 31/35 took at least 5mg Prednisolone daily;25/35 took Hydroxychloroquine;7/35 took Azathioprine;7/35 had previously been on Methotrexate, 3/35 took Tacrolimus;1/35 took Ciclosporin. Regarding B-cell depleting monoclonal antibody therapy, 13/35 had received Rituximab and 8/35 were receiving Belimumab. Antibody levels were measured between 4 weeks and 13 months after last dose of vaccination;mean duration was 6 months. 11/35 had confirmed COVID-19 infection;a further 8/35 reported a possible history. Of the 35, 32 (91%) had mounted detectable SARS-CoV-2 spike antibody above the bottom 10% of assay detection, indicating some immunity to vaccination or natural exposure. 20 (57%) had detectable nucleocapsid antibody, suggesting natural infection with antibody response. Only 2 (6%) had not mounted any antibody response. Of note, neither were fully vaccinated: one had 1 vaccination with blood test 8 months subsequent;one had 2 vaccinations with blood test 7 months subsequent. The latter was also notably on haemodialysis. All who received 3+ vaccinations had detectable spike antibody responses, as well as 75% of those who had received 2 vaccinations. Conclusion Our study is the first analysis, to our knowledge, of SARS-CoV-2 antibody response in a LN cohort. Whilst neutralising capacity and level of antibody providing protection remains under research, these findings provide at least some reassurance that individuals with LN on immunosuppression are capable of mounting an immune response against SARS-CoV-2. Further work is required to establish extent and duration of protection with serial vaccinations in this cohort.

Journal of the American Society of Nephrology ; 32:775, 2021.
Article in English | EMBASE | ID: covidwho-1489595


Background: Mortality rates from COVID-19 are significantly higher in patients requiring renal replacement therapy (20-30%) than the overall estimated mortality of 1-4% worldwide. COVID-19 vaccines offer a strategy to protect this vulnerable cohort. Patients on hemodialysis are at higher risk of exposure to COVID-19 due to an inability to self-isolate, and were prioritised for vaccination in the UK. The Oxford Astra-Zeneca (Ox/AZ) vaccine allows administration on the dialysis unit, due to ease of storage and transportation. During the time period between the 1st and 2nd dose in the vaccination schedule, a rare clinical syndrome of thrombocytopenia and thrombosis was observed in patients after receiving the Ox/AZ vaccine. Methods: We undertook a retrospective analysis of routine dialysis bloods, examining any significant changes in platelet count pre and post vaccine in our dialysis cohort, prior to offering 2nd doses. Results: Data for 780 hemodialysis patients with platelet count pre and post first dose Covid-19 vaccine were analysed. Of these, 471 patients received the Ox/AZ vaccine, 145 received Pfizer, and the remainder were vaccinated elsewhere, therefore data on vaccine type not available. Mean platelet count for the whole cohort pre-vaccine was 215x109/L, and post was 218x109/L. 126 patients had a platelet count below 150x109/L pre-vaccine, and this number was the same post vaccination. No difference was observed based on vaccine type (see table). Conclusions: No signal of vaccine-induced thrombocytopaenia was detected in this cohort, though the numbers were small to detect such a rare event. The benefits of completing the vaccine schedule outweigh any small risk of vaccine-associated thrombocytopaenia and thrombosis in this clinically extremely vulnerable cohort.

Journal of the American Society of Nephrology ; 32:84, 2021.
Article in English | EMBASE | ID: covidwho-1489488


Background: Broad adoption of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is key to fighting the spread of Covid-19. Hemodialysis patients are at increased risk of exposure to SARS-CoV2 and associated with high morbidity and mortality if they contract Covid-19, therefore attaining high vaccination rates in dialysis patients is of utmost importance. The aim of this study was to establish the prevalence of vaccine hesitance across the multi-ethnic population of dialysis patients in North East London, and to assess whether vaccine uptake could be improved by offering vaccination in a familiar setting by trusted healthcare professionals. Methods: Prior to the initiation of the hemodialysis vaccine programme, a survey was conducted of 837 in-centre haemodialysis patients to identify those willing to accept the vaccine. The vaccine was then offered to all haemodialysis patients during their dialysis attendance, by their dialysis team of nurses and nephrologists. Results: Of 674 responses, 476 (71%) patients reported willingness to accept the vaccine. However only 41% of the 232 patients of Black ethnicity stated that they would accept the vaccine with 59% undecided or declined, compared to acceptance of 77% and 82% of the Asian and White patients respectively (p<0.0001). The actual acceptance rate was significantly higher in all ethnic groups than that predicted by the survey (82.2% uptake in total), with 71.5%, 86.0% and 89.3% in Black, Asian and White cohorts respectively (p<0.0001). In total, 59.1% of patients who responded 'no' in the initial survey, accepted the vaccine when offered on the unit. Conclusions: Though vaccine hesitancy remains a concern, even in this particularly vulnerable patient group, our data show that uptake can be improved by offering Covid-19 vaccination in a familiar environment by a trusted healthcare team.

Journal of the American Society of Nephrology ; 31:811, 2020.
Article in English | EMBASE | ID: covidwho-984963


Background: It is reported that patients of BAME origin are at greater risk of infection and death due to COVID-19. We describe outcomes in an inner city, ethnically diverse in-centre haemodialysis (HD) population during the pandemic. Methods: A total of 1253 patient electronic records were analysed retrospectively. 207 infections were recorded -197 patients tested positive for Sars-Cov-2 on validated nasopharyngeal PCR analysis and 10 patients included due to high clinical suspicion. Ethnicity data is self-reported. All COVID-19 positive patients were isolated for subsequent dialysis sessions. Whole-cohort screening confirmed the rates of infection. Results: Overall rate of infection amongst the group was 16.5% (n=207), hospitalisation 7.5% (n=94) and death 3.5% (n=44). Within COVID-19 infections, hospitalization rate was 45% and mortality 21%. Seven patients received critical care and two were intubated. Ethnicity data are shown in table 1: There was no significant difference in rates of COVID infection between ethnic groups. The risk of infection in BAME patients was not significantly greater than in white patients (p=0.24, OR 0.79, 95%CI 0.55-1.14). The mean age of those who died from COVID did not differ from the entire cohort (62 vs 63.2 years). Males made up the majority of both the baseline cohort (61.2%) and those infected with COVID (58.5%). 71% of those who died were male. Body mass index did not differ between the group as a whole and those infected with COVID. Rates of diabetes mellitus did not differ significantly between those infected with COVID and those who died. Conclusions: We have defined COVID infections and outcomes within a real-life, large haemodialysis population. Hospitalisation and mortality rates were high, and patients self-reporting as black or Asian were over-represented in the infected group compared to the baseline prevalent HD population. Higher rates of death were observed in black and asian groups but conclusions are limited by small numbers. Larger collaborative studies are required to expand on these findings.

Journal of the American Society of Nephrology ; 31:274, 2020.
Article in English | EMBASE | ID: covidwho-984578


Background: Haemodialysis patients represent a unique challenge in the COVID-19 pandemic, balancing infection risk while safely providing life-sustaining haemodialysis. Asymptomatic infection rates in haemodialysis patients are unknown. Aims: 1 - To define rates of asymptomatic swab positivity in a cohort of prevalent haemodialysis patients 2 - To define rates of antibody positivity in patients known to have been historically swab positive 3 - To define rates of antibody positivity in patients without prior symptoms or clinical suspicion of COVID-19 Methods: A programme of COVID-19 screening using a validated nasopharyngeal PCR analysis was carried out across a prevalent cohort of 1253 haemodialysis patients. Concurrently all patients were offered antibody testing for Anti-SARS-CoV-2 IgG/IgM (Roche) and a total of 848 tests were completed. Results: 1 - Routine screening over a 4 week period from 4/5/20 to 1/6/20 confirmed 7 cases of asymptomatic swab positivity (0.6%). 2 - In our cohort there were 197 confirmed swab positive cases of COVID, and of the 153 survivors 124 were antibody positive (81%). 10 patients were highly clinically suspicious of COVID and managed as such;of those 3 were antibody positive (30%). 3 - Of the remaining swab negative patients who had antibody testing (n=710) 82 were antibody positive (11.5%). Conclusions: In a large inner-city London haemodialysis where the population prevalence of COVID has been high, we demonstrate 1 - low asymptomatic rates of virus carriage at this later stage in the pandemic 2 - significant proportions of swab positive patients seroconverting to be antibody positive 2 - suggestion that 11.5% of patients had previous been asymptomatic carriers and had seroconverted to be antibody positive.