Expanding the potential therapeutic options of hemoperfusion in the era of improved sorbent biocompatibility.

Hemoperfusion has been considered a promising adjuvant treatment for chronic diseases and some acute states when specific removal of pathogenic factors from the bloodstream is desired. Over the years, advances in adsorption materials (e.g., new synthetic polymers, biomimetic coating, and matrixes with novel structures) have renewed scientific interest and expanded the potential therapeutic indications of hemoperfusion. There is growing evidence to suggest a prominent place for hemoperfusion as an adjuvant treatment in the setting of sepsis or severe coronavirus disease 2019 and as a therapeutic option for chronic complications associated with accumulated uremic toxins in patients with end-stage renal disease. This literature review will describe the principles, therapeutic perspectives, and the emerging role of hemoperfusion as a complementary therapy for patients with kidney disease.

YouTube as a source of information on COVID-19 and dialysis.

INTRODUCTION: The coronavirus 2019 pandemic has become a serious threat to the global health and spreading rapidly. Dialysis patients may have developed anxiety because of their disease characteristics during this pandemic. The aim of this study was to assess the reliability and quality of the most viewed English-language YouTube videos on COVID-19 and dialysis link. METHODS: A YouTube search was achieved using the key words "COVID-19 dialysis," "SARS CoV-2 dialysis," "coronavirus hemodialysis," and "COVID peritoneal dialysis." RESULTS: Among the 43 videos analyzed, 24 (55.8%) were high quality, 11 (25.6%) were moderate quality, and 8 (18.6%) were of low quality according to global quality score. Significant differences were found between the groups in modified DISCERN scores and the number of views, likes, comments. CONCLUSION: The most reliable sources such as universities, governments, professional societies should better use YouTube for dissemination of accurate, reliable, and useful health-related information to the general public.

The Association Between Catheter Type and Dialysis Treatment: A Retrospective Data Analysis at Two U.S.-Based ICUs.

Dialysis catheter type may be associated with differences in continuous renal replacement therapy (CRRT) treatment in the critically ill, with potential implications for patient outcomes and healthcare costs. OBJECTIVES: To evaluate the association between the catheter type and multiple dialysis treatment outcomes among the critically ill. DESIGN: Retrospective, observational study. SETTING: Two U.S.-based ICUs. PARTICIPANTS: Critically ill patients receiving CRRT between April 1, 2018, and July 1, 2020. A total of 1,037 CRRT sessions were analyzed. MAIN OUTCOMES AND MEASURES: Circuit life, alarm interruption frequency (including a subset of vascular access [VA]-related alarms), termination type (elective vs nonelective), and blood flow rates. Pre- (n = 530) and post-catheter change (n = 507) periods were assessed, and the post-change period was further divided into intervals of pre-COVID (n = 167) and COVID contemporaneous (n = 340) to account for the pandemic's impact. RESULTS: Compared with pre-change sessions, post-change sessions had 31% longer circuit life (95% CI, 1.14-1.49; p < 0.001), 3% higher blood flow rate (1.01-1.05; p < 0.01), and lower proportion of nonelective terminations (adjusted odds ratio [OR], 0.42 [0.28-0.62]; p < 0.001). There were fewer interruptions for all alarms (adjusted count ratio, 0.95 [0.87-1.05]; p = 0.31) and VA-related alarms (0.80 [0.66-0.96]; p = 0.014). The sessions during COVID period were statistically similar to pre-COVID sessions for all outcomes except a lower proportion of nonelective terminations (adjusted OR, 0.39 [0.22-0.70]; p < 0.01). CONCLUSIONS: A change in catheter type was associated with longer CRRT sessions with fewer interruptions and unexpected terminations in a population of critical patients.

Antibody and T-Cell Responses against SARS-CoV-2 after Booster Vaccination in Patients on Dialysis: A Prospective Observational Study.

Intensive vaccination is recommended for populations more vulnerable to COVID-19 infection, although data regarding the built of immunity after vaccination for dialysis patients are lacking. This prospective, observational cohort study of maintenance hemodialysis patients examined IgG antibody levels against the SARS-CoV-2 spike (S1) protein, neutralizing activity, and interferon gamma levels after the third dose of the BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine. Humoral immunity was repeatedly measured for up to two months. The study includes 58 patients on hemodialysis. Median neutralizing antibodies reached a maximum at 56 and 9 days after booster vaccination with BNT162b2 and mRNA-1273, respectively. The median IgG antibody titer reached a maximum of 3104.38 and 7209.13 AU/mL after 16 days of booster dose, and cellular immunity was positive in 61.9% and 100% of patients with BNT162b2 and mRNA-1273 vaccination, respectively. By repeating the measurements over a period of two months, we clarified the chronological aspects of the acquisition of humoral immunity in dialysis patients after a booster COVID-19 vaccination; most dialysis patients acquired not only humoral immunity, but also cellular immunity against SARS-CoV-2. Future research should investigate the continued long-term dynamics of antibody titers and cellular immunity after the third or further vaccinations, evaluating the need for additional vaccinations for hemodialysis patients.

Factors related to mortality in patients with stage 5 chronic kidney disease on dialysis with COVID-19: An exploratory case series analysis.

Introduction: Different studies describe the clinical profile and factors that could explain the evolution and outcome of patients with chronic kidney disease and COVID-19. This study aims to evaluate the factors related to the mortality of patients with stage-5 chronic kidney disease on chronic dialysis hospitalized for COVID-19 at the Hospital Nacional Arzobispo Loayza from April to December 2020. Methods: Retrospective case series and exploratory analysis were performed. Patients with stage-5 chronic kidney disease on dialysis, older than 18 years, and hospitalized for COVID-19 disease were included. Hospital medical records were the primary data source. Results: A total of 105 medical records were reviewed. 57 were male (54.3%), with a mean age of 58.6 years (standard deviation: 14.3). Eighty-four patients survived (80%), and 21 died (20%). The main cause of hospital admission, present in 80 patients (76.2%), was respiratory failure; the mean hospital stay was of 11.8 days (SD: 7.8). In the bivariate analysis: patients with moderate to severe COVID-19, overweight and obesity, increased levels of leukocytes, D-dimer, ferritin, C-reactive protein, lactate dehydrogenase, as well as, decreased levels of lymphocytes, bicarbonate and arterial oxygen pressure/inspired oxygen fraction were related to mortality risk. In multivariate analysis, only severe COVID-19 disease (OR 1.48; 95% CI 2.24 to 7.77), C-reactive protein > 10 mg/dL (OR: 9.72; 95% CI: 1.41 to 18.58), and arterial oxygen pressure/inspired oxygen fraction ≤ 150 millimeters of mercury (OR: 10.23; 95% CI: 5.87 to 36.06) were factors associated with poor survival. Conclusions: In patients with stage-5 chronic kidney disease hospitalized for COVID-19, severe COVID-19 disease, C-protein reactive levels > 10 milligrams per deciliter, arterial oxygen pressure / inspired oxygen fraction ≤ 150 millimeters of mercury and severe COVID-19 disease were the main factors related to mortality.

Introducción: Diferentes estudios describen el perfil clínico y los factores que podrían explicar la evolución y el resultado de los pacientes con enfermedad renal crónica y COVID-19. El objetivo de este estudio fue evaluar los factores relacionados con la mortalidad de los pacientes con enfermedad renal crónica estadio-5 en diálisis crónica hospitalizados por COVID-19 en el Hospital Nacional Arzobispo Loayza de abril a diciembre de 2020. Métodos: Serie de casos retrospectiva y análisis exploratorio. Se incluyeron pacientes con enfermedad renal crónica estadio 5 en diálisis, mayores de 18 años, hospitalizados por COVID-19. La fuente primaria de datos fueron las historias clínicas. Resultados: Se revisaron 105 historias clínicas. 57 (54,3%) eran varones, con una edad media de 58,6 años (desviación estándar: 14,3). Sobrevivieron 84 (80%) pacientes y fallecieron 21 (20%). La principal causa de ingreso hospitalario fue la insuficiencia respiratoria en 80 (76,2%). La estancia hospitalaria fue de 11,8 días (desviación estándar: 7,8). En el análisis bivariante: los pacientes con COVID-19 moderada a grave, sobrepeso y obesidad, aumento de los niveles de leucocitos, dímero D, ferritina, proteína c reactiva, lactato deshidrogenasa, así como, disminución de los niveles de linfocitos, bicarbonato y presión arterial de oxígeno/fracción inspirada de oxígeno se relacionaron con el riesgo de mortalidad. En el análisis multivariante, sólo la enfermedad grave por COVID-19 (odds ratio: 1,48; intervalo de confianza del 95%: 2,24 a 7,77), la proteína C reactiva > 10 mg/dL (odds ratio: 9,72; intervalo de confianza del 95%: 1,41 a 18,58) y una presión arterial de oxígeno/fracción de oxígeno inspirado ≤ 150 milímetros de mercurio (odds ratio: 10,23; intervalo de confianza del 95%: 5,87 a 36,06) fueron factores asociados a una mala supervivencia. Conclusiones: En los pacientes con enfermedad renal crónica en estadio-5 hospitalizados por COVID-19, la enfermedad grave por COVID-19, los niveles de proteína C reactiva > 10 miligramos por decilitro, la presión arterial de oxígeno/fracción inspirada de oxígeno ≤ 150 milímetros de mercurio y la enfermedad grave por COVID-19 fueron los principales factores relacionados con la mortalidad.

Vacuna contra el SARS-CoV-2 (COVID-19) y enfermedad renal crónica

La literatura más reciente indica que la enfermedad renal crónica constituye la comorbilidad con mayor riesgo de desarrollar enfermedad grave por SARS-CoV-2, coronavirus 2019 (COVID-19). Muchas sociedades científicas se han posicionado a favor de la vacunación de los pacientes con enfermedad renal crónica como prioritaria, debido a esta alta vulnerabilidad. En España, la quinta actualización de la Estrategia de vacunación frente a COVID-19 del Consejo Interterritorial de Salud, incluyó a los pacientes con ERC dentro del grupo 7 (personas con condiciones de muy alto riesgo). A lo largo del artículo se describen los tipos de vacunas según mecanismo de acción, las vacunas actualmente aprobadas por la Agencia Europea del Medicamento (EMA) y todo lo relacionado con el proceso de vacunación (preparación, administración y seguimiento), además de los aspectos a tener en cuenta en los pacientes con enfermedad renal crónica.Alternate : The most recent evidence indicates that chronic kidney disease is the comorbidity with the highest risk of developing severe disease due to SARS-CoV-2, coronavirus 2019 (COVID-19). Many scientific societies have advocated for vaccination of patients with chronic kidney disease as a priority, due to this high vulnerability. In Spain, the fifth update of the COVID-19 vaccination strategy published by the Interterritorial Health Council included CKD patients in group 7 (people with very high-risk conditions). This manuscript describes the types of vaccines according to mechanism of action, the vaccines currently approved by the European Medicines Agency (EMA) and information related to the vaccination process (preparation, administration and follow-up), as well as aspects to be taken into account in patients with CKD.

COVID-19 en el paciente en diálisis. Una revisión sistemática

Introducción: La pandemia por COVID-19 acaecida en 2019 afectó con mayor gravedad a la población de mayor edad y con enfermedades subyacentes, siendo estos factores de riesgo de mortalidad. Estas características son propias del paciente renal en diálisis, por lo que es importante conocer cuál fue el impacto del COVID-19 en este grupo poblacional. Objetivo: El objetivo principal fue conocer y sintetizar la evidencia científica existente sobre las características clínicas de la enfermedad COVID-19 en el paciente con enfermedad renal crónica en diálisis. Metodología: Se realizó una revisión sistemática basada en la declaración PRISMA, en la que se analizaron 23 artículos procedentes de las bases de datos PubMed y Scopus. Se incluyeron artículos originales en inglés y español que excluyeran la población pediátrica. Resultados: Se incluyeron 23 artículos de diseño observacional. Principalmente los resultados se centraron en incidencia, características clínicas, como sintomatología o evolución, mortalidad y medidas preventivas en las unidades de diálisis. Conclusiones: La incidencia de la COVID-19 fue mayor en unidades de diálisis que en los pacientes que recibían diálisis domiciliaria. La sintomatología más leve fue la común a la población general. En los casos más graves, cerca del 50% de los pacientes necesitaron hospitalización y/o ingreso en una Unidad de Cuidados Intensivos. La mortalidad fue bastante elevada y se relacionó con la edad avanzada, comorbilidad, sexo masculino o fragilidad clínica. Además, en las unidades de diálisis se implementaron medidas de prevención de la enfermedad, al ser espacios físicos cerrados donde se concentra un gran número de pacientes.Alternate : Introduction: The COVID-19 pandemic that occurred in 2019 most severely affected the older population and those with underlying diseases, these being risk factors for mortality. Circumstances present in renal patients on dialysis, so it is important to know what the impact of COVID-19 was on this population group. Objective: To understand and synthesise the existing scientific evidence on the clinical characteristics of COVID-19 disease in patients with chronic kidney disease on dialysis. Material and Method: A systematic review was carried out based on the PRISMA statement, in which 23 articles from the PubMed and Scopus databases were analysed. Original articles in English and Spanish that excluded the paediatric population were included. Results: 23 articles of observational design were included. Mainly the results focused on incidence, clinical characteristics, such as symptomatology or evolution, mortality and preventive measures in dialysis units. Conclusions: The incidence of COVID-19 was higher in dialysis units than in patients receiving home dialysis. The mildest symptomatology was common to the general population. In the most severe cases, about 50% of patients required hospitalisation and/or admission to an Intensive Care Unit. Mortality was quite high and was related to advanced age, comorbidity, male sex or clinical frailty. In addition, disease prevention measures were implemented in the dialysis units, as they are closed physical spaces where many patients are concentrated.

Acute kidney injury and electrolyte disorders in COVID-19.

Acute kidney injury (AKI) and electrolyte disorders are important complications of hospitalized coronavirus disease 2019 (COVID-19) patients. AKI is thought to occur due to multiple pathophysiological mechanisms, such as multiple organ dysfunction (mainly cardiac and respiratory), direct viral entry in the renal tubules, and cytokine release syndrome. AKI is present in approximately one in every ten hospitalized COVID-19 patients. The incidence rates of AKI increase in patients who are admitted to the intensive care unit (ICU), with levels higher than 50%. Additionally, renal replacement therapy (RRT) is used in 7% of all AKI cases, but in nearly 20% of patients admitted to an ICU. COVID-19 patients with AKI are considered moderate-to-severe cases and are managed with multiple interdisciplinary conducts. AKI acts as a risk factor for mortality in severe acute respiratory syndrome coronavirus 2 infection, especially when RRT is needed. Electrolyte disorders are also common manifestations in hospitalized COVID-19 patients, mainly hyponatremia, hypokalemia, and hypocalcemia. Hyponatremia occurs due to a combination of syndrome of inappropriate secretion of antidiuretic hormone and gastrointestinal fluid loss from vomiting and diarrhea. When it comes to hypokalemia, its mechanism is not fully understood but may derive from hyperaldosteronism due to renin angiotensin aldosterone system overstimulation and gastrointestinal fluid loss as well. The clinical features of hypokalemia in COVID-19 are similar to those in other conditions. Hypocalcemia is the most common electrolyte disorder in COVID-19 and seems to occur because of vitamin D deficiency and parathyroid imbalance. It is also highly associated with longer hospital and ICU stay.

COVID-19 among Chronic Dialysis Patients after First Year of Pandemic, Argentina.

We performed a descriptive study to characterize effects from COVID-19 among chronic dialysis patients compared with the general population in Argentina during March 2020-February 2021. COVID-19 case-fatality rate of chronic dialysis patients was 10 times the national rate; the age-standardized mortality ratio was 6.8 (95% CI 6.3-7.3).

Humoral Immune Response of BNT162b2 and CoronaVac Vaccinations in Hemodialysis Patients: A Multicenter Prospective Cohort.

The CoronaVac vaccine is the most used anti-SARS-CoV-2 vaccine worldwide. Previous data indicate that this vaccine produces a lower immune response than RNA vaccines such as BNT162b2. End-stage renal disease (ESRD) patients have an increased rate of COVID-19 and a reduced immune response to vaccinations. Currently, there is little data on this population's immune response induced by CoronaVac. METHODS: This study involved a prospective cohort of ESRD patients in chronic hemodialysis who received a two-dose immunization scheme of either CoronaVac (Sinovac Biotech) or BNT162b2 vaccines (Pfizer-BioNTech). We measured the plasma levels of anti-SARS-CoV-2 IgG antibodies. We determined antibody titers before immunization, 2 and 4 months after two doses, plus 4 months after a booster dose. RESULTS: We evaluated 208 patients in three hemodialysis centers. The mean age was 62.6 ± 15.6 years, of whom 91 were female (41.75%). Eighty-one patients (38.94%) received the BNT162b2 vaccine and 127 (61.06%) received the CoronaVac vaccine. Patients who received the BNT162b2 vaccine had a higher humoral response compared to those who received the CoronaVac vaccine (4 months after the second dose: BNT162b2: 88.89%, CoronaVac: 51.97%, p < 0.001; 4 months after the booster: BNT162b2: 98.77%, CoronaVac: 86.61%, p < 0.001). CONCLUSIONS: Our results suggest that the CoronaVac vaccine induced a lower humoral response than the BNT162b2 vaccine in ESRD patients on hemodialysis.

Implementation and Effectiveness of a Learning Collaborative to Improve Palliative Care for Seriously Ill Hemodialysis Patients.

BACKGROUND AND OBJECTIVES: Limited implementation of palliative care practices in hemodialysis may contribute to end-of-life care that is intensive and not patient centered. We determined whether a learning collaborative for hemodialysis center providers improved delivery of palliative care best practices. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Ten US hemodialysis centers participated in a pre-post study targeting seriously ill patients between April 2019 and September 2020. Three practices were prioritized: screening for serious illness, goals of care discussions, and use of a palliative dialysis care pathway. The collaborative educational bundle consisted of learning sessions, communication skills training, and implementation support. The primary outcome was change in the probability of complete advance care planning documentation among seriously ill patients. Health care utilization was a secondary outcome, and implementation outcomes of acceptability, adoption, feasibility, and penetration were assessed using mixed methods. RESULTS: One center dropped out due to the coronavirus disease 2019 pandemic. Among the remaining nine centers, 20% (273 of 1395) of patients were identified as seriously ill preimplementation, and 16% (203 of 1254) were identified as seriously ill postimplementation. From the preimplementation to postimplementation period, the adjusted probability of complete advance care planning documentation among seriously ill patients increased by 34.5 percentage points (95% confidence interval, 4.4 to 68.5). There was no difference in mortality or in utilization of palliative hemodialysis, hospice referral, or hemodialysis discontinuation. Screening for serious illness was widely adopted, and goals of care discussions were adopted with incomplete integration. There was limited adoption of a palliative dialysis care pathway. CONCLUSIONS: A learning collaborative for hemodialysis centers spanning the coronavirus disease 2019 pandemic was associated with adoption of serious illness screening and goals of care discussions as well as improved documentation of advance care planning for seriously ill patients. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: Pathways Project: Kidney Supportive Care, NCT04125537.

Interventions, Participative Role, Barriers, and Facilitators for Involvement in eHealth Communication for People Undergoing Hemodialysis: Protocol for a Scoping Review.

BACKGROUND: eHealth interventions have been shown to offer people living with chronic kidney disease the opportunity of embracing dialysis therapies with greater confidence, the potential to obtain better clinical outcomes and increased quality of life, and diverse and flexible designs and delivery options. eHealth interventions or solutions can offer one-way information without the possibility for dialogue, as with most mobile apps. eHealth interventions intending to enable two-way communication between patients undergoing hemodialysis and health professionals are the focus of this review. eHealth communication interventions that enable two-way communication between patients undergoing hemodialysis and health professionals is an emerging field, but issues relating to participation in eHealth communication for patients undergoing hemodialysis are scarcely described. The current conceptualization of this issue is too scattered to inform the development of future interventions. In this scoping review, we want to assemble and examine this scattered knowledge on participation in two-way eHealth communication for patients undergoing hemodialysis. OBJECTIVE: We want to understand the participative role of people living with chronic kidney disease undergoing hemodialysis in available communicative eHealth interventions and to understand which barriers and facilitators exist for patient involvement in eHealth communication with health professionals. METHODS: A scoping review methodology is guiding this study. Peer-reviewed primary studies, including quantitative, qualitative, and mixed methods study designs will be included. A systematic search for published studies, dissertations, and theses at the doctoral level in the English language will be conducted in five databases (MEDLINE, Embase, CINAHL, Scopus, and ProQuest Dissertations and Theses). The included literature will focus on adult (18 years or older) patients undergoing hemodialysis who are involved in eHealth communication with health professionals. Data on the type of eHealth communication interventions, the participative role, and barriers and facilitators for the involvement in eHealth communication for people undergoing hemodialysis will be extracted independently by two reviewers. The extracted data will be collected in a draft charting table prepared for the study. Any discrepancies between the reviewers will be solved through discussion or with a third reviewer. RESULTS: Results are anticipated by the spring of 2023 and will be presented in tabular format along with a narrative summary. The anticipated results will be presented in alignment with the objectives of the study, presenting findings on the participative role of patients undergoing hemodialysis in eHealth communication interventions. CONCLUSIONS: We anticipate that this study will inform on eHealth communication interventions and the level of patient participation in eHealth communication for patients undergoing hemodialysis. The systematized overview will possibly identify research gaps and motivate further development of eHealth communication to ensure patient participation. The findings will be of interest to key stakeholders in clinical care, research, development, policy, and patient advocacy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/38615.

Clinical Efficacy of SARS-CoV-2 Vaccination in Hemodialysis Patients.

Introduction: The COVID-19 pandemic is a global public health problem. Patients with end-stage renal disease on hemodialysis are at a higher risk of infection and mortality than the general population. Worldwide, a vaccination campaign has been developed that has been shown to reduce severe infections and deaths in the general population. However, there are currently limited data on the clinical efficacy of vaccinations in the hemodialysis population. Methods: A national multicenter observational cohort was performed in Chile to evaluate the clinical efficacy of anti-SARS-CoV-2 vaccination in end-stage renal disease patients on chronic hemodialysis from February 2021 to August 2021. In addition, the BNT162b2 (Pfizer-BioNTech) and CoronaVac (Sinovac) vaccines were evaluated. The efficacy of vaccination in preventing SARS-CoV-2 infection, hospitalizations, and deaths associated with COVID-19 was determined. Results: A total of 12,301 patients were evaluated; 10,615 (86.3%) received a complete vaccination (2 doses), 490 (4.0%) received incomplete vaccination, and 1196 (9.7%) were not vaccinated. During follow-up, 1362 (11.0%) patients developed COVID-19, and 150 died (case fatality rate: 11.0%). The efficacy of the complete vaccination in preventing infection was 18.1% (95% confidence interval [CI]:11.8-23.8%), and prevention of death was 66.0% (95% CI:60.6-70.7%). When comparing both vaccines, BNT162b2 and CoronaVac were effective in reducing infection and deaths associated with COVID-19. Nevertheless, the BNT162b2 vaccine had higher efficacy in preventing infection (42.6% vs. 15.0%) and deaths (90.4% vs. 64.8%) compared to CoronaVac. Conclusion: The results of our study suggest that vaccination against SARS-CoV-2 in patients on chronic hemodialysis was effective in preventing infection and death associated with COVID-19.

[Intoxications in nephrology: clinical cases and local experience in Sciacca Hospital]

Intoxications are a common problem all over the world and cause acid-base balance disturbances, dysionias or acute renal failure;they can develop rapidly leading to severe cellular dysfunction and death. Intoxications and drug overdoses often require the intervention of Nephrologists, for the correction of acidosis, the administration of selective inhibitory enzymes and also hemodialysis treatment. Extracorporeal therapies have been used to remove toxins for over fifty years and have acquired an increasing role, thanks to the use of new treatment modalities in intoxicated patients. In our clinical practice in the Covid period we have found an increase in clinical cases of intoxication with psychiatric drugs, including benzodiazepines, clozapine, lithium, quetiapine and cocaine.

SARS-CoV-2 vaccine (COVID-19) and chronic kidney disease

The most recent evidence indicates that chronic kidney disease is the comorbidity with the highest risk of developing severe disease due to SARS-CoV-2, coronavirus 2019 (COVID-19). Many scientific societies have advocated for vaccination of patients with chronic kidney disease as a priority, due to this high vulnerability. In Spain, the fifth update of the COVID-19 vaccination strategy published by the Interterritorial Health Council included CKD patients in group 7 (people with very high-risk conditions). This manuscript describes the types of vaccines according to mechanism of action, the vaccines currently approved by the European Medicines Agency (EMA) and information related to the vaccination process (preparation, administration and follow-up), as well as aspects to be taken into account in patients with CKD. © 2021, Sociedad Espanola de Enfermeria Nefrologica. All rights reserved.

Reactogenicity of COVID-19 vaccine in hemodialysis patients: a single-center retrospective study

Introduction: Some hemodialysis patients are reluctant to undergo COVID-19 vaccination for the fear of developing adverse events (AEs). The aim of this study was to verify the safety of the mRNA-1273 vaccine in hemodialysis patients. Methods: We conducted a retrospective analysis of in-center hemodialysis patients who underwent mRNA-1273 vaccine from March 1st to April 30th, 2021. All AEs occurring after the first and the second doses were collected and classified as local or systemic. Results: Overall, 126 patients on chronic maintenance dialysis without a prior COVID-19 diagnosis were vaccinated with two doses of mRNA-1273 vaccine. Mean age was 68 (IQR, 54,7-76) years and 53.6% of patients were aged ≥65 years. During the observational period of 68 (IQR, 66-70) days, AEs occurred in 57.9% and 61.9% of patients after the first dose and second dose, respectively. The most common AEs were: injection-site pain (61.9%), erythema (4.8%), itching (4.8%), swelling (16.7%), axillary swelling/tenderness (2.4%), fever (17.5%) headache (7.9%), fatigue (23.8%), myalgia (17.5%), arthralgia (12.7%), dyspnoea (2.4%), nausea/vomiting (7.1%), diarrhoea (5.6%), shivers (4%) and vertigo (1.6%). The rates of local AEs were similar after the first and second doses (P=0.8), whereas systemic AEs occurred more frequently after the second dose (P=0.001). Fever (P=0.03), fatigue (P=0.02) and nausea/vomiting (P=0.03) were significantly more frequent after the second dose of the vaccine. There were no age-related differences in the rate of AEs. Overall, vaccine-related AEs in hemodialysis patients seem to be lower than in the general population. Conclusion: The RNA-1273 vaccine was associated with the development of transient AEs after the first and second doses in patients on chronic maintenance hemodialysis. They were mostly local, whereas systemic AEs were more prevalent after the second dose. Overall, all AEs lasted for a few days, without any apparent sequelae. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

[COVID-19 related mortality in Swedish patients with renal replacement therapy]

Data from the Swedish Renal Registry (SRR) show that during the period March 16, 2020 to March 15, 2021 0.4% of all renal transplant recipients and 3% of all dialysis patients died due to COVID-19 in Sweden. Of all registered deaths, 20% were attributed to COVID-19. In the age group 50-59 years the risk ratio for COVID-19 related mortality was 16 (95% CI 6.5-38) among transplant recipients and 22 (95% CI 7.1-69) among dialysis patients, compared to the background population in the same age group. Excess mortality, compared to the five years preceding the pandemic, was 30% for transplant recipients and 8.7% for dialysis patients, compared to 7.7% for the entire Swedish population. Detailed reports were sent to SRR for 864 patients with confirmed COVID-19 infection representing 5.0% of all transplant recipients and 13% of all dialysis patients. The case fatality rate was 7.0% and 21% respectively.

Immunogenicity of the BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis Is Associated with Medical Conditions.

BACKGROUND AND OBJECTIVES: Patients undergoing maintenance hemodialysis have an attenuated immune response to vaccination. The aim of our study was to determine the predictive factors for humoral response to vaccination with the BNT162b2 mRNA vaccine (Pfizer-BioNTech) in patients on maintenance hemodialysis. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: In this retrospective, single-center study, we included patients on maintenance hemodialysis already vaccinated with two doses of the BNT162b2 vaccine (Pfizer-BioNTech) and with a post-vaccination serological follow-up. RESULTS: 252 patients were included for study with a mean age of 71.9 (±14.4) years. Twelve patients (4.7%) were under immunosuppressive therapy (calcineurin inhibitors: n = 4; chemotherapy for myeloma: n = 3; last infusion of rituximab over the previous 4 years: n = 2; abatacept: n = 2; adalimumab n = 1). Three of these patients were under immunosuppressive therapy for nonrenal solid organ transplantation. Multivariate analysis identified immunosuppressive therapy (OR 4.73 [1.38-16.17], p = 0.013) and lower baseline albumin levels (OR 1.23 [1.09-1.38], p < 0.001) as independent predictive factors of nonresponse to vaccination. Older age (ß = -0.59 ± 0.21, p = 0.006) and immunosuppressive therapy (ß = 40.33 ± 13.33, p = 0.003) were significantly associated with lower humoral response to vaccination. CONCLUSIONS: Approximately 90% of patients under maintenance hemodialysis developed specific antibodies to the BNT162b2 mRNA vaccine. Immunosuppressive therapy, malnutrition, and older age were associated with a higher risk of nonseroconversion or lower humoral response to mRNA-based vaccination against SARS-CoV-2. We strongly recommend serological monitoring after vaccination to determine booster timing, especially for patients with malnutrition or on immunosuppressive therapy.