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Maintenance hemodialysis patients need to return to hospital 3 times a week for routine hemodialysis treatment. In the case of coronavirus disease 2019 (COVID-19) and regional lockdown, a set of management systems and standardizations has been established in our hemodialysis center, including forward movement of the critical nodes of treatment, specialists pooling program for hemodialysis technology, and dynamic bubble personnel management, to implement dynamic prevention and control strategies, precise management of inpatient wards and closed-loop management of outbreaks. While improving the management of our own hemodialysis center, it is recommended to strengthen multi-center collaboration to build a municipal grid management system for hemodialysis and explore different dialysis strategies for end-stage renal disease to meet the treatment needs and safety management of maintenance hemodialysis patients in lockdown areas under the epidemic.Copyright © 2022, Second Military Medical University Press. All rights reserved.
ABSTRACT
Maintenance hemodialysis patients need to return to hospital 3 times a week for routine hemodialysis treatment. In the case of coronavirus disease 2019 (COVID-19) and regional lockdown, a set of management systems and standardizations has been established in our hemodialysis center, including forward movement of the critical nodes of treatment, specialists pooling program for hemodialysis technology, and dynamic bubble personnel management, to implement dynamic prevention and control strategies, precise management of inpatient wards and closed-loop management of outbreaks. While improving the management of our own hemodialysis center, it is recommended to strengthen multi-center collaboration to build a municipal grid management system for hemodialysis and explore different dialysis strategies for end-stage renal disease to meet the treatment needs and safety management of maintenance hemodialysis patients in lockdown areas under the epidemic.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Objective. Evaluation of clinical observation, the course, the risk factors, and treatment options for SARS-CoV-2 infection in hemodialysis patients with end-stage chronic kidney disease. Material and methods. The retrospective, single-center, uncontrolled study involved 231 patients (132 M/99 W) aged 61.7+/-14.7 years with COVID-19 diagnosed. The SPSS software package was used for statistical analysis. Results. 72 (31.2%) of patients died, 68 (94.4%) of them had ARDS as the main cause of death. Comparative analysis in groups with favorable and unfavorable outcomes of the disease showed that age (68.1+/- 13.2 years vs 58.7+/-14.5 years, p<0.0001) and the comorbidity index (8.8+/-2.2 vs 6.2+/-2.6, p<0.0001) were significantly higher in those who have died compared to survivors. According to CT data, they were more likely to have 3rd or 4th-degree lung damage (72.2 vs 36.5%, p<0.0001), and the minimum oxygen saturation index: 67.6+/-12.8 and 87.8+/-10.9%, respectively (p<0.0001). Somorbidity index and the need for invasive ventilation were independent predictors of the fatal outcome of COVID-19. Early administration of monoclonal antibodies to IL-6 (in the first 3 days after hospitalization) in patients with a low prevalence of the pulmonary process (CT stage 1-2) was associated with a significantly lower frequency of fatal outcome. Conclusions. SARS-CoV-2 infection in HD patients is characterized by a high rate of mortality. Predictors of severe disease in this population are comorbidity index and the need for invasive ventilation.Copyright © Infectious Diseases: News, Opinions, Training.
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Patients with end-stage chronic kidney disease treated with hemodialysis are at risk of infection and severe course of the new coronavirus infection. This opinion was based on the data obtained as a result of PCR testing during the active phase of the disease with detailed clinical symptoms. However, this diagnostic method does not allow one to fully assess the prevalence of infection in the population. The aim - studying of the frequency of SARS-CoV-2 infection in patients receiving hemodialysis treatment and the spectrum of antiviral antibodies, depending on the nature of the course of COVID-19. Material and methods. 100 patients with chronic kidney disease (stage 5D) treated at the outpatient Dialysis Center (MCVTP) were included in the study by a simple random sample. The assessment of SARS-CoV-2 infection was carried out by analyzing the material of smears obtained from the naso-oropharynx by PCR and blood serum samples by ELISA. The study excluded 14 patients with dubious results for the determination of serological markers SARS-CoV-2 and 1 patient with active infection, who was isolated from the RNA of the virus. Results. IgM and IgG antibodies were detected in 49 (57.6%) of the 85 examined patients. 24 of them (group 1) were diagnosed with COVID-19 infection with typical clinical symptoms 3-9 months ago, and 25 (group 2) had no clinical manifestations of the acute respiratory infection at the appropriate time suggesting an asymptomatic course of the disease. IgM class antibodies were detected with equal frequency in group 1 and in group 2 (33.3 vs 24.0%, respectively, p<0.6). IgG antibodies exclusively to the nucleocapsid N-protein (IgGn) were detected only in the latent form of the disease (32%), while antibodies against the S-protein (spike protein) of the virus (IgGs and IgGn+s) were detected more often in the manifest form compared to the asymptomatic one (100 vs 60%, respectively, p<0.05). Conclusion. In a random cohort of patient receiving hemodialysis treatment, more than half were asymptomatic.Despite a wide range of prevention measures, SARS-CoV-2 infection among patients treated with hemodialysis is more than 2 times higher than in the general population.Copyright © 2021 Geotar Media Publishing Group. All rights reserved.
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Objective To explore the sociodemographic and psychological factors influencing the continuity of treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019 (COVID-19). Methods A total of 277 patients with chronic kidney disease who were admitted to Department of Nephrology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. 2020 to Mar. 2021 were enrolled and divided into 3 groups: non-dialysis group (n=102), hemodialysis (HD) group (n=108), and peritoneal dialysis (PD) group (n=67). All patients were investigated by online and offline questionnaires, including self-designed basic situation questionnaire, self-rating anxiety scale (SAS), and self-rating depression scale (SDS). The general sociodemographic data, anxiety and depression of the 3 groups were compared, and the influence of sociodemographic and psychological factors on the interruption or delay of treatment was analyzed by binary logistic regression model. Results There were significant differences in age distribution, marital status, occupation, medical insurance type, caregiver type, whether there was an urgent need for hospitalization and whether treatment was delayed or interrupted among the 3 groups (all P<0.05). The average SAS score of 65 PD patients was 38.15+/-15.83, including 53 (81.5%) patients without anxiety, 7 (10.8%) patients with mild anxiety, and 5 (7.7%) patients with moderate to severe anxiety. The average SAS score of 104 patients in the HD group was 36.86+/-14.03, including 81 (77.9%) patients without anxiety, 18 (17.3%) patients with mild anxiety, and 5 (4.8%) patients with moderate to severe anxiety. There were no significant differences in the mean score of SAS or anxiety severity grading between the 2 groups (both P>0.05). The mean SDS scores of 65 PD patients were 53.42+/-13.30, including 22 (33.8%) patients without depression, 21 (32.3%) patients with mild depression, and 22 (33.8%) patients with moderate to severe depression. The mean SDS scores of 104 patients in the HD group were 50.79+/-10.76, including 36 (34.6%) patients without depression, 56 (53.8%) patients with mild depression, and 12 (11.6%) patients with moderate to severe depression. There were no significant differences in mean SDS scores or depression severity grading between the 2 groups (both P>0.05). The results of intra-group comparison showed that the incidence and severity of depression were higher than those of anxiety in both groups. Multivariate binary logistic regression analysis showed that high school education level (odds ratio [OR]=5.618, 95% confidence interval [CI]) 2.136-14.776, P<0.01), and unmarried (OR=6.916, 95% CI 1.441-33.185, P=0.016), divorced (OR= 5.588, 95% CI 1.442-21.664, P=0.013), urgent need for hospitalization (OR=8.655, 95% CI 3.847-19.476, P<0.01) could positively promote the continuity of treatment in maintenance dialysis patients under the regular epidemic prevention and control of COVID-19. In the non-dialysis group, no sociodemographic and psychological factors were found to be associated with the interruption or delay of treatment (P>0.05). Conclusion Education, marital status, and urgent need for hospitalization are correlated with the continuity of treatment in patients with chronic kidney disease on maintenance dialysis.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Patients with end-stage kidney disease undergoing hemodialysis have one of the highest COVID-19 mortality rates. The use of innovative methods capable of optimizing their treatment outcomes is important for clinical practice. Aims - to investigate the efficacy and safety of neutralizing monoclonal antibodies in COVID-19 patients treated with hemodialysis. Material and methods. We conducted a retrospective controlled single-center study with 102 COVID-19 patients on maintenance hemodialysis involved (M: 67;65.7%;W: 35;34.3%), aged 57.2+/-15.3 years. PCR-detected SARS-CoV-2 infection was diagnosed in all patients. Neutralizing monoclonal antibodies were administered to 69 patients, who formed the study group (group 1). The control group included 33 patients (group 2). The combination of bamlanevimab and etesevimab was the most frequent therapy used (in 59 patients). Results. In the course of the disease, group 1 patients, compared to those of group 2, had statistically significantly higher blood oxygen saturation values (94.2+/-5.7 vs 89.8+/-10.7);they required less frequent oxygen support (29.0 vs 54.5%) and ICU treatment (18.8 vs 48.5%), respectively. Fatal outcomes occurred in 4 (5.8%) of 69 patients who received neutralizing antibodies and in 6 (18.2%) of 33 patients who did not receive the therapy, p<0.05. Except for one patient, all other patients in both groups developed an unfavorable outcome due to progressive lung damage. However, only 4 of 6 (2/3) patients with progressive lung damage died in group 1, whereas the similar course of the disease proved fatal in all cases in group 2. Conclusion. The use of neutralizing monoclonal antibodies in hemodialysis patients is safe and effective when the drugs are administered early, the pulmonary process progression is insignificant and dominant SARSCoV-2 variants are sensitive to them.Copyright © 2022 Tomsk Polytechnic University, Publishing House. All rights reserved.
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Patients with chronic kidney disease (CKD) are at high risk for coronavirus disease 2019 (COVID-19). Government agencies or learned societies in many countries recommend prioritizing patients with CKD for COVID-19 vaccines. The immune response rate to the COVID-19 vaccines is lower in hemodialysis patients and kidney transplant recipients compared with that in healthy individuals, and increasing the number of vaccinations each member of these population may improve their immune response rate. There was no significant difference in the incidence of adverse reactions after vaccination between patients with CKD and healthy controls. Patients with stable CKD should be vaccinated against COVID-19 unless there were contraindications to vaccination. The mRNA vaccines, inactivated vaccines, and recombinant protein subunit vaccines are all safe for patients with CKD. Patients with CKD treated with rituximab or high-dose glucocorticoid need to weigh the benefits and risks before vaccination, and COVID-19 vaccines can be given when rituximab treatment ends for more than 6 months or after glucocorticoid reduction.Copyright © 2021 by the Chinese Medical Association.
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Introduction: During armed conflicts dialysis patients may experience limitations or interruptions of therapy leading to severe life-threatening complications due to medical and logistical challenges. Before the Russian-Ukrainian war, there were approximately 10,000 adults requiring dialysis in Ukraine. Some patients decided to flee their place of residence and look for opportunities to continue dialysis in another location in Ukraine or abroad. To better understand the needs of conflict-affected kidney failure patients and to provide data which could support equitable and evidence-based prioritization of resources, the Renal Disaster Relief Task Force of the European Renal Association conducted a survey on distribution, preparedness and management of adults requiring dialysis displaced due to the war in Ukraine. Method(s): Cross-sectional online survey was conducted to assess the status of dialysis patients who were displaced across European countries since the beginning of the conflict in February 2022. The survey was sent to all national nephrology societies across Europe with a request to disseminate it to all dialysis centers in their countries. Data were collected between May and August 2022. Fresenius Medical Care (FMC) shared a limited set of aggregated data without direct center participation. Result(s): We received data on 602 patients (290 collected through the survey and 312 from FMC), who were dialyzed in 24 countries. Most patients were dialyzed in Poland (45.0%), followed by Slovakia (18.1%), Czech Republic (7.8%), Romania (6.3%), Germany (4.7%) and Hungary (3.5%). Most patients were originally dialyzed in Kyiv (north-central), Kharkiv (northeast), Odesa (southwest) and Zaporizhzhia (southeast). Before reaching the current reporting center, 34.6% of patients were treated in at least one other center since leaving their regular unit. Mean age was 48.1+/-13.4 years, 43.5% were females. Before patients left Ukraine, 95.7% had been on hemodialysis (HD), 2.5% on continuous ambulatory peritoneal dialysis (PD) and 1.8% on automated PD. HD session frequency was reduced under war conditions in 23.5% of patients. Eighty-eight percent of HD patients had a patent arteriovenous fistula, 7.3% were HBs antigen positive, 16.1% had anti-HCV antibodies, 0.6% anti-HIV antibodies and 27.3% anti-HBc antibodies. In terms of patient preparedness for displacement, 63.9% carried medical records with them, 63.3% had a list of medications, 60.4% had medications themselves and 44.0% had a dialysis prescription. Overall, 26.1% of patients were admitted to the dialysis unit in the possession of all these factors while 16.1% presented with none. After leaving Ukraine, 33.9% of patients were hospitalized. Of the 88.5% of patients tested in the reporting center for COVID-19 1.9% was positive. Communication and language problems were reported by 43.8% of responding physicians. Conclusion(s): Up to the end of August 2022, less than 10% of Ukrainian dialysis patients decided to flee their country since the start of the Russian-Ukrainian conflict and the majority of them chose as their place for dialysis a country neighboring Ukraine. Preparedness for displacement varied and was incomplete in most patients. Results from our survey may inform evidence-based policies and interventions to prepare for and respond to special needs of vulnerable kidney failure populations during armed conflicts and other emergencies. No conflict of interestCopyright © 2023
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Introduction: A dialysis unit is compatible with a long-range airborne transmission environment resulting in a higher risk of Coronavirus disease 2019 (COVID-19) infection in hemodialysis patients. Reduction of hemodialysis frequency is a common practice to prevent COVID-19 from spreading in the dialysis unit. However, the predictors to determine which patient is likely to fail from reducing frequency of dialysis is still lacking. This study determined the predictors for a failure reduction in hemodialysis frequency at 4 weeks. Method(s): This retrospective observational study enrolled adult patients receiving long-term thrice-weekly hemodialysis at Thammasat University Hospital in 2021 who decreased dialysis frequency to twice-weekly during COVID-19 outbreak in Thailand. The outcomes were prevalence of failure reduction in dialysis frequency at 4 and 8 weeks and predictors of failure reduction at 4 weeks. Multivariable logistic regression analysis was performed to determine the predictors and create a predicting model for failure reduction of dialysis frequency. Result(s): Of 161 patients receiving hemodialysis in 2021, 83 patients with dialysis frequency reduction had a median age of 69.6 years and a median dialysis vintage of 4.5 years. 27 (33%) and 68 (82%) patients failed to reduce dialysis frequency at 4 and 8 weeks. At 4 weeks, 22 (81.5%) patients failed to reduce dialysis frequency from hypervolemia-related causes. From multivariate logistic regression analysis showed that the predictors for failure reduction at 4 weeks were pre-existing diabetes, congestive heart failure, pre-dialysis weight gain, dry weight from body composition measurement, mean pre- and post-dialysis weight gain during one week before dialysis reduction (Table 1). The model including these predictors (Table 2) demonstrated an Area Under the Receiver Operating Characteristic (AUROC) of 0.78 (95% CI 0.69-0.88) for predicting a failure reduction. At 4 weeks, 0 (0%), 7 (28.0%), and 20 (54.1%) of patients with low risk (score of <0 point), intermediate risk (score of 0-1 point) and high risk (score of >1 point) failed to reduce dialysis frequency, respectively. Conclusion(s): During the COVID-19 pandemic, 33% and 88% of hemodialysis patients failed to reduce their dialysis frequency at 4 and 8 weeks. The predicting model for a failure dialysis reduction demonstrated a good performance. Conflict of interest Potential conflict of interest: - Speaker fee from Fresenius Medical Care and Boehringer Ingelheim (Thai) - Registration fee from Novo Nordisk and Sanofi Aventis ThailandCopyright © 2023
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Introduction: We report results on immunogenicity of the recombinant adenovirus (rAd) 26 and rAd5 vector-based COVID-19 vaccine Gam-COVID-Vac (Sputnik V, developed by Gamaleya National Research Centre, Russia) in patients, receiving maintenance hemodialysis (HD). We aimed to compare the dynamics of humoral and cellular immunity after 2 doses of Gam-COVID-Vac in patients receiving HD and individuals with normal kidney function. Method(s): We recruited 23 patients treated with maintenance HD and 28 volunteers with normal kidney function (control group). All participates were adult, had been vaccinated twice with Gam-COVID-Vac vaccine and had no prior history of confirmed COVID-19. In all participants, the levels of anti-SARS-CoV-2-specific IgG were quantified at 1 month and 6 months from the second vaccine shot using ELISA. Specific T-cell responses (CD4+ and CD8+ cytotoxic T-lymphocytes) were evaluated using the TIGRA-test (Generium, Russia) at the same timepoints. [Formula presented] Results: Participant's characteristics and tolerability data are summarized in Table 1. Patients receiving HD were older and had more comorbidities compared with the control group. The seropositivity rate declined in both groups over time and was 100% vs 68% in non-renal controls and 91% vs 50% in HD group at months 1 and 6, respectively. In both groups, IgG levels decreased from month 1 to 6, however, antibodies did not vanish more rapidly in the HD group (analysis of variance p = 0.709 for the "time x group" interaction, age-adjusted model) - Figure 1. [Formula presented] IgG levels correlated inversely with age of HD patients (rho= -0.42 [95% CI: -0.64;-0.13], p=0.0047), whereas no correlation was observed in control group. Initially, the T-test result was positive in 79% non-renal and 73% HD subjects. At the end of the study, 48% non-renal and 64% HD participants showed T-cell positivity. T-spot responses to SARS-CoV-2 structural peptides S did not differ in the control group and in patients receiving HD at month 1 (p = 0.75) and 6 (p = 0.6) after vaccination. However, T-spot counts dropped over time in non-renal controls, but not in HD subjects (p=0.008 and p=0.18, respectively) - Figure 2. Over the course of the study, there were 2 confirmed cases of COVID-19 reinfection in control group, and 1 case in HD group. Conclusion(s): Patients receiving hemodialysis maintain significant long-term humoral response after vaccination with Gam-COVID-Vac vaccine, which is comparable to that in subjects with normal kidney function. Cellular response turned up to be more sustained over time in HD group. [Formula presented] No conflict of interestCopyright © 2023
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Introduction: In Mongolia, a total of 922000 patients have had COVID-19 infection in the last 2 years, and 2179 (0.24%) of them have died. Mongolia is considered as one of the countries that has successfully responded to COVID-19 pandemic due to its intensive vaccination, hospitalization of at-risk population and severe patients, and relatively low mortality rate. International studies reported that chronic kidney disease (CKD) increases risk of severe disease, adverse events and complications among COVID-19 patients. We aim to study COVID-19 clinical courses and prognosis in patients with CKD. Method(s): We have collected data from medical records of the First Central Hospital of Mongolia (FCHM) from April, 2021 to March, 2022 and data was assessed with the SPSS program. Result(s): We enrolled 125 patients in our study. Average age was 50.7+/-15.1 and 67(53.6%) of them were male, 58(46.4%) of them were female. 50(40%) patients were in CKD stage 1-4 (non-dialysis patients) and 75(60%) patients were in CKD stage 5 (dialysis patients). Among 125 patients, mild, moderate, severe, very-severe cases were 3(2.4%), 60(48%), 56(44.8%), and 6(4.8%) respectively. 15(12%) patients were treated in ICU, 9(7.2%) patients needed ventilator support, and 5(4%) patients died. Clinically, fever, cough, dyspnea, sore-throat, gastrointestinal symptoms, fatigue, and chest pain presented in 49(39.2%), 94(75.2%), 64(51.2%), 29(23.2%), 19(15.2%), 79(63.2%), and 32(25.6%) patients, respectively. 62(49.6% of total) patients were classified as severe and very-severe, 40(32%) of them were in CKD stage 5. 99(79.2%) patients of all patients were vaccinated against SARS-CoV-2 infection. 90(72%) have received remdesivir, 80(64%) patients have had steroid treatment. Conclusion(s): Dialysis patients had a tendency to have complications of COVID-19. We conclude that hospitalized patients with CKD at risk may have reduced the patient's risk of complications and affected prognosis. No conflict of interestCopyright © 2023
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Introduction: Patients with end-stage kidney disease have been among the most affected by the covid-19 pandemic. Vaccination has been imposed in several countries as the main preventive measure. We conducted this study with the aim of evaluating the immunological response to vaccination in senegalese hemodialysis patients, and therefore the effectiveness of mass vaccination in this population. Method(s): We conducted a prospective, cohort study, in two dialysis centers, over a period of 5 months from March 30, 2021 to August 30, 2021. All patients who had been on dialysis for more than 6 months, vaccinated against SARS-CoV2 and who were willing to participate in the study were systematically included. All included patients received 2 doses of ChAdOx1 nCoV-19/AZD1222 vaccine at 12-week intervals according to the original WHO-recommended vaccination schedule. A vaccine response was considered positive when seroconversion was observed after one dose of vaccine. Vaccine protection was judged by the absence of new COVID-19 infection confirmed by RT-PCR in patients who received a complete vaccination schedule. Result(s): Among the 81 patients included in our study, 2.46% had detectable anti-S IgM antibodies before the first dose of vaccine, while the positivity rate was 12.34% one month after the first dose and 2.46% at M4, 1 month after the 2nd dose. Prior to vaccination, 45.68% of patients had detectable IgG anti-S antibodies, while at M1, 1 month after the first dose, 69.14% of patients were positive and at M4 59.26% of patients were. Of the 19 patients infected with Sars-cov-2 prior to vaccination, 2 (10,52%) had detectable IgM antibodies at M0, then 6 (31.58%) at M1 and 2(10.52%) at M4, while in the covid naive group there was no IgM positive subject at M0, 4(6.45%) at M1 and none at M4. Following the same trend, 17 (89.47%) of the previously infected patients had detectable IgG antibodies at M0, 18 (94.73%) at M1 and and 17 (89.47%) at M4, while in the covid naive group 20(32.26%) had detectable IgG at M0, 38 (61.29%) at M1 and 31 (50%) at M4. The seroconversion rate for IgM anti-S antibodies at M1 was 11.39% and statistically significant. At M4, the seroconversion rate compared to the pre-vaccination threshold was 2.53% and not significant. The seroconversion rate for IgG anti-S antibodies at M1 was 56.81% and statistically significant. At M4, the seroconversion rate compared to the pre-vaccination threshold was 52.27% without reaching the significance threshold. IgG-positive patients after two doses of vaccine had a mean length of dialysis of 22 months, which was significantly lower by 10 months than those who did not develop IgG. None of the other parameters studied showed a statistically significant difference between these two groups, including the number of patients with COVID19 infection before or after vaccination and the use of immunosuppressive therapy. Conclusion(s): Vaccination is currently the main measure in the fight against covid, especially in resource limited countries. However, it appears from this study that the protection it offers in haemodialysis patients is neither definitive nor absolute, and that it can be influenced, among other things, by the time spent on dialysis. No conflict of interestCopyright © 2023
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Introduction: Coronavirus Disease 2019 (COVID-19) rapidly became a global pandemic since its emergence in China in December 2019, affecting more than 4.5 million people since then. Patients with Chronic Kidney Disease on dialysis are said to be susceptible to COVID-19 infection. Data published on COVID-19 among this vulnerable group are limited, hence this study aimed to determine the clinico- demographic characteristics of patients on maintenance dialysis with COVID-19 infection and its association to clinical outcomes in a tertiary hospital in Baguio City, Philippines. Method(s): This is a cross-sectional study with a retrospective design utilizing chart review of 165 of 203 dialysis patients admitted at Baguio General Hospital and Medical Center (BGHMC) for COVID-19 infection from March 01, 2020 to December 31, 2021. The clinico- demographic characteristics were described and it determined the association of these to clinical outcomes. Both descriptive and inferential statistics were used in this study. Result(s): The mean age was 53.48 years old with male predominance. About 97% were on hemodialysis, whereas 2.5% were on peritoneal dialysis. Dialysis vintage mean was 3.19 years. Hypertension, diabetes mellitus and coronary artery disease were the most common comorbidities. Majority of them had severe COVID-19 (69%). Diabetes Mellitus as a comorbidity and COVID-19 severity status were associated with mortality, ICU admission and use of mechanical ventilation. Presence of outliers in length of hospital stay based on COVID-19 severity status and ICU admission was also observed. Conclusion(s): Diabetes Mellitus and COVID-19 severity status were associated with poor outcomes. Therefore, special attention should be given to this group emphasizing the importance of taking appropriate precautions in order to avoid getting infected with Covid-19. Achievement of good glycemic control should be emphasized. Longer data collection period could also allow future researchers investigate the impact of various treatment schemes and vaccination status on clinical outcomes. No conflict of interestCopyright © 2023
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Introduction: Patients with chronic kidney disease on maintenance hemodialysis (HD) have a very high risk of death in the course of COVID-19 and this patient population often has a poor response to vaccinations. The aim of the study was to assess the effectiveness of Covid-19 vaccination to reduce the incidence of COVID-19 in HD patients. Method(s): A retrospective study was performed in all HD adult patients in Hemodialysis Unit Hasan sadikin Hospital Bandung. Secondary data based on patient medical record was taken. Vaccinations were carried out from September 2021 to January 2022 with BNT162b2 (Pfizer) and Sinovac vaccine with two-dose scheduled. Anti-RBD (anti-receptor binding domains) levels are assessed to determine the patient's immune status. Data were analyzed by digital-based statistical application (SPSS) using the Mann Whitney and Wilcoxon tests. Result(s): Seventy four samples of hemodialysis patients with different comorbidities were obtained (hypertension, 95.9%;diabetes, 71.6%;coronary heart disease, 8.1%;stroke, 6.8%;history or being treated for tuberculosis, 12.2%) and 2 different types of vaccines (Sinovac, 75.7%;Pfizer, 24.3%) were identified. Six patients died (8.1%) in vaccinated group. Statistical analysis was done with the Mann Whitney and Wilcoxon test to obtained overall anti-RBD increased after vaccination pre and post vaccination. This study shows that the increase in Anti-RBD in subjects who died was not significantly different by statistical test (median: 75.95 vs 130.34, p=0.173), meanwhile in living subjects there was a statistically significant increase in anti-RBD (median : 25.08 vs. 159.53, p<0.001). [Formula presented] Conclusion(s): Anti-RBD significantly increase after Pfizer and Sinovac vaccinations in hemodialysis patients. The effectiveness of the vaccine among hemodialysis patients still needs to be investigated in the future. No conflict of interestCopyright © 2023
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Introduction: Patients on hemodialysis may mount impaired response to COVID-19 vaccination as seen against Influenza and HBV vaccination. Recently published data had shown that immunogenicity of COVID-19 vaccination in HD population is attenuated when compared to non-dialysis population. Medium and long term response to COVID-19 Vaccination in dialysis population of Pakistan is unknown. Method(s): CDC recommends SARS-Cov2 Vaccination in HD patients. The study was performed at dialysis unit of Jinnah hospital Lahore, Pakistan on patients who had completed 2 vaccine series of SARS-Cov-2. Anti-spike antibody titer with' Abbott-Alinity CI technique' was checked during the month of April, 2022.A comparative analysis of antibody titers was done between patients who completed two dose vaccine series less than 6 months ago and more than 6 months ago Results: Total of 101 dialysis patients were included in the study during the month of April, 2022. All patients had completed two dose series of COVID-19 vaccines. Females comprised 28.7% (29/101) of study population. About 40/101 (38.6%) of patient had diabetes and 75% patients had hypertension. About 19% patient had history of hepatitis C infection. Majority of patients (72.2%) had two doses of either Sinovac or Sinopharm vaccine administered. COVID 19 spike protein antibodies were measured for all participants. Mean COVID-19 spike antibody titers were 1892.4 BAU/mL and median titers were 971 BAU/ML. About 30% patients had their second COVID19 vaccine administered within 6 months of checking antibody titers, while 70% patients have had second dose of vaccine administered more than 6 months ago when their antibody titers were checked. Seropositivity was defined as BAU/mL of equal to or more than 7.1 as per manufacturer guidelines. Only 3 patients (2.9%) were seronegative in the whole sample. All patients who received 2nd COVID vaccines dose less than 6 months ago were seropositive. Meanwhile 65 out of 68 (95.5%) patients among subgroup who received 2nd COVID vaccine more than 6 months ago were seropositive. This small difference was not statistically significant (P value 0.55). A comparative analysis was done between patients who completed two dose vaccine series less than 6 months ago and more than 6 months ago when their antibody levels were measures (Table1). This reflects that there was no significant difference among two groups regarding antibody titers. Moreover, there was also no significant difference regarding antibody titers among subgroups defined by diabetes, hypertension, CAD or gender. Median age of the whole sample was 50 years. Sample was divided into two groups, 50 years or less (young) and >50 years of age (old). Surprisingly, older patients had significantly higher anti-spike antibody titers as compared to younger patients (2417.8 BAU/mL vs 1377.3 BAU/mL, P value 0.008) [Formula presented] Conclusion(s): Contrary to published data, hemodialysis Patients in our study had excellent antibody response to SARS-CoV 2 vaccination without any difference in medium and long term response. This is comparable to the antibody response in non-dialysis Pakistani population who has been vaccinated against Sinopharm & Sinovac. Surprisingly, Older populations had significantly higher anti-spike antibody titers as compared to younger population. This difference could be due to higher risk of SARS-CoV2 infection in older population. No conflict of interestCopyright © 2023
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Introduction: Immunogenicity of COVID-19 vaccines in maintenance haemodialysis (MHD) and kidney transplant recipients (KTR) are suboptimal. However, there is no data in the context of durability of humoral response with ChAdOx1 nCoV-19 vaccines in these groups. Method(s): This was a multicentre, prospective cohort study of MHD (n = 73), KTR (n = 62) and control (n = 22) who received ChAdOx1 nCoV-19 vaccine between Feb 2021 to April 2022. Vaccine response was measured at 1m and 6 m after the second dose. Result(s): The antibody response in MHD group compared to control group was statistically lower at both 1-m and 6 m. However only six (8.2%) cases showed negative seroresponse at 1-m, and five (6.84%) had negative response at 6-m. For KTR group, overall, 26(35.61%) cases had no seroresponse and 36(64.39%) seroconverted at 6 months. In this group, there was lower antibody levels at 6-m, however there was no statistically difference compared to 1 m. In comparing MHD group and KTR, the antibody levels were significantly lower in KTR group. The risk factors for no response at 6-m in KTR group was older age, history of anti-rejection in recent times and early transplant period while only age was linked with low response in MHD group. [Formula presented] Conclusion(s): Our report highlights the consistent and durable response of COVID-19 vaccine in both group of patients, despite having an attenuated response compared to control. No conflict of interestCopyright © 2023
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Introduction: Covid-19 affects multiple organs including the kidneys. Mortality from covid-19 is found in those with co-morbid conditions, including end-stage kidney disease. Patients on maintenance hemodialysis appear vulnerable to SARS-CoV 2 infection due to uremia-related immune system dysfunction which consist in both impaired immune defense and pro-inflammatory stated, increased comorbidity burden, frequent hospital admissions and the risk of cross-contamination in the dialysis centers. Mortality risk is associated with covid-19 severity. In non-covid hemodialysis patients, age, diabetes, hypertension, coronary artery disease, smoking history, and frequency of hemodialysis were correlated with mortality. Little is known on the impact of covid-19 in these hemodialysis patients and their clinical and laboratory features. Method(s): This is a retrospective study of adult patients on chronic hemodialysis admitted for covid-19 from March 2020 to December 2021 in a tertiary public hospital in Manila. Data extracted included demographic profile, clinical characteristics, etiology of chronic kidney disease, baseline chest x-ray, and laboratory tests such as white blood cell count, erythrocyte sedimentation rate, c-reactive protein, serum albumin, alanine transaminase, aspartate aminotransferase, lactate dehydrogenase, d-dimer, and ferritin. Also included were the frequency of hemodialysis, covid-19 severity and outcome, whether discharged or died. Descriptive statistics, comparative analysis, and one-way ANOVA were used to analyze the data. Cramer's V was used to test the association of covid severity to a nominal variable. Result(s): The study included 48 patients. There were 19 moderate patients (39.58%), 14 severe patients (29.17%) and 15 critical patients (15%). Among the included patients, 77% improved and were discharged from the hospital. However, 10 patients (20%) expired, particularly those who had severe pneumonia upon hospitalization and critical covid-19. Among the variables analyzed, only elevated lactate dehydrogenase (LDH) significantly predicted the risk for critical covid-19 (p=0.0204). One unit of increase in LDH increases the relative risk for developing critical covid-19 by one-fold. An increase in LDH increases the chance of having critical covid-19 than having moderate covid-19. Conclusion(s): An elevated LDH in hemodialysis patients was associated with risk of developing critical covid-19. A majority of end-stage renal disease patients on maintenance hemodialysis died from cirtical covid-19 with mortality rate of 20% which was higher than that observed in general population. Other variables has no association between the composite outcome or mortality and risk factors previously identified in the general population such as age, diabetes, hypertension, coronary artery disease and history of smoking. No conflict of interestCopyright © 2023
ABSTRACT
Introduction: To describe the incidence and outcomes of SARS-CoV-2 infection, to evaluate its impact (mortality), and the factors associated with infection and mortality in dialysis patients in Argentina. Method(s): All prevalent dialysis patients were included from the period from April 2020 to February 2022. The positive COVID diagnosis was always made with swab and PCR. Signs and symptoms at disease onset were included, as well as the evolution of the patient that included the requirement of hospitalization, hospitalization in a care unit (ICU) and the need for invasive respiratory assistance. Continuous variables are expressed as mean +/- standard deviation or median and range, whether or not they are parametric, continuous variables are expressed as frequency and prevalence. According to the pandemic in the general population, 3 periods were considered: period 1 (Jan2020-Feb2021), period 2 (Mar2021-Nov2021), period 3 (Dec2021-Feb2022). Univariate analysis was performed for infection and mortality as dependent variables, using the T Test, Wilcoxon or Chi2 as appropriate. Multivariate analysis was performed for the dependent variable mortality. A p<0.05 was considered significant. The analysis was performed with the software MedCalc 20113. Result(s): 27,548 cases were recorded (12,221, 10,241, and 5,086 in periods 1, 2, and 3, respectively). The median age was 60.8 years (52% > 60 years) and 58% were male. The most frequent antecedents were community transmission and close contact with a suspected or confirmed case. The most frequent symptoms were malaise (16%), headaches (13%), odynophagia (10%) and myalgia (11%). The most frequent clinical signs were: cough (28%9, Tdegree >= 38degreeC (20%), dyspnoea (12%) and tachypnoea (6%). Mean time between the onset of symptoms and the PCR result of 3.8 days. Of the positive cases, 31% required hospitalization, and of these 26% were in the ICU. Of those admitted to the ICU, 50% required MV. Overall mortality was 23.4%. Mortality was higher during the first period and consequently reduced during 2nd and 3rd period (27, 2%;19, 8%;2, 9% respectively).The most frequent CKD aetiologies were DBT, unknown and nephroangiosclerosis. Most of the patients had less than 3 years on dialysis, but the highest mortality was seen in the group with more than 3 years of dialysis. COVID-19 cases were more prevalent in HD patients compared to PD patients, however the type of modality did not show differences in terms of mortality. Table 1 shows those variables associated with mortality. [Formula presented] Conclusion(s): Throughout the three periods of the COVID pandemic, a decrease in hospitalization and mortality was observed. These variables as well as the infection rate were higher than in the general population. Vaccination, a priority in this population, was associated with lower mortality. Joint actions between Public Health entities and Scientific Societies in pandemic situations ensure an adequate diagnosis of the situation and the bases for timely actions. No conflict of interestCopyright © 2023
ABSTRACT
Introduction: The Coronavirus disease (COVID-19) is more severe in patients with pre-existing comorbidities;therefore, dialysis patients fall into this category. Not to mention the risk among patients receiving in-center dialysis, since they are known to be at higher risk of contracting this disease. Information about the clinical characteristics among hemodialysis patients with COVID-19 in Latin America and low-and middle-income countries are limited. Considering the importance of this topic, the aim of this study was to describe the clinical characteristics along with the outcome of 70 hemodialysis patients hospitalized for COVID-19. Method(s): This is a retrospective study in chronic hemodialysis patients hospitalized with COVID-19. All patients diagnosed with COVID-19 from March 2020 to January 2022 are included. Result(s): The mean age of the patients was 58 (range 19-87), where 65.7% were male. The most prevalent comorbidities were hypertension (98.6%) and type 2 diabetes (54.3%). The most common presenting symptoms were dyspnea (71.4%), fever (68.6%) and cough (58.6%). In addition of abnormal pulmonary auscultation in most patients (78.6%). Lymphocytopenia and elevated inflammatory markers as procalcitonin, erythrocyte sedimentation rate (ESR), D-dimer and C-reactive protein (CRP) were the main prevalent lab findings. At admission 90.1% had ground- glass abnormalities in the CT findings, being CO-RADS 3 the most frequent category between these patients. The average hospital stay was 8.51+/- 6.39 days;35.7% of these patients were admitted to the ICU and only 4 (5.7%) required mechanical ventilation. Therapeutic management included statins and antithrombotic therapy for all the patients at prophylactic doses. Treatment options were remdesivir, corticosteroids, hydroxychloroquine, antibiotics, and other immunosuppressant drugs. A total of 8 (11.4%) patients died during hospitalization and 62 (88.6%) were discharged. Conclusion(s): Even though dialysis patients are at higher risk of death, especially in developing countries, our findings suggest that the mortality rate were lower in comparison with other studies in Latin America and similar to some developed countries. The use of statins and antithrombotic prophylaxis in all hospitalized patients seems to be associated with a lower risk of death in conjunction with other therapeutic regimens according to the guidelines. No significant adverse effects were observed with remdesivir in these patients, so we believe that its use is beneficial in conjunction with the use of statins and antithrombotic prophylaxis, based on the patient's requirements. No conflict of interestCopyright © 2023