ABSTRACT
Introduction: The aims of this study were to determine the prevalence and post-immunisation adverse events of COVID-19 vaccination in chronic hemodialysis patients in Senegal and to assess the factors associated with their occurrence. Method(s): This was a cross-sectional, multicenter, descriptive and analytical study from 1 April to 1 July 2021 including all chronic hemodialysis patients in the targeted centers who received at least one dose of COVID-19 vaccine and consented to participate in the study. Chronic hemodialysis patients unable to complete the questionnaire are not included. For each patient included, the following parameters were studied: socio-demographic data, history and comorbidities and COVID-19 vaccination (type of vaccine, existence of side effects and their type, and time of occurrence). Result(s): Of 535 chronic hemodialysis patients surveyed, 367 were included, representing a prevalence of 68.6% of COVID-19 vaccination. The median age was 51 years with extremes of 20 and 100 years and a sex ratio of 1.08. The most representative age group was over 60 years with 30.3%. The median duration of dialysis was 44.5 months with an interquartile range of [25;73] and extremes of 3 and 183 months. Patients with less than 30 months on dialysis (31.9%) were more represented. Hypertensive nephropathy was the most frequent cause of chronic kidney disease. It was observed in 128 patients (34.9%). The AstraZeneca vaccine was the most widely administered vaccine (98.4%). Post-immunisation adverse events were noted in 52.6% of patients. They were dominated by local side effects (65.6%) followed by influenza-like illness (60.8%). Other side effects were digestive (11,1%), neurological (9%), otorhinolaryngological (5,3%) and cardiovascular (4,8%). No deaths were recorded. One case of post-vaccination cellulitis was noted. Coagulation of the extracorporeal circuit during the 4 sessions of hemodialysis following the vaccination, despite the anticoagulation of the latter, was observed in one patient. Side effects occurred mainly on the day after vaccination in 56% of patients. Age < 50 years, diabetes and anticoagulation were associated with post-immunisation adverse events in the bivariate analysis. In the multivariate analysis, age < 50 years was a risk factor and anticoagulation had a protective effect. Conclusion(s): Vaccination against COVID-19 is well tolerated in chronic hemodialysis patients. No conflict of interestCopyright © 2023
ABSTRACT
Background: Dialysis patients have a higher COVID-19 fatality rate than the general population and are priority candidates for SARS-CoV-2 vaccination. However, dialysis patients are immunocompromised, suggesting that they may develop a less immune response to COVID-19 vaccination than healthy individuals. Objective and Methods: A total of 358 hemodialysis patients who were twicevaccinated with BNT162b2 were included. SARS-CoV-2 IgG antibody titer was measured within 7 days to 1 month, 1∼2 months, and 3∼4 months after the second vaccination, and factors influencing antibody titer were statistically investigated. SARS-CoV-2 IgG measurement was performed using SARS-CoV-2 IgG II Quant Reagent (Abbott), which is a reagent to quantitatively measure IgG antibodies against the receptor-binding domain of SARS-CoV-2 spike protein. Results: The patients were 240 males (67%) and 118 females, ranging from 37 to 95 years old, with a median age of 70 years. Causes of kidney failure were diabetes mellitus in 35.2%, hypertensive kidney disease in 7.3%, glomerular disease in 30.5%, and polycystic kidney disease in 4.5% of the patients. Comorbidities were hypertension in 64.3% and diabetes in 48.9%. Steroids or immunosuppressive drugs were used in 9% of the patients. SARS-CoV-2 IgG antibody titers at 7 days to 1 month, 1 to 2 months, and 3 to 4 months (median 10, 42, and 98 days) after the second vaccination have the median of 4092 AU/mL(with interquartile range: 1354, 7592), 2199 (927, 4692), and 789 (323, 1559), respectively. Post-vaccination SARS-CoV-2 IgG titers were significantly correlated with Kt/V, the presence of autoimmune diseases, the use of steroids or immunosuppressive drugs, malignancy treatment, and serum albumin and hemoglobin levels. Multivariate analysis showed that the factors that decreased post-vaccination SARS-CoV-2 IgG titer were the use of steroids and immunosuppressive drugs, the presence of malignant tumors under treatment, and hypoalbuminemia. Conclusion: Compared to healthy subjects in previous reports, dialysis patients had lower SARS-CoV-2 IgG titers after COVID-19 vaccination, suggesting that the vaccine may not be sufficiently effective. In addition, SARS-CoV-2 IgG titers are likely to be even lower in patients at high risk for decreased immune response due to medications or comorbidities. Additional vaccination may be essential for hemodialysis patients who are expected to have low SARS-CoV-2 IgG titers.
ABSTRACT
Lack of awareness of a diagnosis of chronic kidney disease (CKD) in patients and physicians is a major contributor to fueling the CKD pandemic by also making it invisible to researchers and health authorities. This is an urgent matter to tackle if dire predictions of future CKD burden are to be addressed. CKD is set to become the fifth-leading global cause of death by 2040 and the second-leading cause of death before the end of the century in some countries with long life expectancy. Coronavirus disease 2019 (COVID-19) illustrated this invisibility: only after the summer of 2020 did it become clear that CKD was a major driver of COVID-19 mortality, both in terms of prevalence as a risk factor and of the risk conferred for lethal COVID-19. However, by that time the damage was done: news outlets and scientific publications continued to list diabetes and hypertension, but not CKD, as major risk factors for severe COVID-19. In a shocking recent example from Sweden, CKD was found to be diagnosed in just 23% of 57 880 persons who fulfilled diagnostic criteria for CKD. In the very same large cohort, diabetes or cancer were diagnosed in 29% of persons, hypertension in 82%, cardiovascular disease in 39% and heart failure in 28%. Thus, from the point of view of physicians, patients and health authorities, CKD was the least common comorbidity in persons with CKD, ranking sixth, after other better-known conditions. One of the consequences of this lack of awareness was that nephrotoxic medications were more commonly prescribed in patients with CKD who did not have a diagnosis of CKD. Low awareness of CKD may also fuel concepts such as the high prevalence of hypertensive nephropathy when CKD is diagnosed after the better-known condition of hypertension.
ABSTRACT
BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic impacted healthcare services for kidney disease patients. Lockdown and social distancing were mandated worldwide, resulting in closure of medical services. The diagnosis of various kidney diseases may have been delayed during the COVID-19 pandemic because non-urgent tests and visits were postponed due to closure of medical services during the lockdown. METHODS: We here report the impact of the COVID-19 pandemic on a total number of 209 native kidney diseases requiring renal biopsy for diagnosis in a retrospective observational study from a tertiary hospital in Germany. RESULTS: The lockdown period in March and April 2020 primarily affected patients admitted to the normal medical ward with a compensatory increased rate of renal biopsies in the postlockdown phase. In addition, there was a shift toward more patients admitted with hemoglobinuria during the COVID-19 pandemic. This phenomenon of an increased number of patients with hemoglobinuria during the COVID-19 pandemic was specifically observed in a subgroup with hypertensive nephropathy requiring renal biopsy and associated with increased proteinuria, not attributed to the COVID-19 lockdown period itself. CONCLUSION: To our knowledge, this is the first report of identifying a subpopulation susceptible to closure of medical services during the COVID-19 pandemic and diagnostic delay of specific kidney diseases. Therefore, the COVID-19 pandemic should be regarded as a risk factor especially in patients with diseases other than COVID-19 primarily admitted to the normal medical ward.