Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 120
Filter
1.
Kidney360 ; 1(6): 432, 2020 Jun 25.
Article in English | MEDLINE | ID: covidwho-1776851
4.
J Am Soc Nephrol ; 32(9): 2147-2152, 2021 09.
Article in English | MEDLINE | ID: covidwho-1708655

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a high rate of mortality in patients with ESKD, and vaccination is hoped to prevent infection. METHODS: Between January 18 and February 24, 2021, 225 kidney transplant recipients (KTRs) and 45 patients on hemodialysis (HDPs) received two injections of mRNA BNT162b2 vaccine. The postvaccinal humoral and cellular response was explored in the first 45 KTRs and ten HDPs. RESULTS: After the second dose, eight HDPs (88.9%) and eight KTRs (17.8%) developed antispike SARS-CoV-2 antibodies (P<0.001). Median titers of antibodies in responders were 1052 AU/ml (IQR, 515-2689) in HDPs and 671 AU/ml (IQR, 172-1523) in KTRs (P=0.40). Nine HDPs (100%) and 26 KTRs (57.8%) showed a specific T cell response (P=0.06) after the second injection. In responders, median numbers of spike-reactive T cells were 305 SFCs per 106 CD3+ T cells (IQR, 95-947) in HDPs and 212 SFCs per 106 CD3+ T cells (IQR, 61-330) in KTRs (P=0.40). In KTRs, the immune response to BNT162b2 seemed influenced by the immunosuppressive regimen, particularly tacrolimus or belatacept. CONCLUSION: Immunization with BNT162b2 seems more efficient in HDPs, indicating that vaccination should be highly recommended in these patients awaiting a transplant. However, the current vaccinal strategy for KTRs may not provide effective protection against COVID-19 and will likely need to be improved.


Subject(s)
Antibodies, Viral/biosynthesis , COVID-19 Vaccines/pharmacology , COVID-19/immunology , Kidney Transplantation , Renal Dialysis , SARS-CoV-2/immunology , T-Lymphocytes/immunology , Aged , COVID-19/complications , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Cohort Studies , Female , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/immunology , Kidney Failure, Chronic/therapy , Kidney Transplantation/adverse effects , Male , Middle Aged , Pandemics , RNA, Messenger/genetics , Retrospective Studies , SARS-CoV-2/genetics , Spike Glycoprotein, Coronavirus/genetics , Spike Glycoprotein, Coronavirus/immunology , Transplant Recipients
5.
Transplantation ; 105(7): 1423-1432, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1704612

ABSTRACT

BACKGROUND: There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. METHODS: We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. RESULTS: Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. CONCLUSIONS: Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.


Subject(s)
COVID-19/complications , Kidney Failure, Chronic/surgery , Kidney Transplantation , Adult , Aged , COVID-19/diagnosis , Donor Selection/methods , Female , Follow-Up Studies , Humans , India , Kidney Failure, Chronic/complications , Male , Middle Aged , Patient Selection , Retrospective Studies , Survivors , Treatment Outcome
6.
Rev Esp Enferm Dig ; 114(2): 124-125, 2022 02.
Article in English | MEDLINE | ID: covidwho-1689699

ABSTRACT

We present the case of a 57-year-old female with bloody diarrhea, fever and abdominal pain. Her medical history included human immunodeficiency virus (HIV) infection with an undetectable viral load and end-stage kidney disease secondary to HIV on dialysis. At admission, she had a painful abdomen, no skin lesions and bloody stools in the rectal examination. Laboratory findings included a white blood cell count of 12,900 x 103 cells/µl, CD4 counts of 243 cells/µl and C-reactive protein of 24.5 mg/dl. Serologies, cytomegalovirus and PCR SARS-CoV-2 were negative.


Subject(s)
COVID-19 , HIV Infections , Kidney Failure, Chronic , Vasculitis , Female , HIV Infections/complications , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Middle Aged , SARS-CoV-2 , Vasculitis/complications
7.
Saudi J Kidney Dis Transpl ; 32(2): 468-480, 2021.
Article in English | MEDLINE | ID: covidwho-1622689

ABSTRACT

According to the elevated infection mortality risks, the incidence of coronavirus disease 2019 (COVID-19) could be raised in rheumatoid arthritis patients with end-stage renal disease (ESRD). Our objectives are to describe the impact of COVID-19 infection on rheumatoid arthritis patients with end-stage renal disease and to identify the risk of in-hospital mortality, comorbid conditions. and the proper way to deal with this category. It was a retrospective analysis of COVID-19 patients in Saudi Arabia from March 1, 2020 to April 27, 2020 and from May 27, 2020 to August 20, 2020. Of 10,482 patients with COVID-19, 419 had ESRD. We assessed main (in-hospital death) outcomes and secondary (mechanical breathing and residence) outcomes. Patients with ESRD were aged and more comorbid disorders. Rheumatoid arthritis patients with ESRD were aged. ESRD rheumatoid arthritis patients have a higher hospital mortality risk relative to rheumatoid arthritis patients not getting complicated with ESRD (31.7% vs. 25.4%, chances 1.38, and 95% trust range 1.12-1.70). After population and comorbid conditions had changed, the rate of rise stayed the same (changed chances: 1.37, 1.09-1.73). In both the crude and modified study (1.62, 1.26-2.07; vs. 1.57, 1.22-2.02), chances for the period of stay of seven or more days have been higher inside a group than in the non-ESRD group. Old age, respiratory support, lymphopenia, and elevated blood urea nitrogen and low serum ferritin were the independent contributing factors for the in-hospital mortality of ESRD rheumatoid arthritis patients infected with severe acute respiratory syndrome coronavirus 2.


Subject(s)
Arthritis, Rheumatoid/complications , COVID-19/complications , Hospital Mortality , Kidney Failure, Chronic/complications , Adult , Aged , Aged, 80 and over , Arthritis, Rheumatoid/epidemiology , COVID-19/mortality , China/epidemiology , Female , Humans , Kidney Failure, Chronic/mortality , Kidney Failure, Chronic/therapy , Male , Middle Aged , Renal Dialysis , Retrospective Studies , Risk Factors , SARS-CoV-2
8.
BMC Nephrol ; 22(1): 384, 2021 11 17.
Article in English | MEDLINE | ID: covidwho-1523286

ABSTRACT

BACKGROUND: Hemodialysis patients are among high-risk groups for COVID-19. Africa is the continent with the lowest number of cases in the general population but we have little information about the disease burden in dialysis patients. OBJECTIVES: This study aimed to describe the seroprevalence of SARS-CoV-2 antibodies in the hemodialysis population of Senegal. PATIENTS AND METHODS: We conducted a multicenter cross-sectional survey, between June and September 2020 involving 10 public dialysis units randomly selected in eight regions of Senegal. After seeking their consent, we included 303 patients aged ≥ 18 years and hemodialysis for ≥ 3 months. Clinical symptoms and biological parameters were collected from medical records. Patients' blood samples were tested with Abbott SARS-CoV-2 Ig G assay using an Architect system. Statistical tests were performed with STATA 12.0. RESULTS: Seroprevalence of SARS-CoV-2 antibodies was 21.1% (95% CI = 16.7-26.1%). We noticed a wide variability in SARS-CoV-2 seroprevalence between regions ranging from 5.6 to 51.7%. Among the 38 patients who underwent nasal swab testing, only six had a PCR-confirmed infection and all of them did seroconvert. Suggestive clinical symptoms were reported by 28.1% of seropositive patients and the majority of them presented asymptomatic disease. After multivariate analysis, a previous contact with a confirmed case and living in a high population density region were associated with the presence of SARS-CoV-2 antibodies. CONCLUSION: This study presents to our knowledge the first seroprevalence data in African hemodialysis patients. Compared to data from other continents, we found a higher proportion of patients with SARS-CoV-2 antibodies but a lower lethality rate.


Subject(s)
Antibodies, Viral/blood , COVID-19/epidemiology , Renal Dialysis , SARS-CoV-2/immunology , Adolescent , Adult , Aged , COVID-19/blood , COVID-19/complications , Contact Tracing , Cross-Sectional Studies , Educational Status , Female , Geography, Medical , Health Surveys , Humans , Immunoglobulin G/blood , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Male , Middle Aged , Population Density , Prevalence , Senegal/epidemiology , Seroepidemiologic Studies , Symptom Assessment , Young Adult
9.
Ren Fail ; 43(1): 1394-1407, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1462086

ABSTRACT

BACKGROUND: New evidence from studies on risk factors for mortality in hemodialysis (HD) patients with COVID-19 became available. We aimed to review the clinical risk factors for fatal outcomes in these patients. METHODS: We performed meta-analysis using the PubMed, EMBASE, and Cochrane databases. A fixed- or random-effects model was used for calculating heterogeneity. We used contour-enhanced funnel plot and Egger's tests to assess potential publication bias. RESULTS: Twenty-one studies were included. The proportion of males was lower in the survivor group than in the non-survivor group (OR = 0.75, 95% CI [0.61, 0.94]). The proportion of respiratory diseases was significantly lower in the survivor group than in the non-survivor group (OR = 0.42, 95% CI [0.29, 0.60]). The proportion of patients with fever, cough, and dyspnea was significantly lower in the survivor group (fever: OR = 0.53, 95% CI [0.31, 0.92]; cough: OR = 0.50, 95% CI [0.38, 0.65]; dyspnea: OR = 0.25, 95% CI [0.14, 0.47]) than in the non-survivor group. Compared with the non-survivor group, the survivor group had higher albumin and platelet levels and lower leucocyte counts. CONCLUSIONS: Male patients might have a higher risk of developing severe COVID-19. Comorbidities, such as respiratory diseases could also greatly influence the clinical prognosis of COVID-19. Clinical features, such as fever, dyspnea, cough, and abnormal platelet, leucocyte, and albumin levels, could imply eventual death. Our findings will help clinicians identify markers for the detection of high mortality risk in HD patients at an early stage of COVID-19.


Subject(s)
COVID-19/mortality , Kidney Failure, Chronic/mortality , COVID-19/complications , Comorbidity , Humans , Kidney Failure, Chronic/complications , Risk Factors
14.
J Am Soc Nephrol ; 32(9): 2153-2158, 2021 09.
Article in English | MEDLINE | ID: covidwho-1341564

ABSTRACT

BACKGROUND: Kidney transplant recipients and patients receiving hemodialysis are immunocompromised populations that are prioritized for COVID-19 vaccination but were excluded from clinical trials of SARS-CoV-2 mRNA vaccines. Antibody titers and rates of seroconversion after vaccination are lower among patients with CKD and those taking immunosuppressants compared with controls. Data are lacking regarding their humoral response to vaccination to prevent COVID-19. METHODS: This investigation of early serological response after COVID-19 vaccination with the Pfizer/BioNTech (BNT162b2) mRNA vaccine included 78 patients undergoing hemodialysis, 74 kidney transplant recipients, and seven healthy controls. We recorded data from the medical file for various clinical parameters, including response to hepatitis B vaccination, and measured antibody titers against SARS-CoV-2 at 0, 14, 28, 36, and 58 days after the first injection. RESULTS: In controls, we detected antibodies at a positive level (>13 arbitrary units per ml; AU/ml) at day 14 postinjection, which increased progressively to peak at day 36 (1082 AU/ml; interquartile range [IQR], 735.0-1662.0). Patients undergoing hemodialysis had lower titers that peaked at day 58 (276 AU/ml; IQR, 83.4-526.0). We detected a positive antibody level in only three transplant recipients at day 36. In patients on hemodialysis, those aged <75 years had a higher antibody response versus those aged >75 years, and serum albumin and Kt/V were positively correlated with serological response (P<0.04 and P<0.0, respectively); nonresponders to HBV vaccine had the lowest anti-SARS-CoV-2 antibody titers. CONCLUSIONS: Our results suggest that the postvaccination humoral response is strongly inhibited by immunosuppressant therapy in kidney transplant recipients, and is reduced by the uremic condition in patients undergoing hemodialysis.


Subject(s)
Antibodies, Viral/biosynthesis , COVID-19 Vaccines/pharmacology , COVID-19/immunology , COVID-19/prevention & control , Kidney Transplantation , Renal Dialysis , SARS-CoV-2/immunology , Age Factors , Aged , Antibodies, Viral/blood , COVID-19/complications , COVID-19 Vaccines/administration & dosage , Case-Control Studies , Cohort Studies , Female , Hepatitis B Vaccines/pharmacology , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/immunology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Pandemics , Retrospective Studies , Spike Glycoprotein, Coronavirus/immunology , Time Factors , Transplant Recipients
15.
J Am Soc Nephrol ; 32(8): 1880-1886, 2021 08.
Article in English | MEDLINE | ID: covidwho-1337589

ABSTRACT

BACKGROUND: Although reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rare among individuals with few coronavirus disease 2019 (COVID-19) risk factors, the ability of naturally acquired immunity to prevent reinfection among patients with ESKD is not known. METHODS: This prospective study was conducted among adults with ESKD treated with in-center hemodialysis (ICHD) in the United States. Exposure was ascribed on the basis of the presence or absence of IgG against SARS-CoV-2 at baseline, and separately, a history of documented COVID-19 before study entry. Outcomes were assessed after an infection-free period, and were any SARS-CoV-2 infection (i.e., detected by protocolized PCR tests or during routine clinical surveillance), and clinically manifest COVID-19 (consisting of only the latter). RESULTS: Of 2337 consented participants who met study inclusion criteria, 9.5% were anti-SARS-CoV-2 IgG positive at baseline; 3.6% had a history of COVID-19. Over 6679 patient-months of follow-up, 263 participants had evidence of any SARS-CoV-2 infection, including 141 who had clinically manifest COVID-19. Presence of anti-SARS-CoV-2 IgG (versus its absence) at baseline was associated with lower risk of any SARS-CoV-2 infection (incidence rate ratio, 0.55; 95% confidence interval, 0.32 to 0.95) and clinically manifest COVID-19 0.21 (95% confidence interval, 0.07 to 0.67). CONCLUSION: Among patients with ESKD, naturally acquired anti-SARS-CoV-2 IgG positivity is associated with a 45% lower risk of subsequent SARS-CoV-2 infection, and a 79% lower risk of clinically manifest COVID-19. Because natural immunity is incomplete, patients with ESKD should be prioritized for SARS-CoV-2 vaccination, independent of their COVID-19 disease history.


Subject(s)
Antibodies, Viral/blood , COVID-19/complications , COVID-19/immunology , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/immunology , Renal Dialysis , SARS-CoV-2/immunology , Aged , COVID-19/epidemiology , COVID-19 Vaccines/pharmacology , Cohort Studies , Female , Humans , Immunity, Innate , Immunoglobulin G/blood , Incidence , Kidney Failure, Chronic/therapy , Male , Middle Aged , Pandemics , Prospective Studies , Reinfection/complications , Reinfection/epidemiology , Reinfection/immunology , Risk Factors , United States/epidemiology
16.
Int J Hematol ; 114(5): 626-629, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1310613

ABSTRACT

Thrombotic thrombocytopenic purpura (TTP) is a known menace in hematology and is quite rare in practice with known triggers. Lately, in the COVID-19 pandemic, hematology has seen a new pathology amongst which TTP associated with COVID-19 messenger RNA (mRNA) vaccine is unique. We report a case of a 69-year-old male with multiple comorbidities who presented to the hospital with severe fatigue and shortness of breath. Labs were significant for thrombocytopenia, anemia, and hemolysis with schistocytes consistent with TTP with a second dose of BNT162b2 mRNA vaccine as a likely culprit been documented.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19 , Immunization, Secondary/adverse effects , Pandemics , Purpura, Thrombotic Thrombocytopenic/etiology , SARS-CoV-2 , ADAMTS13 Protein/immunology , Aged , COVID-19/prevention & control , COVID-19 Vaccines/immunology , Combined Modality Therapy , Dyspnea/etiology , Fatigue/etiology , HIV Infections/complications , Hepatitis B, Chronic/complications , Humans , Hypertension/complications , Immunosuppressive Agents/therapeutic use , Kidney Failure, Chronic/complications , Male , Plasma Exchange , Purpura, Thrombotic Thrombocytopenic/blood , Purpura, Thrombotic Thrombocytopenic/therapy , Venous Thrombosis/complications
17.
J Am Soc Nephrol ; 32(8): 2048-2056, 2021 08.
Article in English | MEDLINE | ID: covidwho-1305593

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected socially disadvantaged populations. Whether disparities in COVID-19 incidence related to race/ethnicity and socioeconomic factors exist in the hemodialysis population is unknown. METHODS: Our study involved patients receiving in-center hemodialysis in New York City. We used a validated index of neighborhood social vulnerability, the Social Vulnerability Index (SVI), which comprises 15 census tract-level indicators organized into four themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. We examined the association of race/ethnicity and the SVI with symptomatic COVID-19 between March 1, 2020 and August 3, 2020. COVID-19 cases were ascertained using PCR testing. We performed multivariable logistic regression to adjust for demographics, individual-level social factors, dialysis-related medical history, and dialysis facility factors. RESULTS: Of the 1378 patients on hemodialysis in the study, 247 (17.9%) developed symptomatic COVID-19. In adjusted analyses, non-Hispanic Black and Hispanic patients had significantly increased odds of COVID-19 compared with non-Hispanic White patients. Census tract-level overall SVI, modeled continuously or in quintiles, was not associated with COVID-19 in unadjusted or adjusted analyses. Among non-Hispanic White patients, the socioeconomic status SVI theme, the minority status and language SVI theme, and housing crowding were significantly associated with COVID-19 in unadjusted analyses. CONCLUSIONS: Among patients on hemodialysis in New York City, there were substantial racial/ethnic disparities in COVID-19 incidence not explained by neighborhood-level social vulnerability. Neighborhood-level socioeconomic status, minority status and language, and housing crowding were positively associated with acquiring COVID-19 among non-Hispanic Whites. Our findings suggest that socially vulnerable patients on dialysis face disparate COVID-19-related exposures, requiring targeted risk-mitigation strategies.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Health Status Disparities , Kidney Failure, Chronic/complications , Renal Dialysis , SARS-CoV-2 , Adolescent , Adult , African Americans , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Incidence , Male , Middle Aged , New York City/epidemiology , Pandemics , Residence Characteristics , Retrospective Studies , Risk Factors , Socioeconomic Factors , Vulnerable Populations , Young Adult
19.
BMC Nephrol ; 22(1): 251, 2021 07 06.
Article in English | MEDLINE | ID: covidwho-1298049

ABSTRACT

BACKGROUND: The ongoing coronavirus pandemic has major impacts on both patients and healthcare systems worldwide, thus creating new realities. Patients on maintenance dialysis listed for renal transplantation are a vulnerable subgroup with many comorbidities and recurring contacts with the healthcare system. Due to the COVID-19 pandemic transplant numbers have dropped considerably, further increasing waiting times in this high-risk population. On the other hand, knowledge of the severity of SARS-CoV-2 infection in immunocompromised patients, development and persistence of neutralising antibodies in such patients is just emerging. It is unclear how best to address the dilemma of postponing the life-saving transplantation. CASE PRESENTATION: We present a case report of a successful kidney transplantation only 65 days after the recipient was hospitalized for treatment of COVID-19 pneumonia. In a follow up of 9 months, we observed no signs of recurrent disease and transplant function is excellent. Monitoring SARS-CoV-2 antibody response demonstrates stable IgG levels. CONCLUSION: This reassuring case provides guidance to transplant centers how to proceed with kidney transplantation safely during the pandemic. Careful consideration of risks and benefits of the organ offer, full recovery from COVID-19 symptoms and the presence of a positive SARS-CoV-2 IgG antibody test, qualifies for kidney transplantation.


Subject(s)
Antibodies, Viral/immunology , COVID-19/immunology , Kidney Failure, Chronic/surgery , Kidney Transplantation , Aged , COVID-19/complications , COVID-19 Serological Testing , Female , Graft Rejection/prevention & control , Humans , Immunoglobulin G/immunology , Immunoglobulin M/immunology , Immunosuppressive Agents/therapeutic use , Kidney Failure, Chronic/complications , Renal Dialysis , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL