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1.
Artif Organs ; 46(12): 2453-2459, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2118471

ABSTRACT

AIMS: Hemodialysis (HD) patients are at increased risk of respiratory infections, due to increased use of communal travel, waiting areas, close proximity to others when dialysing, and contact with healthcare personnel. We wished to determine the major factors associated with transmission of COVID-19 within dialysis centres. METHODS: We compared the differences in the number of COVID-19 infections in patients and staff in 5 dialysis centres during the 1st COVID-19 pandemic between March and June 2020, and analyzed differences between centres. Isolation policies and infection control practices were identical between centres. RESULTS: 224 (30.3%) patients tested positive for COVID-19, by reverse transcriptase polymerase chain reaction, ranging from 4.8% (centre 1 size 55 patients) to 41.5% (centre 5-248 patients) p = 0.007. Communal transport had a significant effect; with 160 of 452 (35.4%) patients using communal testing positive compared to 22.2% of those not using communal transport (X214.5, p < 0.001). Staff sickness varied; 35 of 36 (97.3% centre 5) dialysis staff contracting COVID-19, compared to 60% from centre 4 (189 patients 30 staff) (p < 0.001). Whereas centre 5 had no natural ventilation, and fan assisted ventilation did not meet standards for air changes and air circulation, centre 4 met ventilation standards. CONCLUSIONS: Although there are many potential risk factors accounting for the increased risk of COVID-19 infection in hemodialysis patients, we found that differences in communal transport for patients and ventilation between centres was a major contributor accounting for the differences in patients testing positive for COVID-19 and staff sickness rates. This has important practical applications for designing kidney dialysis centres.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics/prevention & control , Renal Dialysis/adverse effects , Health Personnel , Lung
2.
Kidney360 ; 3(8): 1317-1322, 2022 08 25.
Article in English | MEDLINE | ID: covidwho-2111635

ABSTRACT

Background: Persistent hyperkalemia (hyperK) and hyperphosphatemia (hyperP) despite renal replacement therapy (RRT) was anecdotally reported in COVID-19 and acute kidney injury (AKI) requiring RRT (CoV-AKI-RRT). However, observation bias could have accounted for the reports. Thus, we systematically examined the rate and severity of hyperK and hyperP in patients with CoV-AKI-RRT in comparison with the pre-COVID-19 era. Methods: We identified patients with CoV-AKI-RRT treated with sustained low-efficiency dialysis (SLED) for ≥2 days in March-April 2020. As pre-COVID-19 control, we included patients with AKI treated with SLED in December 2019. We examined the rates of hyperK (serum potassium [sK] ≥5.5 mEq/L), severe hyperK (sK ≥6.5 mEq/L), hyperP (serum phosphate [sP] ≥4.5 mg/dl), and moderate or severe hyperP (sP ≥7-10 and >10 mg/dl, respectively) as %SLED-days with an event. Results: Along the duration of SLED, the incidence of hyperK was greater in CoV-AKI-RRT (n=64; mean 19%±2% versus 14%±3% SLED-days, P=0.002) compared with control (n=60). The proportion of patients with one or more event of severe hyperK was greater in CoV-AKI (33% versus 7%, P<0.001). The incidence of hyperP was similar between groups (mean 56%±4% versus 53%±5% SLED-days, P=0.49). However, the proportion of patients with one or more event of moderate and severe hyperP was greater in CoV-AKI-RRT (86% versus 60%, P=0.001, and 50% versus 18%, P<0.001, respectively). Among those with CoV-AKI-RRT, sK and sP correlated with lactate dehydrogenase (LDH; r=0.31, P=0.04, and r=0.31, P=0.04, respectively), whereas hyperP also correlated with shorter SLED runs (hours/run; r=-0.27, P=0.05). Conclusions: Refractory hyperK and hyperP were more frequent in CoV-AKI-RRT compared with the pre-COVID-19 era. Because of the correlation of sK and sP with higher LDH and sP with shorter SLED runs, intracellular ion release from cell injury due to cytokine storm and RRT interruptions may account for the findings.


Subject(s)
Acute Kidney Injury , COVID-19 , Hyperkalemia , Hyperphosphatemia , Acute Kidney Injury/epidemiology , COVID-19/complications , Humans , Hyperkalemia/epidemiology , Hyperphosphatemia/etiology , Lactate Dehydrogenases , Phosphates , Potassium , Renal Dialysis/adverse effects
4.
Int J Mol Sci ; 23(19)2022 Sep 29.
Article in English | MEDLINE | ID: covidwho-2066125

ABSTRACT

SARS-CoV-2 infection and vaccination have been associated with autoimmune thyroid dysfunctions. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) and molecular mimicry have been referred to as potential causes. Such a case has not been reported in immunocompromised end-stage renal disease (ESRD) patients. Herein we present two dialysis patients with no previous history of thyroid disease who developed immune mediated thyroid disorders after BNT162b mRNA vaccine against SARS-CoV-2. The first patient is a 29-year-old man on hemodialysis diagnosed with Grave's disease four months post-vaccination and the second one is a 67-year-old female on peritoneal dialysis who developed Hashimoto's thyroiditis two months post-vaccination. Grave's disease is uncommon in dialysis patients, whereas Hashimoto's thyroiditis has a higher incidence in this population. Time proximity in both cases suggests potential causality. To our knowledge, this is the first report of de novo immune-mediated thyroid disorders in dialysis patients following vaccination against SARS-CoV-2.


Subject(s)
COVID-19 Vaccines , COVID-19 , Graves Disease , Hashimoto Disease , Adult , Aged , Female , Humans , Male , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Graves Disease/chemically induced , Hashimoto Disease/chemically induced , mRNA Vaccines , Renal Dialysis/adverse effects , SARS-CoV-2 , Vaccination/adverse effects , Vaccines, Synthetic
5.
Clin J Am Soc Nephrol ; 17(10): 1526-1534, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2065333

ABSTRACT

How maintenance dialysis modality, dialysis setting, and residence in a nursing facility have jointly associated with coronavirus disease 2019 (COVID-19)-related outcomes in the United States is relevant to future viral outbreaks. Using Medicare claims, we determined the incidence of COVID-19-related infection, hospitalization, and death between March 15, 2020 and June 5, 2021. The exposure was one of five combinations of dialysis modality and care setting: in-facility hemodialysis without a recent history of skilled nursing facility care, in-facility hemodialysis with a recent history of skilled nursing facility care, hemodialysis in a skilled nursing facility, home hemodialysis, and (home) peritoneal dialysis. Patient-weeks were pooled to estimate the adjusted associations of event incidence with each dialysis modality/setting during four intervals in 2020-2021. Relative to in-facility hemodialysis without a recent history of skilled nursing facility care, home dialysis was associated with 36%-60% lower odds of all events during weeks 12-23 of 2020; 24%-37% lower odds of all events during weeks 24-37 of 2020; 20%-33% lower odds of infection and hospitalization during the winter of 2020-2021; and similar odds of all events thereafter. In contrast, exposure to skilled nursing facilities was associated with 570%-1140% higher odds of all events during spring of 2020, although excess risk attenuated as the pandemic transpired, especially among patients who received hemodialysis in skilled nursing facilities. In conclusion, home dialysis was associated with lower risks of COVID-19 diagnosis, hospitalization, and death until vaccines were available, whereas care in skilled nursing facilities was associated with higher risks.


Subject(s)
COVID-19 , Renal Dialysis , Humans , Aged , United States/epidemiology , Renal Dialysis/adverse effects , COVID-19/epidemiology , COVID-19 Testing , Medicare , Retrospective Studies
6.
BMC Nephrol ; 23(1): 308, 2022 09 08.
Article in English | MEDLINE | ID: covidwho-2009365

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) was common in the first two waves of the SARS-COV-2 pandemic in critically ill patients. A high percentage of these patients required renal replacement therapy and died in the hospital. METHODS: The present study examines the clinical presentation, laboratory parameters and therapeutic interventions in critically ill patients with AKI admitted to the ICU in two centres, one each in India and Pakistan. Patient and outcome details of all critically ill COVID 19 patients admitted to the ICU requiring renal replacement therapy were collected. Data was analysed to detect patient variables associated with mortality. RESULTS: A total of 1,714 critically ill patients were admitted to the ICUs of the two centres. Of these 393 (22.9%) had severe acute kidney injury (AKIN stage 3) requiring dialysis. Of them, 60.5% were men and the mean (± SD) age was 58.78 (± 14.4) years. At the time of initiation of dialysis, 346 patients (88%) were oligo-anuric. The most frequent dialysis modality in these patients was intermittent hemodialysis (48.1%) followed by slow low efficiency dialysis (44.5%). Two hundred and six (52.4%) patients died. The mortality was higher among the Indian cohort (68.1%) than the Pakistani cohort (43.4%). Older age (age > 50 years), low serum albumin altered sensorium, need for slower forms of renal replacement therapy and ventilatory support were independently associated with mortality. CONCLUSION: There was a very high mortality in patients with COVID-19 associated AKI undergoing RRT in the ICUs in this cohort from the Indian sub-continent.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/therapy , Adult , Aged , COVID-19/therapy , Critical Illness/therapy , Female , Humans , Intensive Care Units , Male , Middle Aged , Pakistan/epidemiology , Renal Dialysis/adverse effects , Renal Replacement Therapy , Retrospective Studies , SARS-CoV-2
7.
Ital J Pediatr ; 48(1): 149, 2022 Aug 19.
Article in English | MEDLINE | ID: covidwho-2002209

ABSTRACT

BACKGROUND: Chronic kidney disease stage 5 (CKD 5) populations have peculiar risk for severe Covid-19 infection. Moreover; pediatric data are sparse and lacking. The aim of this study is to report our experience in CKD 5 children treated by hemodialysis (CKD 5D) and CKD 5 children after kidney transplantation (KTR) during one year of Covid-19 pandemic. METHODS: Retrospective analysis of 57 CKD 5 children with Covid-19 like symptoms during 1 year pandemic was performed. A cohort of 19 confirmed patients (13 CKD 5D and 6 KTR) was analyzed in details as regard clinical, laboratory, radiological criteria, management and their short term outcome. RESULTS: CONCLUSION: Pediatric patients on regular HD (CKD 5D) are at higher risk and worse outcome of Covid-19 infection than KT recipients (KTR). Pre-existing HTN and shorter duration after KT are potential risk factors. Reversible AGD after KT and CVC related infections in HD patients are additional presenting features of Covid-19 infection.


Subject(s)
COVID-19 , Kidney Failure, Chronic , Kidney Transplantation , COVID-19/epidemiology , Child , Egypt/epidemiology , Humans , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/surgery , Kidney Transplantation/adverse effects , Pandemics , Renal Dialysis/adverse effects , Retrospective Studies
8.
Cochrane Database Syst Rev ; 4: CD013554, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1990403

ABSTRACT

BACKGROUND: Patients with kidney failure require vascular access to receive maintenance haemodialysis (HD), which can be achieved by an arteriovenous fistula or a central venous catheter (CVC). CVC use is related to frequent complications such as venous stenosis and infection. Venous stenosis occurs mainly due to trauma caused by the entrance of the catheter into the venous lumen and repeated contact with the vein wall.  A biofilm, a colony of irreversible adherent and self-sufficient micro-organisms embedded in a self-produced matrix of exopolysaccharides, is associated with the development of infections in patients with indwelling catheters. Despite its clinical relevance, the treatment of catheter-related bloodstream infections (CRBSIs) in patients receiving maintenance HD remains controversial, especially regarding catheter management. Antibiotic lock solutions may sterilise the catheter, treat the infection and prevent unnecessary catheter procedures. However, such treatment may also lead to antibiotic resistance or even clinical worsening in certain more virulent pathogens. Catheter removal and delayed replacement may remove the source of infection, improving infectious outcomes, but this approach may also increase vascular access stenosis, thrombosis or both, or even central vein access failure. Catheter guidewire exchange attempts to remove the source of infection while maintaining access to the same vein and, therefore, may improve clinical outcomes and preserve central veins for future access. OBJECTIVES: To assess the benefits and harms of different interventions for CRBSI treatment in patients receiving maintenance HD through a permanent CVC, such as systemic antibiotics alone or systemic antibiotics combined with either lock solutions or catheter guidewire exchange or catheter replacement. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 21 December 2021 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register were identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) and quasi-RCTs evaluating the management of CRBSI in permanent CVCs in people receiving maintenance HD. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies for inclusion, assessed their risk of bias, and performed data extraction. Results were expressed as risk ratios (RR) or hazard ratios (HR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with their 95% confidence intervals (CI). The certainty of the evidence was assessed using GRADE. MAIN RESULTS: We identified two RCTs and one quasi-RCT that enrolled 760 participants addressing the treatment of CRBSIs in people (children and adults) receiving maintenance HD through CVC. No two studies compared the same interventions. The quasi-RCT compared two different lock solutions (tissue plasminogen activator (TPA) and heparin) with concurrent systemic antibiotics. One RCT compared systemic antibiotics alone and in association with an ethanol lock solution, and the other compared systemic antibiotics with different catheter management strategies (guidewire exchange versus removal and replacement). The overall certainty of the evidence was downgraded due to the small number of participants, high risk of bias in many domains, especially randomisation, allocation, and other sources of bias, and missing outcome data. It is uncertain whether an ethanol lock solution used with concurrent systemic antibiotics improved CRBSI eradication compared to systemic antibiotics alone (RR 1.61, 95% CI 1.16 to 2.23) because the certainty of this evidence is very low. There were no reported differences between the effects of TPA and heparin lock solutions on cure rates (RR 0.92, 95% CI 0.74 to 1.15) or between catheter guidewire exchange versus catheter removal with delayed replacement, expressed as catheter infection-free survival (HR 0.88, 95% CI 0.43 to 1.79). To date, no results are available comparing other interventions. Outcomes such as venous stenosis and/or thrombosis, antibiotic resistance, death, and adverse events were not reported. AUTHORS' CONCLUSIONS: Currently, there is no available high certainty evidence to support one treatment over another for CRBSIs. The benefit of using ethanol lock treatment in combination with systemic antibiotics compared to systemic antibiotics alone for CRBSIs in patients receiving maintenance HD remains uncertain due to the very low certainty of the evidence. Hence, further RCTs to identify the benefits and harms of CRBSI treatment options are needed. Future studies should unify CRBSI and cure definitions and improve methodological design.


Subject(s)
Catheter-Related Infections , Central Venous Catheters , Sepsis , Adult , Catheter-Related Infections/etiology , Catheter-Related Infections/prevention & control , Central Venous Catheters/adverse effects , Child , Heparin/therapeutic use , Humans , Renal Dialysis/adverse effects , Sepsis/drug therapy
10.
Nephrology (Carlton) ; 27(10): 804-809, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1968171

ABSTRACT

AIM: It is unclear if variant of concern and vaccination status impact COVID-19 infection virological dynamics in haemodialysis patients and affect de-isolation protocol for dialysis centres. METHOD: We performed a retrospective observational cohort study between February 2020 to September 2021, to examine the virological kinetics of vaccinated and unvaccinated haemodialysis patients with polymerase chain reaction (PCR)-confirmed COVID-19 infection of the delta and pre-delta variants. RESULTS: Of the 38 subjects with PCR-confirmed COVID-19 infection, we found that individuals infected during the delta-variant period had higher viral load at presentation and required longer duration to achieve a negative PCR swab, compared to those infected in the pre-delta variant period. Time to achieve negative PCR swab was longest in unvaccinated individuals infected during delta-variant period. However, vaccinated and unvaccinated individuals achieved high PCR cycle threshold value of ≥25 and ≥30 at similar timing. CONCLUSION: Our study suggests that patients infected during delta-variant period of COVID-19 illness, have higher viral load at presentation and prolonged viral shedding, especially in the unvaccinated cohort. However, prolonged time to negative PCR is likely due to inactive virus shedding, and that conversion to negative PCR may not be a necessary pre-requisite for de-isolation.


Subject(s)
COVID-19 , Kidney Failure, Chronic , COVID-19/diagnosis , COVID-19/epidemiology , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Renal Dialysis/adverse effects , Retrospective Studies , SARS-CoV-2 , Vaccination
11.
J Nephrol ; 35(9): 2377-2381, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1966207

ABSTRACT

The COVID-19 pandemic has transformed the health landscape by hampering the management of patients with chronic diseases. Providing optimal healthcare has become a critical issue, especially for patients with end-stage renal disease (ESRD) receiving in-center dialysis. Peritoneal Dialysis (PD) has the advantage of being a home-based therapy. Several papers about COVID-19 in the chronic kidney disease (CKD) population have been published, but few studies focused on the PD population, with limited case series. In this paper, we share our strategy for managing PD patients during the pandemic and describe the characteristics of 24 episodes of COVID-19 that occurred in our PD patients. Also, we report the impact of the pandemic on different outcomes and discuss the challenges of renal replacement therapy (RRT) in the time of COVID-19 and the advantages of PD. During the period from December 2019 to September 2021, 127 patients received PD in our center. Among them, we recorded 24 episodes of COVID-19 that occurred in 20 patients, corresponding to an incidence of 8.4 per 1000 patient-months. None of the 20 patients with COVID-19 were vaccinated and there was a significant male gender predominance in the COVID-19 group compared to the non-COVID-19 group. The prevalence of diabetic nephropathy and primary glomerulonephritis were also significantly higher in the COVID-19 group. The revealing symptoms were asthenia, dry cough, and the deterioration of general conditions in 100%, 75%, and 63% of the patients, respectively. A biological inflammatory syndrome was found in 30% of the patients. Chest computed tomography (CT) scan, performed in 5 patients, showed features of COVID pneumonia with an average extent of damage of 55%. The rate of patients starting PD during the study period was comparable to that before the pandemic. Furthermore, we did not find a significant difference between the infected and the non-infected groups regarding the incidence of peritonitis, PD technique failure, and mortality (6.1 [0-1.46] vs 3.9 [0.15-0.64] deaths per 1000 patient-months. COVID-19 does not seem to have influenced the outcomes of our patients treated with PD even before the launch of mass immunization in our country. Thus, PD can be a great option for RRT in the era of the COVID-19 pandemic since many issues could be managed remotely to avoid regular hospital visits and contribute to maintaining social distancing, which is the cornerstone of breaking the chain of transmission of the novel virus.


Subject(s)
COVID-19 , Kidney Failure, Chronic , Peritoneal Dialysis , Humans , Male , COVID-19/epidemiology , Pandemics , Peritoneal Dialysis/adverse effects , Peritoneal Dialysis/methods , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Kidney Failure, Chronic/diagnosis , Renal Dialysis/adverse effects , Retrospective Studies
12.
Intern Med ; 61(12): 1869-1876, 2022 Jun 15.
Article in English | MEDLINE | ID: covidwho-1951857

ABSTRACT

A 73-year-old man receiving hemodialysis and antiplatelets was admitted with a mild case of COVID-19. Heparin was added, and iliopsoas hemorrhage developed. He was successfully treated by interventional radiology. A 76-year-old man receiving hemodialysis and antiplatelets was admitted with mild COVID-19. Heparin was added, and iliacus hemorrhage developed. Despite heparin discontinuation, he died of worsening pneumonia. A 74-year-old man undergoing hemodialysis was admitted with severe COVID-19. Gastrointestinal bleeding developed during continuous hemodiafiltration with heparin. Upon switching to nafamostat and increasing the dose, iliopsoas hemorrhage developed. Despite interventional radiology, he died of infectious complications. Attention to hemorrhagic complications is therefore needed in patients with COVID-19.


Subject(s)
COVID-19 , Aged , Anticoagulants/adverse effects , COVID-19/complications , Hemorrhage/drug therapy , Heparin/therapeutic use , Humans , Male , Renal Dialysis/adverse effects
13.
Am J Nephrol ; 53(7): 586-590, 2022.
Article in English | MEDLINE | ID: covidwho-1950519

ABSTRACT

The optimal SARS-CoV-2 vaccination schedule in dialysis patients and the potential need for a fourth vaccine dose are debatable. We prospectively assessed the humoral responses to three and four doses of BNT162b2 among dialysis patients. The study included 106 dialysis patients; 60 (56.6%) and 46 (43.4%) received 3 and 4 vaccine doses, respectively. Anti-spike (anti-S) antibody titers significantly increased after the third vaccine dose, followed by a decline, yet still remained higher than all previous measurements. The fourth vaccine dose led to another profound rise in anti-S titers. The absolute increase following the fourth dose correlated with response to the third dose. Infection risk however was similar between patients vaccinated with three or four doses.


Subject(s)
BNT162 Vaccine , COVID-19 , Antibodies, Viral , BNT162 Vaccine/administration & dosage , BNT162 Vaccine/adverse effects , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Renal Dialysis/adverse effects , SARS-CoV-2 , Viral Vaccines
14.
CEN Case Rep ; 11(4): 487-489, 2022 11.
Article in English | MEDLINE | ID: covidwho-1943430

ABSTRACT

COVID-19 is known to affect numerous organs which have ACE-2 receptors, lung being the most involved organ. Nevertheless, cardiac involvement is not uncommon and can occur through a variety of manifestations. The authors hereby report a case of pericarditis following SARS-CoV-2 infection. A 54-year-old man with end stage kidney disease under peritoneal dialysis presented with acute chest pain approximately 1 month after being diagnosed with COVID-19. Electrocardiogram revealed widespread ST segment elevation. The diagnosis of acute pericarditis secondary to the viral infection was made and the patient was treated accordingly. Etiology of acute pericarditis can be very varied, and, in many times, no cause is ascertained. In such circumstances, viral or immune mediated etiologies are assumed. In our case, since no cause was proven, pericarditis was assumed as secondary to the SARS-CoV-2 infection. This entity is probably underdiagnosed. In patients undergoing dialysis, uremic pericarditis is commonly the etiology. However, different causes must be taken into consideration, COVID-19 being one of them.


Subject(s)
COVID-19 , Pericarditis , Peritoneal Dialysis , Male , Humans , Middle Aged , Renal Dialysis/adverse effects , SARS-CoV-2 , Pericarditis/complications , Pericarditis/diagnosis , Peritoneal Dialysis/adverse effects
15.
Am J Infect Control ; 50(10): 1118-1124, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1935957

ABSTRACT

BACKGROUND: While dialysis patients are at greater risk of serious SARS-CoV-2 complications, stringent infection prevention measures can help mitigate infection and transmission risks within dialysis facilities. We describe an outbreak of 14 cases diagnosed in a hospital-based outpatient ESRD facility over 13 days in the second quarter of 2021, and our coordinated use of epidemiology, viral genome sequencing, and infection control practices to quickly end the transmission cycle. METHODS: Symptomatic patients and staff members were diagnosed by RT-PCR. Facility-wide screening utilized SARS-CoV-2 antigen tests. SARS-CoV-2 genome sequences were obtained from residual diagnostic specimens. RESULTS: Of the 106 patients receiving dialysis in the facility, 10 were diagnosed with SARS-CoV-2 infection, as was 1 patient support person. Of 3 positive staff members, 2 were unvaccinated and had provided care for 6 and 4 of the affected patients, respectively. Sequencing demonstrated that all cases in the cluster shared an identical B.1.1.7./Alpha substrain. Attack rates were greatest among unvaccinated patients and staff. Vaccine effectiveness was 88% among patients. CONCLUSIONS: Prompt recognition of an infection cluster and rapid intervention efforts successfully ended the outbreak. Alongside consistent adherence to core infection prevention measures, vaccination was highly effective in reducing disease incidence and morbidity in this vulnerable population.


Subject(s)
COVID-19 , Kidney Failure, Chronic , COVID-19/epidemiology , COVID-19/prevention & control , Disease Outbreaks/prevention & control , Humans , Infection Control , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Renal Dialysis/adverse effects , SARS-CoV-2 , Vaccination
16.
G Ital Nefrol ; 39(3)2022 Jun 20.
Article in English | MEDLINE | ID: covidwho-1929243

ABSTRACT

Background: Pandemic condition due to Coronavirus disease (COVID-19) caused a fastest augmentation of hospitalization, impairing the healthcare organization. As a consequence, diagnostic and therapeutic delays have been showed. COVID-19-associated coagulopathy is an endothelial disease related to SARSCoV-2 infection. Our study evaluated the thrombosis of arteriovenous fistula (AVF) as risk marker of mortality. Methods: the analysis included 24 dialysis-dependent patients admitted in a period between March 2020 and June 2021. Patients were divided based on AVF thrombosis: the A group without AVF thrombosis (13 patients), and the B group with AVF thrombosis events (11 patients). Pearson or Spearman' correlation tests were performed to detect possible confounding variable to include in multivariate models. Kaplan Meier and Cox regression analysis were performed to compute mortality analysis. Results: Delta D-dimer (Rho: 0.613, p=0.007), over-infections (Rho 0.456; p= 0,026), C-reactive Protein (CRP) (Rho=0.417, p=0.043), death (Rho=0.492, p=0.027), positive pulmonary imaging (Rho 0.388, p=0.074), and high OLT (0.408, p=0.047) were related to AVF thrombosis, using Pearson or Spearman correlation tests. Kaplan Meier test showed a death average of 19 days in group B compared to a global average of 38 days (p=0.029), and Cox analysis showed an HR of 5.01, 95% CI 1.01-24.99, p=0.049. Furthermore, AVF thrombosis explained about the 68% of the mortality, evaluated through the Harrel's C test. Conclusion: We can speculate that AVF thrombosis in hemodialysis patients with COVID-19 could be an early marker of both pro-coagulative process and severe clinical disease and it could be used to stratify patients and identify the ones that can be considered "frail".


Subject(s)
Arteriovenous Fistula , Arteriovenous Shunt, Surgical , COVID-19 , Thrombosis , Arteriovenous Fistula/complications , Arteriovenous Shunt, Surgical/adverse effects , Biomarkers , COVID-19/complications , Humans , Renal Dialysis/adverse effects , Retrospective Studies , Risk Factors , Thrombosis/diagnosis , Thrombosis/etiology
17.
Nephrol Dial Transplant ; 37(10): 1944-1950, 2022 09 22.
Article in English | MEDLINE | ID: covidwho-1908870

ABSTRACT

BACKGROUND: Hemodialysis patients are at high risk of Covid-19, though vaccination has significant efficacy in preventing and reducing the severity of infection. Little information is available on disease severity and vaccine efficacy since the dissemination of the Omicron variant. METHODS: In a multi-center study, during a period of the epidemic driven by the Omicron variant, all hemodialysis patients positive for SARS-CoV-2 were identified. Outcomes were analyzed according to predictor variables including vaccination status. Risk of infection was analyzed using a Cox proportional hazards model. RESULTS: SARS-CoV-2 infection was identified in 1126 patients including 200 (18%) unvaccinated, 56 (5%) post first dose, 433 (38%) post second dose, and 437 (39%) at least 7 days beyond their third dose. The majority of patients had a mild course but 160 (14%) were hospitalized and 28 (2%) died. In regression models adjusted for age and comorbidity, two-dose vaccination was associated with a 39% (95%CI: 2%-62%) reduction in admissions, but third doses provided additional protection, with a 51% (95%CI: 25%-69%) further reduction in admissions. Among 1265 patients at risk at the start of the observation period, SARS-CoV-2 infection was observed in 211 (17%). Two-dose vaccination was associated with a 41% (95%CI: 3%-64%) reduction in the incidence of infection, with no clear additional effect provided by third doses. CONCLUSIONS: These data demonstrate lower incidence of SARS-CoV-2 infection after vaccination in dialysis patients during an Omicron dominant period of the epidemic. Among those developing infection, severe illness was less common with prior vaccination, particularly after third vaccine doses.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Cohort Studies , Humans , Renal Dialysis/adverse effects , SARS-CoV-2 , Vaccination
18.
J Nephrol ; 35(5): 1479-1487, 2022 06.
Article in English | MEDLINE | ID: covidwho-1899388

ABSTRACT

INTRODUCTION: Breakthrough COVID-19 may occur in vaccinated people, and may result from declining vaccine effectiveness or highly transmittable SARS-CoV-2 variants, such as the B.167.2 (delta) variant. We investigated risk factors and outcomes for infection with the delta variant among vaccinated hemodialysis patients. METHODS: Patients on maintenance hemodialysis who received two doses of the BNT162b2 (Pfizer-BioNTech) vaccine were analysed according to having developed COVID-19 (study group) or not (control group), in a retrospective, observational, comparative study. We compared risk-factors for developing breakthrough COVID-19 and assessed clinical outcomes, including 30-day mortality rates. RESULTS: Twenty-four cases of breakthrough SARS-CoV-2 infection were compared to 91 controls without infection. Breakthrough infection was associated with chronic immunosuppressive treatment, hematological malignancies, and low antibody levels against SARS-CoV-2 spike protein. All COVID-19 cases occurred at least 5 months after vaccination, and most were caused by the B.1.617.2 variant (at least 23/24 cases). COVID-19 was categorized as severe or critical disease in 11/24 patients (46%), and 54% required hospitalization and COVID-19-directed treatment. The source of infection was nosocomial in 6/24 cases (25%), and healthcare-related in 3/24 (12.5%). Mortality rate was 21%. Overall mortality was significantly higher in patients who developed COVID-19 than in controls (odds ratio for all-cause mortality 7.6, 95% CI 1.4-41, p = 0.002). CONCLUSIONS: Breakthrough COVID-19 with the B.1.617.2 variant can occur in vaccinated hemodialysis patients and is associated with immunosuppression and weaker humoral response to vaccination. Infections may be nosocomial and result in significant morbidity and mortality.


Subject(s)
COVID-19 , Cross Infection , Viral Vaccines , BNT162 Vaccine , COVID-19/prevention & control , Humans , Renal Dialysis/adverse effects , Retrospective Studies , SARS-CoV-2 , Spike Glycoprotein, Coronavirus
19.
Nephrology (Carlton) ; 27(10): 815-822, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1879088

ABSTRACT

AIMS: Vitamin D plays a role in innate immune system activation, and deficiency increases susceptibility to respiratory infections and disease severity including COVID-19. We determined whether vitamin D levels and medications were associated with contracting COVID-19, and disease severity defined by hospitalisation and dialysis patient mortality. METHODS: We reviewed serum vitamin D levels, and prescription of cholecalciferol and alfacalcidol along with corresponding medical records of adult dialysis patients from a United Kingdom tertiary centre between March 2020 and May 2021. COVID-19 infection was determined by polymerase chain reaction (PCR) results. RESULTS: 362 (35%) of 1035 dialysis patients tested PCR positive for COVID-19. COVID-19 positive patients had lower native median vitamin D (65 (39-95) versus 74 (40.5-101) nmol/L (p = .009) despite greater prescription of cholecalciferol (median 20 000 (20000-20 000) versus 20 000 (0-20 000) IU/week), p < .001, but lower prescription of alfacalcidol 0 (0-3.0) versus 2.0 (0.-5.0) ug/week, p < .001. On multivariate logistic regression COVID-19 infection was associated with haemodialysis versus peritoneal dialysis (p < .001), cholecalciferol dose (p < .001) and negatively with alfacalcidol (p < .001). However, serum vitamin D levels and alfacalcidol dosages were not significantly different for those requiring hospitalisation compared to those managed at home, although those who died were prescribed lower alfacalcidol dosages. CONCLUSION: Dialysis patients who contracted COVID-19 had lower levels of native vitamin D prior to COVID-19 and were prescribed lower dosages of alfacalcidol. However, there was no association between vitamin D status and disease severity. This retrospective observational analysis supports a potential role for vitamin D and susceptibility to COVID-19 infection in dialysis patients.


Subject(s)
COVID-19 , Vitamin D Deficiency , Adult , COVID-19/diagnosis , COVID-19/therapy , Cholecalciferol/therapeutic use , Humans , Kidney , Renal Dialysis/adverse effects , Retrospective Studies , Vitamin D , Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/epidemiology , Vitamins/therapeutic use
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