Lessons from SENCOVAC: A prospective study evaluating the response to SARS-CoV-2 vaccination in the CKD spectrum.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has negatively impacted on patients of the whole CKD spectrum, causing high rates of morbi-mortality. SARS-CoV-2 vaccines opened a new era, but patients with CKD (including kidney transplant, hemodialysis and peritoneal dialysis) were systematically excluded from pivotal clinical trials. The Spanish Society of Nephrology promoted the multicentric national SENCOVAC study aimed at assessing immunological responses after vaccination in patients with CKD. During the first year after vaccination, patients with non-dialysis CKD and those on hemodialysis and peritoneal dialysis presented good anti-Spike antibody responses to vaccination, especially after receiving the third and fourth doses. However, kidney transplant recipients presented suboptimal responses after any vaccination schedule (initial, third and fourth dose). Especially worrisome is the situation of a patients with a persistently negative humoral response that do not seroconvert after boosters. In this regard, monoclonal antibodies targeting SARS-CoV-2 have been approved for high-risk patients, although they may become obsolete as the viral genome evolves. The present report reviews the current status of SARS-CoV-2 vaccination in the CKD spectrum with emphasis on lessons learned from the SENCOVAC study. Predictors of humoral response, including vaccination schedules and types of vaccines, as well as the integration of vaccines, monoclonal antibodies and antiviral agents are discussed.

Update of the prevention and isolation measure recommendations against SARS-COV-2 in dialysis units of Spain: A position paper of the Spanish Society of Nephrology Council.

SARS-CoV-2 pandemic has changed across the last two years. The development and approval of SARS-CoV-2 vaccines and the emergence of new variants has opened up a new scenario. On this regard, Spanish Society of Nephrology (S.E.N.) Council considers that an update of the previous recommendations should be performed. In the present statement, and taking into account the current epidemiological situation, are included updated recommendations of protection and isolation for patients on dialysis programs.

Increase in peritoneal dialysis-related hospitalization rates after telemedicine implementation during the COVID-19 pandemic.

INTRODUCTION AND OBJECTIVES: To minimize our peritoneal dialysis (PD) population exposure to coronavirus disease (COVID-19), in April 2020 we developed and implemented a telemedicine program. In this investigation, we aimed to compare the hospitalization rates and metabolic disorders in patients undergoing PD 6 months before and after the COVID-19 pandemic and telemedicine implementation. MATERIALS AND METHODS: This single-center retrospective analysis included all active prevalent patients undergoing PD from April 2020. Dialysis records were reviewed to obtain clinical, demographic, laboratory, appointment, and hospitalization data. We compared hospitalization rates (total, non-PD-related, and PD-related), hospitalization-associated factors, and metabolic disorders (hemoglobin, serum potassium, and serum phosphate) 6 months before and after the pandemic. RESULTS: Our sample comprised 103 participants. During the pre-pandemic and post-pandemic periods, there were 13 and 27 hospital admissions, respectively. The total hospitalization incident rate ratio (IRR) was 2.48 (95% confidence interval [CI], 1.29-4.75). PD-related hospitalizations increased from 3 to 15 episodes (IRR=7.25 [95% CI, 2.11-24.78]). In the pre-pandemic period, the educational level was lower in participants hospitalised due to PD-related issues than in participants not hospitalised. In the post-pandemic period, only sex distribution differed between patients not hospitalised and those hospitalised due to non-PD-related issues. Only serum potassium levels changed significantly in the post-pandemic period (4.79±0.48 vs. 4.93±0.54mg/dL; P<0.01). CONCLUSION: This study showed a significant increase in hospitalization rates after the COVID-19 pandemic period and telemedicine implementation, mainly due to PD-related infectious causes. Strategies to improve distance monitoring assistance are needed for the PD population.

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

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

Recomendaciones dietéticas para pacientes con Enfermedad Renal Crónica e infección por SARS-CoV-2

La prevalencia de malnutrición en paciente con Enfermedad Renal Crónica es elevada, aumentando en pacientes con infección por SARS-CoV-2. La relación existente entre inflamación y nutrición es conocida en la enfermedad renal, por lo que la presencia previa de cuadros de malnutrición empeora el pronóstico de la infección. El objetivo del presente artículo es la creación de recomendaciones dietéticas específicas para pacientes con enfermedad renal crónica e infección o post- infección por SARS-CoV-2, adaptadas al estadio de enfermedad y a la etapa del proceso de infección. El abordaje nutricional comienza por la valoración del estado nutricional, para lo que se recomiendan minimizar el contacto físico mediante la utilización de los criterios Global Leadership Initiative on Malnutrition (GLIM), y el cuestionario rápido de sarcopenia (SARC-F). Las recomendaciones dietéticas deben considerar el estadio de enfermedad renal crónica, la etapa de infección por SARS-CoV-2 y las complicaciones surgidas que comprometan la ingesta oral, entre las más comunes se encuentran: anorexia, ageusia, disfagia y diarrea. En el presente documento se han elaborado tablas de raciones de ingestas diarias adaptadas a las diferentes situaciones. En aquellos pacientes que no cubran los requerimientos nutricionales se recomienda comenzar con la suplementación nutricional de manera precoz, considerando las consecuencias de la infección descrita. Debido al elevado riesgo de malnutrición en pacientes con enfermedad renal cónica e infección por SARS-CoV-2, se recomienda la adaptación de la valoración del estado nutricional y su tratamiento, así como realizar una monitorización tras la fase de infección activa.Alternate : The prevalence of malnutrition in patients with Chronic Kidney Disease is high, increasing in patients with SARS-CoV-2 infection. The relationship between inflammation and nutrition in kidney disease is known, so the previous presence of malnutrition conditions worsens the prognosis of infection. The objective of this article is the creation of specific dietary recommendations for patients with chronic kidney disease and infection or post-infection by the SARS-CoV-2 virus, adapted to the stage of the disease and the stage of the infection process. The nutritional approach begins with the assessment of nutritional status, recommending minimizing physical contact through the use of the Global Leadership Initiative on Malnutrition (GLIM) criteria and the rapid sarcopenia questionnaire (SARC-F). The dietary recommendations should consider the stage of chronic kidney disease, the stage of infection by SARS-CoV-2 and the complications arising that compromise oral intake, among the most common are: anorexia, ageusia, dysphagia and diarrhea. In this document, tables of daily intakes have been prepared adapted to different situations. In those patients who do not meet the nutritional requirements, it is recommended to start with an early nutritional supplementation, considering the consequences of the infection described. Due to the high risk of malnutrition in patients with chronic kidney disease and SARS-CoV-2 infection, it is recommended to adapt the assessment of nutritional status and treatment, as well as to carry out monitoring after the active infection phase.

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

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

Position statement of the Spanish Society of Nephrology on the SARS-CoV-2 vaccines.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide over the last year causing more than one million deaths. Several treatments have tried to modify the natural history of the coronavirus disease 2019 (COVID-19) but only corticosteroids have demonstrated to be effective in moderate or severe affectation. In that situation, the development of vaccines for preventing the SARS-CoV-2 infection has focused the attention of the scientific community. At present, available messenger RNA-based technology vaccines have received the approval of local and international sanitary authorities. In this position statement, the Spanish Society of Nephrology wants to state that patients with chronic kidney disease and healthcare workers are at high-risk for contagion and complications of COVID-19 so they must have priority in the vaccine administration.

COVID-19 incidence and outcomes in a home dialysis unit in Madrid (Spain) at the height of the pandemic.

INTRODUCTION: The 2019 coronavirus (COVID-19) is a viral infection caused by a new coronavirus that is affecting the entire world. There have been studies of patients on in-center hemodialysis (HD), but home dialysis population data are scarce. Our objective is to study the incidence and course of COVID-19 in a home dialysis unit (HDU) at the height of the pandemic. METHODS: an observational, retrospective study enrolling all patients diagnosed with COVID-19 from the HDU of Hospital Universitario La Paz [La Paz University Hospital] (Madrid, Spain) between March 10 and May 15, 2020. We collected clinical data from the HDU (57 patients on peritoneal dialysis [PD] and 22 patients on home hemodialysis [HHD]) and compared the clinical characteristics and course of patients with and without COVID-19 infection. RESULTS: twelve patients were diagnosed with COVID-19 (9 PD; 3 HHD). There were no statistically significant differences in terms of clinical characteristics between patients with COVID-19 and the rest of the unit. The mean age was 62 ± 18.5 years; most were men (75%). All patients but one required hospitalization. Ten patients (83%) were discharged following a mean of 16.4 ± 9.7 days of hospitalization. Two patients were diagnosed while hospitalised for other conditions, and these were the only patients who died. Those who died were older than those who survived. CONCLUSION: The incidence of COVID-19 in our HDU in Madrid at the height of the pandemic was high, especially in patients on PD. No potential benefit for preventing the infection in patients on home dialysis was observed. Advanced age and nosocomial transmission were the main factors linked to a worse prognosis.

[COVID-19 incidence and outcomes in a home dialysis unit in Madrid (Spain) at the height of the pandemic]. / Incidencia y resultados de la COVID-19 en una unidad de diálisis domiciliaria en Madrid (España) durante el pico de la pandemia.

INTRODUCTION: The 2019 coronavirus (COVID-19) is a viral infection caused by a new coronavirus that is affecting the entire world. There have been studies of patients on in-center hemodialysis, but home dialysis population data are scarce. Our objective is to study the incidence and course of COVID-19 in a home dialysis unit (HDU) at the height of the pandemic. METHODS: An observational, retrospective study enrolling all patients diagnosed with COVID-19 from the HDU of Hospital Universitario La Paz (La Paz University Hospital) (Madrid, Spain) between March 10 and May 15, 2020. We collected clinical data from the HDU (57 patients on peritoneal dialysis and 22 patients on home hemodialysis) and compared the clinical characteristics and course of patients with and without COVID-19 infection. RESULTS: Twelve patients were diagnosed with COVID-19 (9 peritoneal dialysis; 3 home hemodialysis). There were no statistically significant differences in terms of clinical characteristics between patients with COVID-19 and the rest of the unit. The mean age was 62±18.5 years; most were men (75%). All patients but one required hospitalization. Ten patients (83%) were discharged following a mean of 16.4±9.7 days of hospitalization. Two patients were diagnosed while hospitalized for other conditions, and these were the only patients who died. Those who died were older than those who survived. CONCLUSION: The incidence of COVID-19 in our HDU in Madrid at the height of the pandemic was high, especially in patients on peritoneal dialysis. No potential benefit for preventing the infection in patients on home dialysis was observed. Advanced age and nosocomial transmission were the main factors linked to a worse prognosis.

[Impact of the COVID-19 pandemic on Spanish Nephrology Services]. / Impacto de la pandemia COVID-19 en los servicios de Nefrología españoles.

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has required a rapid and drastic transformation of hospitals, and consequently also of Spanish Nephrology Units, to respond to the critical situation. The Spanish Society of Nephrology conducted a survey directed to the Heads of Nephrology Departments in Spain that addressed the reorganisation of Nephrology departments and activity during the peak of COVID-19 pandemic. The survey has been focused on the integration of nephrologists in COVID-19 teams, nephrology inpatient care activities (elective admissions, kidney biopsies), the performance of elective surgeries such as vascular accesses or implantation of peritoneal catheters, the suspension of kidney transplantation programmes and the transformation of nephrology outpatient clinics. This work details the adaptation and transformation of nephrology services during the COVID-19 pandemic in Spain. During this period, elective admissions to Nephrology Services, elective surgeries and biopsies were suspended, and the kidney transplant programme was scaled back by more than 75%. It is worth noting that outpatient nephrology consultations were carried out largely by telephone. In conclusion, the pandemic has clearly impacted clinical activity in Spanish Nephrology departments, reducing elective activity and kidney transplants, and modifying activity in outpatient clinics. A restructuring and implementation plan in Nephrology focused on telemedicine and/or virtual medicine would seem to be both necessary and very useful in the near future.