Anti-Spike antibodies 3 months after SARS-CoV-2 mRNA vaccine booster dose in patients on hemodialysis: the prospective SENCOVAC study.

Background: Patients on hemodialysis are at high-risk for complications derived from coronavirus disease 2019 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity 3 months after the booster dose. Methods: This is a multicentric and prospective study assessing immunoglobulin G anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Results: A total of 711 patients [67% male, median age (range) 67 (20-89) years] were included. Of these, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, P = .001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, P = .693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated with mRNA-1273 booster (P = .001), lower time from booster (P = .043) and past breakthrough SARS-CoV-2 infection (P < .001). Conclusions: In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated with mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infection.

El nivel de la hormona paratiroidea (PTH) y no el de fósforo sérico es predictor de la progresión de la enfermedad renal en pacientes mayores con enfermedad renal crónica avanzada / PTH levels and not serum phosphorus levels are a predictor of the progression of kidney disease in elderly patients with advanced chronic kidney disease

Antecedentes: En la actualidad hay una elevada incidencia de pacientes ancianos con enfermedad renal crónica avanzada (ERCA), siendo importante conocer la evolución a largo plazo y qué factores influyen. Objetivos: Analizar la evolución de la ERCA en pacientes ancianos y la influencia del metabolismo óseo-mineral. Métodos: Estudio retrospectivo de 125 pacientes ≥70años con ERC 4-5, que iniciaron seguimiento desde el 1 de enero de 2007 al 31 de diciembre de 2008, observándose la progresión de la ERC (medida con la pendiente de la línea de regresión del filtrado glomerular estimado [FGe] obtenido mediante MDRD-4) durante 5años. Resultados: Progresión grupo completo (mediana y percentiles 25 y 75): -1,15 (-2,80/0,17) ml/min/1,73m2/año, ERC-4: -1,3 (-2,8/0,03) ml/min/1,73m2/año, ERC-5: -1,03 (-3/0,8) ml/min/1,73m2/año; pendiente de línea de regresión positiva en 35 pacientes (28%: ERC no progresa) y negativa 90 pacientes (72%: ERC progresa). Correlación (Spearman) negativa (progresión más lenta): hormona paratiroidea (PTH), albuminuria/Cr, excreción diaria de Na (todos basales). No se correlacionó con FGe, P sérico, excreción urinaria de P, ingesta proteica e ingesta de P (todas basales). Regresión lineal (variable dependiente: pendiente de progresión): albuminuria y PTH (ambos a nivel basal) influyeron de forma independiente en dicha variable. Regresión logística (progresa vs. no progresa): PTH, albuminuria y FGe (todos basales) influyeron de forma significativa. Conclusiones: En nuestro grupo de pacientes de edad avanzada el deterioro de la función renal es muy lento, especialmente en los pacientes en estadio5. La albuminuria y la PTH al inicio del seguimiento son factores pronósticos en la evolución de su función renal (AU)

Background: At present, there is a high incidence of elderly patients with advanced chronic kidney disease (CKD) and it is important to know the long term progression and the factors that influence it. Objectives: To analyse the progression of advanced CKD in elderly patients and the influence of bone-mineral metabolism. Methods: Retrospective study of 125 patients ≥70years of age with CKD stages 4-5 who started follow-up from January 1, 2007 to December 31, 2008, showing the progression of CKD (measured by the slope of the regression line of the estimated glomerular filtration rate [eGFR] by MDRD-4) over 5years. Results: Progression in the entire group (median and 25th and 75th percentiles): -1.15 (-2.8/0.17) ml/min/1.73m2/year, CKD-4: -1.3 (-2.8/0.03) ml/min/1.73m2/year, CKD-5: -1.03 (-3.0/0.8) ml/min/1.73m2/year; the slope of the regression line was positive in 35 patients (28%: CKD does not progress) and negative in 90 patients (72%: CKD progresses). Negative correlation (Spearman) (slower progression): PTH, albumin/Cr ratio and daily Na excretion (all baseline measurements). No correlation with eGFR, serum P, urinary P excretion, protein intake and intake of P (all baseline measurements). In the linear regression analysis (dependent variable: slope of progression): albuminuria and PTH (both at baseline measurements) influenced this variable independently. Logistic regression (progresses vs. does not progress): PTH, albuminuria and eGFR (all at baseline measurements) influenced significantly. Conclusions: In our group of elderly patients, impairment of renal function is slow, particularly in CKD-5 patients. Albuminuria and PTH at baseline levels are prognostic factors in the evolution of renal function (AU)

PTH levels and not serum phosphorus levels are a predictor of the progression of kidney disease in elderly patients with advanced chronic kidney disease. / El nivel de la hormona paratiroidea (PTH) y no el de fósforo sérico es predictor de la progresión de la enfermedad renal en pacientes mayores con enfermedad renal crónica avanzada.

BACKGROUND: At present, there is a high incidence of elderly patients with advanced chronic kidney disease (CKD) and it is important to know the long term progression and the factors that influence it. OBJECTIVES: To analyse the progression of advanced CKD in elderly patients and the influence of bone-mineral metabolism. METHODS: Retrospective study of 125 patients ≥70years of age with CKD stages 4-5 who started follow-up from January 1, 2007 to December 31, 2008, showing the progression of CKD (measured by the slope of the regression line of the estimated glomerular filtration rate [eGFR] by MDRD-4) over 5years. RESULTS: Progression in the entire group (median and 25th and 75th percentiles): -1.15 (-2.8/0.17) ml/min/1.73m2/year, CKD-4: -1.3 (-2.8/0.03) ml/min/1.73m2/year, CKD-5: -1.03 (-3.0/0.8) ml/min/1.73m2/year; the slope of the regression line was positive in 35 patients (28%: CKD does not progress) and negative in 90 patients (72%: CKD progresses). Negative correlation (Spearman) (slower progression): PTH, albumin/Cr ratio and daily Na excretion (all baseline measurements). No correlation with eGFR, serum P, urinary P excretion, protein intake and intake of P (all baseline measurements). In the linear regression analysis (dependent variable: slope of progression): albuminuria and PTH (both at baseline measurements) influenced this variable independently. Logistic regression (progresses vs. does not progress): PTH, albuminuria and eGFR (all at baseline measurements) influenced significantly. CONCLUSIONS: In our group of elderly patients, impairment of renal function is slow, particularly in CKD-5 patients. Albuminuria and PTH at baseline levels are prognostic factors in the evolution of renal function.

Supervivencia de pacientes de edad avanzada (≥ 70 años) con enfermedad crónica estadios 4-5: diálisis vs tratamiento conservador / Survival of patients ≥ 70 years with advanced chronic kidney disease: Dialysis vs. conservative care

Introducción: Los pacientes de edad avanzada que llegan a enfermedad renal crónica avanzada (ERCA) se han incrementado en los últimos años. No hay evidencia de la mejor actitud terapéutica en estos pacientes. Objetivos: Observar la evolución de pacientes ancianos en consulta de ERCA (estadios 4 y 5) y comparar la supervivencia de los pacientes con ERC estadio 5 tratados con diálisis o no. Material y métodos: Se incluyó a todos los pacientes con ≥70 años que iniciaron seguimiento en consulta de ERCA desde el 1-1-2007 hasta el 31-12-2008 y se observó su evolución hasta el 31-12-2013. Se recogieron datos demográficos, índice de comorbilidad de Charlson, antecedentes de cardiopatía isquémica (CI) y diabetes mellitus (DM). Resultados: Se estudió a 314 pacientes con ERC estadios 4 y 5 con ≥70 años, 162 de los cuales estaban en el momento del inicio del seguimiento o a lo largo del mismo en estadio 5; 69 de estos pacientes recibieron tratamiento con diálisis. En el grupo estadio 5: mediana de edad de 77 años (74-81); 48% CI; 50% DM; Charlson 7 (6-9). Supervivencia Kaplan-Meier: ≥70 años (93 vs. 69 pacientes con diálisis) log rank: 15 (p<0,001), con ≥75 años (74 vs. 46 pacientes con diálisis; log rank: 8,9; p = 0,003), con ≥80 años (40 vs. 15 pacientes con diálisis) y p=0,2. Los pacientes que recibieron tratamiento con diálisis tenían menor edad e índice de Charlson y el tiempo de seguimiento en consulta era inferior. Conclusiones: En nuestro estudio el tratamiento con diálisis mejora la supervivencia, si bien esta ventaja se pierde en los pacientes con ≥80 años (AU)

Introduction: The number of elderly patients with advanced chronic kidney disease (ACKD) has increased in recent years, and the best therapeutic approach has not been determined due to a lack of evidence. Objectives: To observe the progression of elderly patients with ACKD (stages 4 and 5) and to compare the survival of stage 5 CKD patients with and without dialysis treatment. Material and methods: All patients ≥70 years who began ACKD follow-up from 01/01/2007 to 31/12/2008 were included, and their progression was observed until 31/12/2013. Demographic data, the Charlson comorbidity index, history of ischaemic heart disease (IHD) and diabetes mellitus (DM) were assessed. Results: A total of 314 patients ≥70 years with stages 4 and 5 CKD were studied. Of these patients, 162 patients had stage 5 CKD at the beginning of follow-up or progressed to stage 5 during the study, and 69 of these patients were treated with dialysis. In the stage 5 group: median age was 77 years (74-81); 48% had IHD; 50% had DM, Charlson 7 (6-9). Kaplan-Meier survival analysis: ≥70 years (93 vs. 69 patients with dialysis, log rank: 15P<.001); patients ≥75 years (74 vs. 46 patients with dialysis, log rank: 8.9 P=.003); patients ≥80 (40 vs. 15 patients with dialysis) and p=0,2. Patients receiving dialysis were younger, with a lower Charlson comorbidity index and shorter follow-up time. Conclusions: Our study shows that dialysis treatment improves survival, although this benefit is lost in patients ≥80 years (AU)

Survival of patients ≥70 years with advanced chronic kidney disease: Dialysis vs. conservative care. / Supervivencia de pacientes de edad avanzada (≥70 años) con enfermedad crónica estadios 4-5: diálisis vs tratamiento conservador.

INTRODUCTION: The number of elderly patients with advanced chronic kidney disease (ACKD) has increased in recent years, and the best therapeutic approach has not been determined due to a lack of evidence. OBJECTIVES: To observe the progression of elderly patients with ACKD (stages 4 and 5) and to compare the survival of stage 5 CKD patients with and without dialysis treatment. MATERIAL AND METHODS: All patients ≥70 years who began ACKD follow-up from 01/01/2007 to 31/12/2008 were included, and their progression was observed until 31/12/2013. Demographic data, the Charlson comorbidity index, history of ischaemic heart disease (IHD) and diabetes mellitus (DM) were assessed. RESULTS: A total of 314 patients ≥70 years with stages 4 and 5 CKD were studied. Of these patients, 162 patients had stage 5 CKD at the beginning of follow-up or progressed to stage 5 during the study, and 69 of these patients were treated with dialysis. In the stage 5 group: median age was 77 years (74-81); 48% had IHD; 50% had DM, Charlson 7 (6-9). Kaplan-Meier survival analysis: ≥70 years (93 vs. 69 patients with dialysis, log rank: 15 P<.001); patients ≥75 years (74 vs. 46 patients with dialysis, log rank: 8.9 P=.003); patients ≥80 (40 vs. 15 patients with dialysis) and p=0,2. Patients receiving dialysis were younger, with a lower Charlson comorbidity index and shorter follow-up time. CONCLUSIONS: Our study shows that dialysis treatment improves survival, although this benefit is lost in patients ≥80 years.