Safety of ChAdOx1 nCoV-19 vaccination in patients with end-stage renal disease on hemodialysis.

BACKGROUND: COVID-19 vaccination is essential. However, no study has reported adverse events (AEs) after ChAdOx1 nCoV-19 vaccination in patients with end-stage renal disease (ESRD) on hemodialysis (HD). This study investigated the AEs within 30-days after the first dose of ChAdOx1 nCoV19 (Oxford-AstraZeneca) in ESRD patients on HD. METHODS AND FINDINGS: A total of 270 ESRD patients on HD were enrolled in this study. To determine the significance of vascular access thrombosis (VAT) post vaccination, we performed a self-controlled case study (SCCS) analysis. Of these patients, 38.5% had local AEs; local pain (29.6%), tenderness (28.9%), and induration (15.6%) were the most common. Further, 62.2% had systemic AEs; fatigue (41.1%), feverishness (20%), and lethargy (19.9%) were the most common. In addition, post-vaccination thirst affected 18.9% of the participants with female predominance. Younger age, female sex, and diabetes mellitus were risk factors for AEs. Five patients had severe AEs, including fever (n = 1), herpes zoster (HZ) reactivation (n = 1), and acute VAT (n = 3). However, the SCCS analysis revealed no association between vaccination and VAT; the incidence rate ratio (IRR)-person ratio was 0.56 (95% CI 0.13-2.33) and 0.78 (95% CI 0.20-2.93) [IRR-event ratio 0.78 (95% CI 0.15-4.10) and 1.00 (95% CI 0.20-4.93)] in the 0-3 months and 3-6 months period prior to vaccination, respectively. CONCLUSIONS: Though some ESRD patients on HD had local and systemic AEs after first-dose vaccination, the clinical significance of these symptoms was minor. Our study confirmed the safety profile of ChAdOx1 nCoV-19 in HD patients and presented a new viewpoint on vaccine-related AEs. The SCCS analysis did not find an elevated risk of VAT at 1 month following vaccination. Apart from VAT, other vaccine-related AEs, irrespective of local or systemic symptoms, had minor clinical significance on safety issues. Nonetheless, further coordinated, multi-center, or registry-based studies are needed to establish the causality.

Effect of buttonhole cannulation versus rope-ladder cannulation in hemodialysis patients with vascular access: A systematic review and meta-analysis of randomized/clinical controlled trials.

BACKGROUND: Safe and effective arteriovenous fistula (AVF) puncture techniques must be used to reduce harm to hemodialysis patients. The relative benefits of buttonhole (BH) cannulation over those of rope ladder (RL) cannulation for AVF remain unclear and inconsistent. METHODS: This systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Literature searches were conducted in June 2020 in multiple scientific databases including Cochrane library, CINAHL, PubMed/ Medline, Airiti Library, National Digital Library of Theses and Dissertations in Taiwan, Google scholar, Embase, and ProQuest. We included all randomized controlled trials (RCTs) and clinical controlled trials (CCTs) that explored the efficacy of BH cannulation in hemodialysis patients. These included reports published in either English or Chinese that enrolled adults aged 18 years or older who underwent hemodialysis using an autogenous AVF. Studies that showed poor design, such as use of a self-control group or no control group, were excluded from analysis. The critical appraisal skills program checklist for RCTs were used to assess the quality of the evidence and RevMan software were used to perform the meta-analysis. RESULTS: Fifteen studies (11 RCTs and 4 CCTs) met the inclusion criteria and were used for the meta-analysis. Meta-analysis showed that BH cannulation significantly reduced aneurysm formation (RR = 0.18, 95% confidence interval [CI] [0.1, 0.32]), stenosis (RR = 0.44, 95% CI [0.25, 0.77]), thrombosis formation (RR = 0.4, 95% CI [0.2, 0.8]), and hematoma (RR = 0.63, 95% CI [0.40, 0.99]) and showed no differences in AVR infection (≦6 months, RR = 2.17, 95% CI [0.76, 6.23]; >6 months, RR = 2.7, 95% CI [0.92, 7.92]) compared to RL cannulation. CONCLUSIONS: Given the benefits of BH, this meta-analysis found that BH cannulation should be recommended as a routine procedure for hemodialysis but that hospitals and hemodialysis clinics should strengthen staff knowledge and skills of BH cannulation to reduce the risk of AVF infection.