COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment

Kidney International, Journal Year: 2022, Volume and Issue: 101(5), P. 883 - 894

Published: Feb. 14, 2022

Language: Английский

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COVID-19 in kidney transplant recipients: what have we learned one year later? A cohort study from a tertiary center

Brazilian Journal of Nephrology, Journal Year: 2022, Volume and Issue: 44(4), P. 533 - 542

Published: July 4, 2022

Kidney transplant (KT) recipients have a high risk for adverse outcomes from infections, such as COVID-19.We retrospectively reviewed all KT with documented COVID-19 between March 1, 2020, and 15, 2021, analyzed patients' characteristics, clinical course, treatment, outcomes.We identified 123 patients, 72% were male, mean age of 54.5±13.0 years. Twenty percent asymptomatic, 7% had nosocomial transmission, 36% the remainder required hospitalization. Almost admitted patients received oxygen, 30% invasive mechanical ventilation (IMV), more than half acute kidney injury, 10% requiring dialysis, 20% died. Incidence was comparable to that Portuguese population, but mortality rate almost four times higher (SMR 3.768 (95% CI:1.723-7.154). Higher body mass index (OR 1.275, P=0.001), lower baseline graft function 0.968, P=0.015), transmission 13.836, P=0.019) associated oxygen demand, whereas female gender 3.801, P=0.031) 0.955, P=0.005), not index, IMV and/or death.Mortality in general population most consistent marker outcomes.

Language: Английский

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The urgent need to vaccinate dialysis patients against severe acute respiratory syndrome coronavirus 2: a call to action

Kidney International, Journal Year: 2021, Volume and Issue: 99(4), P. 791 - 793

Published: Feb. 15, 2021

The coronavirus disease 2019 (COVID-19) pandemic is causing extreme stress to many health systems and an ever-mounting death toll. Out of the darkness last 14 months comes a beacon hope in form multiple severe acute respiratory syndrome 2 (SARS-CoV-2) vaccines. To best utilize this precious resource, we must efficiently deploy vaccination high-risk groups. Providing equitable access vaccines requires considerations, including quantification risk serious according age comorbidities, safety efficacy vaccines, operational considerations relating vaccine availability administration. This editorial aims highlight both catastrophic risks infection with SARS-CoV-2 subsequent from COVID-19 dialysis patients current failure recognize these when considering priorities for vaccination. "Call Action" policy makers worldwide ensure prioritized designation their countries. People receiving treatment end-stage kidney have specific circumstances that lead increased infection. Most receive in-center hemodialysis (ICHD), which necessitates traveling center 3 times week, attending at least 4 hours, generally surrounded by numerous other as well staff. Therefore, cannot self-isolate. As example, ICHD Flanders, France, New York, USA, were 5 16 more likely be diagnosed compared general population.1De Meester J. De Bacquer D. Naesens M. et al.Incidence, characteristics, outcome adults on replacement therapy: regionwide registry study.J Am Soc Nephrol. 2021; 32: 385-396Crossref PubMed Scopus (107) Google Scholar,S1–S3 Reports England, Belgium, Italy, United States during 4- 15-week interval first surge showed 5% 20% infected short period.1De Scholar,2Alberici F. Delbarba E. Manenti C. al.A report Brescia Renal COVID Task Force clinical characteristics short-term infection.Kidney Int. 2020; 98: 20-26Abstract Full Text PDF (191) Scholar,S1,S3–S6 Asymptomatic limitations testing suggest population was even larger, serologic studies London, UK, York units revealing 28% 36% seroprevalence rate, increasing 70% unit serving rehabilitation center.S7,S8 Similar data been reported low- middle-income Longer-term large network India revealed 9% tested positive between March December 2020, rate 20 higher than population. Moreover, being especially susceptible because they self-isolate, people who develop are 30% 130% die (after adjusting age) hospitalized but no chronic disease,1De Scholar,S3,S9–S11 case fatality rates varying 16% 32%.1De Scholar,3Ng J.H. Hirsch J.S. Wanchoo R. al.Outcomes COVID-19.Kidney 1530-1539Abstract (202) Scholar,4Jager K.J. Kramer A. Chesnaye N.C. al.Results ERA-EDTA Registry indicate high mortality due transplant recipients across Europe.Kidney 1540-1548Abstract (351) Scholar,S1,S2,S4,S11–S13 once may impaired immune function prevalence well-established factors COVID-19, hypertension, obesity, diabetes, heart disease.3Ng Scholar,S1,S2,S4,S11,S12,S14 In addition, Black, Asian, minority ethnic groups individuals low socioeconomic status, burden where reported. incidence resulted widespread death, 1 33 Kingdom dying wave.5Savino Casula Santhakumaran S. al.Sociodemographic features haemodialysis test SARS-CoV-2: UK analysis.PLoS One. 15e0241263Crossref (35) Scholar Population-based analysis shows age-matched relative patient ranges 432 20- 39-year-old around 10 aged >80 years.5Savino date, therefore, there clear evidence nonelderly experienced exceptionally rates, most cases equaling or exceeding observed elderly regions (i.e., those years), (properly) given priority There common misconception very thus will automatically qualify immediate fact, average younger (mean age, 65–70 years) classic group ≥85 years, potential gains life years saved vaccine. countries, placed equal groups, such disease, diabetes smokers, represent proportion population.S15 Immunizing enormous take time. We argue should prioritized, much greater acquiring aforementioned and, infected, substantially greater.S16 also underrecognized indirect effects patients. constant threat contracting SARS-CoV-2, particularly session, has led fear anxiety dialysis.S17 For reason, skip sessions, absence disease. system strain complexities isolating SARS-CoV-2–positive surges forced some decrease number weekly sessions 2, further impacting care.S18 nihilism within medical community regarding scarce effectiveness Remarkably, included any trials globally. obvious "renalism" not allowed translate into efforts. Limited all surviving polymerase chain reaction–confirmed had IgG detectable post infection, suggesting seroconversion occur.S19 Vaccinations against hepatitis B, influenza, pneumococcal routinely recommended maintenance hemodialysis.S20 Seroconversion 33% 80% influenza vaccine, older less seroconvert.S20 Some people, patients, require larger doses effectively seroconvert, monitored adapted immunization protocols required. urgent need initiate detailed among (and functioning transplant). Dialysis care utilizers, allowing efficient communication hesitancy. Frequent attendance eases barriers delivery administration, can provided routine sessions. opportunity mass provides unprecedented efficiency, attendees could administered dose days. would, turn, protect families exposure SARS-CoV-2. Administrators use evidence-based prioritization rather "one size fits all" approach highest risk. (Table 1), vaccinating impact through reducing infections, mortality, system. Particular required resource-constrained countries.S21Table 1Urgent reasons prioritize patientsReasonRisk estimatesHigh-risk groupsIncreased infection5–20 5%–20% symptomatic 28%–36% waveS1,S3–S6In-center Diabetes Obesity Lack private transportationS3,S8Increased COVID-1916%–32% fatalityS1,S2,S4,S11–S13 50% ICUS10 1.3–2.3 CKDHypertension Older Heart diseaseS9,S12High translates high(est) deathRelative population5Savino Scholar: 20–39 yr: 40–59 94 60–79 ∼10CKD, disease; 2019; ICU, intensive unit; 2. Open table new tab CKD, profound psychosocial related pandemicS17 anxiously await International Society Nephrology urgently calls life-saving National regional stakeholders advocate assist implementation program vulnerable: dialysis. All authors declared competing interests. gratefully acknowledge assistance Drs. Alan Salama, Katie Vinen, Aakash Shingada creation article visual abstract. Download .pdf (.19 MB) Help pdf files Supplementary File (PDF) Outcomes COVID-19Kidney InternationalVol. 98Issue 6PreviewGiven infection-related (ESKD) COVID-19. assess this, outcomes without ESKD, retrospective study admitted 13 hospitals 1, April 27, followed May 2020. measured primary (in-hospital death), secondary (mechanical ventilation length stay). Full-Text Results EuropeKidney 6PreviewThe aim investigate 28-day after diagnosis European therapy determined role factors, country Europe February 30, Additional collected 7 countries encompassing 4298 AccessA infectionKidney 1PreviewThe epidemic pressuring healthcare worldwide. Disease certain subgroups still scarce, needed. describe here experience four centers Force. During overall 643 RNA positivity detected (15%). At diagnosis, 37 (39%) (group 1) managed outpatient basis, whereas remaining 57 (61%) 2) hospitalization. Immune response therapyKidney 99Issue 6PreviewIn issue Kidney International, initial immunogenicity prior summarized. Preliminary durability Although infection-naïve healthy second significant portion robust antibody titers, show less-strong response. Neutralizing BNT162b2 mRNA vaccine: war far wonKidney 6PreviewOn 21, Commission granted conditional marketing approval developed BioNTech.1,2 population, produce rapid 52% preventing similar protection induced natural disease.2,3 great would fragile individuals, societies nephrology asked vaccinated. Answering call action: programKidney 5PreviewThe devastatingly (up 32%, respectively) (ICHD).1 arrival awaited. Large 62% 95%.2,3 Data suggested benefit despite attenuated responses.4 Given devastating toll (COVID-19), community's action,1 advocated provision ICHD.

Language: Английский

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Predictors and Dynamics of the Humoral and Cellular Immune Response to SARS-CoV-2 mRNA Vaccines in Hemodialysis Patients: A Multicenter Observational Study

Journal of the American Society of Nephrology, Journal Year: 2021, Volume and Issue: 32(12), P. 3208 - 3220

Published: Sept. 29, 2021

Preliminary evidence suggests patients on hemodialysis have a blunted early serological response to SARS-CoV-2 vaccination. Optimizing the vaccination strategy in this population requires thorough understanding of predictors and dynamics humoral cellular immune responses different vaccines.This prospective multicenter study 543 75 healthy volunteers evaluated at 4 or 5 weeks 8 9 after administration BNT162b2 mRNA-1273 vaccine, respectively. We assessed anti-SARS-CoV-2 spike antibodies T cell by IFN-γ secretion peripheral blood lymphocytes upon glycoprotein stimulation (QuantiFERON assay) potential responses.Compared with volunteers, had an incomplete, delayed response. Geometric mean antibody titers both time points were significantly greater vaccinated versus BNT162b2, larger proportion them achieved threshold 4160 AU/ml, corresponding high neutralizing vitro (53.6% 31.8% weeks, P <0.0001). Patients exhibited median QuantiFERON points, 0.15 IU/ml (64.4% 46.9% Multivariate analysis identified COVID-19 experience, vaccine type, use immunosuppressive drugs, serum albumin, lymphocyte count, hepatitis B nonresponder status, dialysis vintage as independent responses.The vaccine's immunogenicity may be related its higher mRNA dose. This high-dose might improve impaired hemodialysis.

Language: Английский

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COVID-19-related mortality in kidney transplant and haemodialysis patients: a comparative, prospective registry-based study

Nephrology Dialysis Transplantation, Journal Year: 2021, Volume and Issue: 36(11), P. 2094 - 2105

Published: June 15, 2021

Coronavirus disease 2019 (COVID-19) has exposed haemodialysis (HD) patients and kidney transplant (KT) recipients to an unprecedented life-threatening infectious disease, raising concerns about replacement therapy (KRT) strategy during the pandemic. This study investigated association of type KRT with COVID-19 severity, adjusting for differences in individual characteristics.

Language: Английский

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COVID-19 and kidney disease: insights from epidemiology to inform clinical practice

Nature Reviews Nephrology, Journal Year: 2022, Volume and Issue: 18(8), P. 485 - 498

Published: April 13, 2022

Language: Английский

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Efficacy of the BNT162b2 mRNA COVID-19 vaccine in a haemodialysis cohort

Nephrology Dialysis Transplantation, Journal Year: 2021, Volume and Issue: 36(9), P. 1756 - 1757

Published: April 23, 2021

Nephrologists call for priority access to coronavirus disease 2019 vaccination in patients receiving in-centre haemodialysis [1] two main reasons: a very high risk of severe acute respiratory syndrome 2 (SARS-CoV-2) infection compared with the general population (5-16 times more likely [2] because they travel their dialysis centre three week and are surrounded by other caregivers) also particular mortality rate (close 20%) when infected SARS-CoV-2 [3].Our team is taking care 470 Marseille its surroundings, region severely affected COVID-19.As soon as was prioritized our patients, we proceeded large-scale campaign 18 January 2021, first injections were administered.Nevertheless, major downside vaccine hyporesponsiveness among such immune-compromised who often show disappointing seroconversion rates (e.g. 44% following double-dose schedule hepatitis B [4]).In this context given lack data on COVID-19 dialysis, decided evaluate response serology testing order optimize future management.

Language: Английский

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Vaccination and COVID-19 Dynamics in Dialysis Patients

Clinical Journal of the American Society of Nephrology, Journal Year: 2022, Volume and Issue: 17(3), P. 395 - 402

Published: Feb. 10, 2022

Dialysis patients have a high mortality risk after coronavirus disease 2019 (COVID-19) and an altered immunologic response to vaccines, but vaccine clinical effectiveness remains unknown in this population.Using Bayesian multivariable spatiotemporal models, we estimated the association between exposure severe acute respiratory syndrome 2 (SARS-CoV-2) infections (with hospital admission) dialysis from simultaneous incidence general population. For patients, cases were reported within French end-stage kidney REIN registry March 11, 2020, April 29, 2021, (first dose) was weekly national surveys since January 2021. Cases population obtained exhaustive inpatient surveillance system (SI-VIC database), vaccination coverage (VAC-SI database).During first wave, approximately proportional However, showed lower relative for during second wave (compared with that observed nondialysis patients), suggesting effect of prevention measures. Moreover, beginning rollout, compared predictions based on waves. Adding coverages as predictors allowed be fit correctly (3685 predicted cases, 95% confidence interval, 3552 3816, versus 3620 reported). Incidence rate ratios 0.37 (95% 0.18 0.71) 0.50 0.40 0.61) per 10% higher same-age population, meaning independently associated hospitalization patients.Our findings suggest may yield protective against forms COVID-19 despite responses.

Language: Английский

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Kidney transplantation and COVID-19 renal and patient prognosis

Clinical Kidney Journal, Journal Year: 2021, Volume and Issue: 14(Supplement_1), P. i21 - i29

Published: Feb. 3, 2021

Coronavirus disease 2019 (COVD-19) emerged as a pandemic in December 2019. Infection has spread quickly and renal transplant recipients receiving chronic immunosuppression have been considered population at high risk of infection, complications infection-related death. During this year large amount information from nationwide registries, multicentre single-centre studies reported. The number patients diagnosed with COVID-19 was higher than the general population, but lower threshold for testing may contributed to its better identification. Major such acute kidney injury respiratory distress syndrome were very frequent patients, comorbidity burden, further are needed support that organ more prone develop these population. Kidney experience mortality rate compared especially during early post-transplant period. Despite fact some report favourable outcomes on waiting list, described period would advise against performing areas where infection is high, >60 years age. Management challenging clinicians strategies less use lymphocyte-depleting agents new transplants or anti-metabolite withdrawal calcineurin inhibitor reduction not based high-quality evidence.

Language: Английский

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The COVID-19 Pandemic Identifies Significant Global Inequities in Hemodialysis Care in Low and Lower-Middle Income Countries—An ISN/DOPPS Survey

Kidney International Reports, Journal Year: 2022, Volume and Issue: 7(5), P. 971 - 982

Published: March 11, 2022

It is unknown how the COVID-19 pandemic has affected care of vulnerable chronic hemodialysis (HD) patients across regions, particularly in low and lower-middle income countries (LLMICs). We aimed to identify global inequities HD delivery during pandemic.

Language: Английский

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