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Mahallawi WH. COVID-19 vaccine in hemodialysis patients: Time for a boost. Saudi Med J 2023; 44:882-888. [PMID: 37717958 PMCID: PMC10505293 DOI: 10.15537/smj.2023.44.9.20230285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/01/2023] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVES To evaluate anti-spike immunoglobulin G (IgG) antibody levels of hemodialysis patients and correlate them with the patients' demographic data and to evaluate these patients' need for a coronavirus disease-19 (COVID-19) vaccine booster. METHODS A cross-sectional multi-center study carried out at King Abdulaziz Kidney Center, Hasan Tahir Hemodialysis Center, and Hayat Organization Hemodialysis Center in Al-Madinah Al-Munawarah, Saudi Arabia. Patients (n=167) who received a minimum single dose of COVID-19 vaccine were recruited. The samples were collected between March 2022 and January 2023. Anti-spike IgG antibody levels were measured using enzyme-linked immunosorbent assays. RESULTS A significantly higher proportion of patients who received 3 doses of COVID-19 vaccine had positive serostatus compared with patients who received one or 2 doses (3 doses: 87.2%, one dose: 0.0%, 2 doses: 77.3%; p=0.000). Compared with patients who received one dose, significantly higher IgG antibody levels were detected in patients who received 2 (p=0.013) and 3 doses (p=0.025; n=35). In contrast, there was no significant difference in IgG antibody levels between patients who received 2 or 3 doses (p=0.45). Significant IgG antibody levels were detected in patients who received 2 and 3 doses (p=0.0125) compared with those received one vaccine dose (p=0.0004). Furthermore, patients who received 3 doses had significantly higher IgG antibody levels than patients who received 2 doses (p=0.000). CONCLUSION The results show a dose-dependent association between IgG antibody levels and the number COVID-19 vaccines received. The study highlights the need for booster COVID-19 vaccination for patients on hemodialysis.
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Affiliation(s)
- Waleed H. Mahallawi
- From the Department of Medical Laboratory Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia
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El Karoui K, De Vriese AS. COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment. Kidney Int 2022; 101:883-894. [PMID: 35176326 PMCID: PMC8842412 DOI: 10.1016/j.kint.2022.01.022] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/01/2022] [Accepted: 01/20/2022] [Indexed: 01/07/2023]
Abstract
The COVID-19 pandemic has profound adverse effects on the population on dialysis. Patients requiring dialysis are at an increased risk of SARS-CoV-2 infection and mortality, and many have experienced psychological distress as well as delayed or suboptimal care. COVID-19 survivors have prolonged viral shedding, but generally develop a robust and long-lasting humoral immune response that correlates with initial disease severity. However, protection against reinfection is incomplete. A growing body of evidence reveals delayed and blunted immune responses to SARS-CoV-2 vaccination. Administration of a third dose within 1 to 2 months of prime-boost vaccination significantly increases antibody levels, in particular in patients with poor initial responses. Patients on dialysis have inferior immune responses to adenoviral vector vaccines than to mRNA vaccines. The immunogenicity of the mRNA-1273 vaccine is markedly better than that of the BNT162b2 vaccine, most likely by virtue of its higher mRNA content. Despite suboptimal immune responses in patients on dialysis, preliminary data suggest that vaccination partially protects against infection and severe disease requiring hospitalization. However, progressive waning of immunity and emergence of SARS-CoV-2 variants with a high potential of immune escape call for a booster dose in all patients on dialysis 4 to 6 months after prime-boost vaccination. Patients with persistent poor vaccine responses may be candidates for primary prophylaxis strategies. In the absence of specific data in patients on dialysis, therapeutic strategies in the event of established COVID-19 must be extrapolated from evidence obtained in the population not on dialysis. Neutralizing monoclonal antibodies may be an attractive option after a high-risk exposure or during the early course of infection.
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Affiliation(s)
- Khalil El Karoui
- Department of Nephrology and Transplantation, Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire TRUE, Université Paris Est, Créteil, France
| | - An S De Vriese
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium.
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Chawki S, Buchard A, Sakhi H, Dardim K, El Sakhawi K, Chawki M, Boulanger H, Kofman T, Dahmane D, Rieu P, Attaf D, Ahriz-Saksi S, Masoumi A, Diddaoui AZ, Fromentin L, Michaut P, Nebbad R, Desassis JF, Nicolet L, Sohier-Attias J, Besson F, Boula R, Hafi A, Ghazali A, Lamriben L, Arezki A, Dupuis E, Rifard MK, Joly D, Attias P, El Karoui K. Long-term impact of COVID-19 among maintenance haemodialysis patients. Clin Kidney J 2022; 15:262-268. [PMID: 35140935 PMCID: PMC8522382 DOI: 10.1093/ckj/sfab166] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/03/2021] [Indexed: 12/14/2022] Open
Abstract
Background Maintenance haemodialysis (MHD) patients have a high risk of initial mortality from coronavirus disease 2019 (COVID-19). However, long-term consequences of this disease in the MHD population are poorly described. We report the clinical presentation, outcome and long-term follow-up of MHD patients affected by COVID-19 in a multicentric cohort from the Paris, France area. Methods We conducted a retrospective analysis of clinical presentation and long-term follow-up of MHD patients affected by COVID-19 in 19 MHD centres in the Paris, France area. Results In this cohort of 248 patients with an initial mortality rate of 18%, age, comorbidities, dyspnoea and previous immunosuppressive treatment were associated with death at <30 days. Among the 203 surviving patients following the acute phase, long-term follow-up (median 180 days) was available for 189 (93%) patients. Major adverse events occurred in 30 (16%) patients during follow-up, including 12 deaths (6%) after a median of 78 days from onset of symptoms. Overall, cardiovascular events, infections and gastrointestinal bleeding were the main major adverse events. Post-COVID-19 cachexia was observed in 25/189 (13%) patients. Lower initial albuminaemia was significantly associated with this cachexia. No reinfection with severe acute respiratory syndrome coronavirus 2 was observed. Conclusions This work demonstrates the long-term consequences of COVID-19 in MHD patients, highlighting both initial and long-term severity of the disease, including severe cachexia.
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Affiliation(s)
- Sylvain Chawki
- Institut National de la Santé et de la Recherche Médicale Unité U944, Université de Paris, Paris, France
| | | | - Hamza Sakhi
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Créteil, France.,Université Paris-Est Créteil, Institut National de la Santé et de la Recherche MédicaleU955, Institut Mondor de Recherche Biomédicale, Créteil, France
| | | | - Karim El Sakhawi
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Créteil, France
| | - Mokhtar Chawki
- Department of Nephrology and Dialysis, Clinique Claude Bernard, Ermont, France
| | - Henri Boulanger
- Department of Nephrology and Dialysis, Clinique de l'Estrée, Stains, France
| | | | - Djamal Dahmane
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Créteil, France.,Université Paris-Est Créteil, Institut National de la Santé et de la Recherche MédicaleU955, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Philippe Rieu
- Departement of Nephrology and Dialysis, Hôpital Privé Nord Parisien, Sarcelles, France
| | | | - Salima Ahriz-Saksi
- Department of Nephrology and Dialysis, Clinique de l'Estrée, Stains, France
| | | | | | - Luc Fromentin
- Department of Nephrology and Dialysis, Clinique Claude Bernard, Ermont, France
| | - Patrick Michaut
- Department of Nephrology and Dialysis, Clinique Internationale du Parc Monceaux, Paris, France
| | | | | | - Laurence Nicolet
- Department of Nephrology and Dialysis, Centre Edouard Rist, Paris, France
| | | | - Frederic Besson
- Department of Dialysis, Clinique Lambert, La Garenne-Colombes, France
| | - Remy Boula
- Department of Dialysis, Clinique Lambert, La Garenne-Colombes, France
| | - Ali Hafi
- Department of Dialysis, Clinique Lambert, La Garenne-Colombes, France
| | | | - Larbi Lamriben
- Department of Dialysis, Clinique les Martinets, Rueil Malmaison, France
| | - Adem Arezki
- Department of Dialysis, Clinique les Martinets, Rueil Malmaison, France
| | - Emmanuel Dupuis
- Department of Nephrology and Dialysis, American Hospital of Paris, Neuilly-sur-Seine, France
| | - Mohamad-Khair Rifard
- Department of Nephrology and Dialysis, Centre Hospitalier des Quatre Villes, Saint Cloud, France
| | - Dominique Joly
- Department of Adult Nephrology, Assistance Publique des Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Philippe Attias
- Departement of Nephrology and Dialysis, Hôpital Privé Nord Parisien, Sarcelles, France
| | - Khalil El Karoui
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Créteil, France.,Université Paris-Est Créteil, Institut National de la Santé et de la Recherche MédicaleU955, Institut Mondor de Recherche Biomédicale, Créteil, France
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Kolesnyk M, Stepanova N. Post-COVID syndrome in dialysis patients and kidney transplant recipients. UKRAINIAN JOURNAL OF NEPHROLOGY AND DIALYSIS 2022:90-98. [DOI: 10.31450/ukrjnd.1(73).2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Abstract. Patients on maintenance dialysis treatment and kidney transplant recipients who survive coronavirus disease 2019 (COVID-19) are at higher risk of post-COVID syndrome compared to the general population. However, a detailed assessment of the causes, features, and clinical outcomes of the post-COVID syndrome in this patients’ cohort does not yet been established. In this review, we summarize published research on this issue to use these available data to predict the development, treatment and prevention of the post-COVID syndrome in dialysis patients and kidney transplant recipients.
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SARS-CoV-2 Antibodies in Hemodialysis Patients Six Months after Infection Compared to Healthcare Workers. Int J Nephrol 2021; 2021:4747221. [PMID: 34868683 PMCID: PMC8633850 DOI: 10.1155/2021/4747221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background The humoral response to SARS-CoV-2 infection in hemodialysis patients needs to be clarified. Methods In this retrospective study performed in two dialysis facilities, we measured the circulating levels of SARS-CoV-2 antibodies in patients who were on maintenance hemodialysis during the first wave of the epidemic in March and April 2020 and were still alive 6 months later. We also investigated associations between the patients diagnosed as infected during the first wave and several clinical, biological, and radiological parameters of COVID-19. Finally, we compared these circulating levels of SARS-CoV-2 antibodies with those of a control group of healthcare workers infected during the same period. Results Of the 299 hemodialysis patients who recovered from the first wave of the epidemic 6 months before, 59 had a positive SARS-CoV-2 antibody whereas only 45 patients were diagnosed as infected during the first wave of the epidemic. All infected hemodialysis patients developed circulating antibodies. Using a clustering method, a significant correlation was identified between the cluster with the lowest circulating levels of SARS-CoV-2 antibodies and the severity of COVID-19 based on several parameters including CRP, BNP, lymphocyte count, neutrophil-lymphocyte ratio, and oxygen requirements, as well as pulmonary involvement on chest scan. Moreover, the circulating levels of the SARS-CoV-2 antibodies in surviving hemodialysis patients (n = 59) were similar to those of the control group (n = 17). Conclusion The main finding of this study is that all of the surviving hemodialysis patients who were diagnosed with SARS-CoV-2 infection from March to April 2020 developed a persistent humoral response with significant circulating levels of SARS-CoV-2 antibodies, 6 months later. Another important finding is that surviving hemodialysis patients who had more severe disease had lower circulating levels of SARS-CoV-2 antibodies. Finally, circulating levels of SARS-CoV-2 antibodies were similar in surviving hemodialysis patients and healthcare workers without kidney disease.
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Branco CG, Duarte I, Gameiro J, Costa C, Marques F, Oliveira J, Bernardo J, Fonseca JN, Carreiro C, Braz S, Lopes JA. Presentation and outcomes of chronic kidney disease patients with COVID-19. J Bras Nefrol 2021; 44:321-328. [PMID: 34762092 PMCID: PMC9518619 DOI: 10.1590/2175-8239-jbn-2021-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/22/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: COVID-19 is currently a global health issue and an important cause of mortality. Chronic kidney disease (CKD) is one of the risk factors for infection, morbidity and mortality by SARS-CoV-2. In our study, we aimed to evaluate the clinical presentation and outcomes of CKD patients with COVID-19, as well as identify predictors of mortality. Methods: This was a retrospective study of CKD patients admitted in a tertiary-care Portuguese hospital between March and August of 2020. Variables were submitted to univariate and multivariate analysis to determine factors predictive of in-hospital mortality. Results: 130 CKD patients were analyzed (median age 73.9 years, male 60.0%). Hypertension (81.5%), cardiovascular disease (36.2%), and diabetes (54.6%) were frequent conditions. Cough, dyspnea, fever and respiratory failure were also common. Almost 60% had anemia, 50% hypoalbuminemia, 13.8% hyperlactacidemia and 17% acidemia. Mean serum ferritin was 1531 µg/L, mean CRP 8.3 mg/dL and mean LDH 336.9 U/L. Most patients were treated with lopinavir/ritonavir, hydroxychloroquine or corticosteroids and only 2 with remdesivir. Eighty percent had acute kidney injury and 16.2% required intensive care unit admission. The 34 patients who died were older and more likely to have heart failure. They had higher neutrophils/lymphocytes ratio, ferritin, lactate, and LDH levels. Multivariate analysis identified an association between older age [OR 1.1 (CI 1.01-1.24), p=0.027], higher ferritin [OR 1.0 (CI 1.00-1.00), p=0.009] and higher LDH levels [OR 1.0 (CI 1.00-1.01), p=0.014] and mortality. Conclusion: In our cohort of CKD patients with COVID-19, older age, higher ferritin, and higher LDH levels were independent risk factors for mortality.
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Affiliation(s)
- Carolina Gonçalves Branco
- Centro Hospitalar Universitário Lisboa Norte, Departamento de Medicina, Divisão de Nefrologia e Transplante Renal, Lisboa, Portugal
| | - Inês Duarte
- Centro Hospitalar Universitário Lisboa Norte, Departamento de Medicina, Divisão de Nefrologia e Transplante Renal, Lisboa, Portugal
| | - Joana Gameiro
- Centro Hospitalar Universitário Lisboa Norte, Departamento de Medicina, Divisão de Nefrologia e Transplante Renal, Lisboa, Portugal
| | - Cláudia Costa
- Centro Hospitalar Universitário Lisboa Norte, Departamento de Medicina, Divisão de Nefrologia e Transplante Renal, Lisboa, Portugal
| | - Filipe Marques
- Centro Hospitalar Universitário Lisboa Norte, Departamento de Medicina, Divisão de Nefrologia e Transplante Renal, Lisboa, Portugal
| | - João Oliveira
- Centro Hospitalar Universitário Lisboa Norte, Departamento de Medicina, Divisão de Nefrologia e Transplante Renal, Lisboa, Portugal
| | - João Bernardo
- Centro Hospitalar Universitário Lisboa Norte, Departamento de Medicina, Divisão de Nefrologia e Transplante Renal, Lisboa, Portugal
| | - José Nuno Fonseca
- Centro Hospitalar Universitário Lisboa Norte, Departamento de Medicina, Divisão de Nefrologia e Transplante Renal, Lisboa, Portugal
| | - Carolina Carreiro
- Centro Hospitalar Universitário Lisboa Norte, Departamento de Medicina, Divisão de Medicina Interna 2, Lisboa, Portugal
| | - Sandra Braz
- Centro Hospitalar Universitário Lisboa Norte, Departamento de Medicina, Divisão de Medicina Interna 2, Lisboa, Portugal
| | - José António Lopes
- Centro Hospitalar Universitário Lisboa Norte, Departamento de Medicina, Divisão de Nefrologia e Transplante Renal, Lisboa, Portugal
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Alfano G, Ferrari A, Magistroni R, Fontana F, Cappelli G, Basile C. The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review. J Nephrol 2021; 34:1387-1403. [PMID: 34417996 PMCID: PMC8379591 DOI: 10.1007/s40620-021-01136-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients undergoing in-centre haemodialysis (HD) are particularly exposed to the dire consequences of COVID-19. The present systematic scoping review aims to identify the extent, range, and nature of articles related to COVID-19 and maintenance HD: it reports specifically the prevalence of the COVID-19 pandemic in the HD population, implementation of strategies for the prevention, mitigation and containment of the COVID-19 pandemic in HD centres, demographic and clinical characteristics, and outcomes of the pediatric and adult HD patients. METHODS A multi-step systematic search of the literature in Pubmed, Scopus, Ovid Medline, Embase and Web of Science, published between December 1, 2019, and January 30, 2021 was performed. Two authors separately screened the titles and abstracts of the documents and ruled out irrelevant articles. A report of the papers that met inclusion criteria was performed; then, a descriptive analysis of the characteristics of the included articles and a narrative synthesis of the results were performed. RESULTS The review process ended with the inclusion of 145 articles. Most of them were based on single-centre experiences, which spontaneously developed best practices. Most studies were conducted in high-income countries (69.7%) and a part of them (9.6%) were not in English. Prevalence of COVID-19 among dialysis patients accounted for 0%-37.6%. Preventive measures were reported in 54% of the included articles, with particular emphasis on education, triage, hygiene, and containment measures. Patients experienced a heterogeneous spectrum of symptoms that led 35%-88.2% of them to hospital admission. Median and mean hospital length of stay ranged from 8 to 28.5 and 16.2 to 22 days, respectively. Admission to intensive care units varied widely across studies (from 2.6% to 70.5%) and was associated with high mortality (42.8%-100%). Overall, prognosis was poor in 0%-47% of the hospitalized patients. CONCLUSIONS This systematic scoping review provides an overview of the current knowledge on the impact of COVID-19 on the frail world of HD patients. Furthermore, it may help to implement the existing strategies of COVID-19 prevention and provide a list of unmet needs (safe transport, testing, shelter). Finally, it may be a stimulus for performing systematic reviews and meta-analyses which will form the basis for evidence-based guidelines.
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Affiliation(s)
- Gaetano Alfano
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Annachiara Ferrari
- Nephrology and Dialysis Unit, AUSL Reggio Emilia-IRCCS S. Maria Nuova, Reggio Emilia, Italy
| | - Riccardo Magistroni
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Francesco Fontana
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Via Battisti 192, Acquaviva delle Fonti, 74121 Taranto, Italy
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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Thadhani R, Willetts J, Wang C, Larkin J, Zhang H, Fuentes LR, Usvyat L, Belmonte K, Wang Y, Kossmann R, Hymes J, Kotanko P, Maddux F. Transmission of SARS-CoV-2 considering shared chairs in outpatient dialysis: a real-world case-control study. BMC Nephrol 2021; 22:313. [PMID: 34530746 PMCID: PMC8444531 DOI: 10.1186/s12882-021-02518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND SARS-CoV-2 can remain transiently viable on surfaces. We examined if use of shared chairs in outpatient hemodialysis associates with a risk for indirect patient-to-patient transmission of SARS-CoV-2. METHODS We used data from adults treated at 2,600 hemodialysis facilities in United States between February 1st and June 8th, 2020. We performed a retrospective case-control study matching each SARS-CoV-2 positive patient (case) to a non-SARS-CoV-2 patient (control) treated in the same dialysis shift. Cases and controls were matched on age, sex, race, facility, shift date, and treatment count. For each case-control pair, we traced backward 14 days to assess possible prior exposure from a 'shedding' SARS-CoV-2 positive patient who sat in the same chair immediately before the case or control. Conditional logistic regression models tested whether chair exposure after a shedding SARS-CoV-2 positive patient conferred a higher risk of SARS-CoV-2 infection to the immediate subsequent patient. RESULTS Among 170,234 hemodialysis patients, 4,782 (2.8 %) tested positive for SARS-CoV-2 (mean age 64 years, 44 % female). Most facilities (68.5 %) had 0 to 1 positive SARS-CoV-2 patient. We matched 2,379 SARS-CoV-2 positive cases to 2,379 non-SARS-CoV-2 controls; 1.30 % (95 %CI 0.90 %, 1.87 %) of cases and 1.39 % (95 %CI 0.97 %, 1.97 %) of controls were exposed to a chair previously sat in by a shedding SARS-CoV-2 patient. Transmission risk among cases was not significantly different from controls (OR = 0.94; 95 %CI 0.57 to 1.54; p = 0.80). Results remained consistent in adjusted and sensitivity analyses. CONCLUSIONS The risk of indirect patient-to-patient transmission of SARS-CoV-2 infection from dialysis chairs appears to be low.
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Affiliation(s)
| | - Joanna Willetts
- Fresenius Medical Care, Global Medical Office, 920 Winter Street, Waltham, MA, USA
| | | | - John Larkin
- Fresenius Medical Care, Global Medical Office, 920 Winter Street, Waltham, MA, USA.
| | | | | | - Len Usvyat
- Fresenius Medical Care, Global Medical Office, 920 Winter Street, Waltham, MA, USA
| | | | - Yuedong Wang
- University of California-Santa Barbara, Santa Barbara, CA, USA
| | - Robert Kossmann
- Fresenius Medical Care North America, Medical Office, Waltham, MA, USA
| | - Jeffrey Hymes
- Fresenius Medical Care, Global Medical Office, 920 Winter Street, Waltham, MA, USA
| | - Peter Kotanko
- Renal Research Institute, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Franklin Maddux
- Fresenius Medical Care AG & Co. KGaA, Global Medical Office, Bad Homburg, Germany
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Mahapatra HS, Binoy R, Inamdar NA, D P K, Kumar A, Kaur N, Singh M, Kumari A, Krishna C, Balkrishna M, Pursnani L. Continuing arteriovenous fistula creation by nephrologist and its outcome during COVID pandemic-Analysis of 376 cases. Semin Dial 2021; 35:3-5. [PMID: 34498292 PMCID: PMC8661998 DOI: 10.1111/sdi.13010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/11/2021] [Accepted: 07/26/2021] [Indexed: 12/02/2022]
Abstract
There has been a significant reduction of elective surgeries including creation of arteriovenous fistulas (AVF) during the ongoing pandemic by the surgeons. Here, we report the retrospective observational data of AVF creation by nephrologists in a single center, during a period of 8 months. A total of 376 fistulae were created in 310 patients. Patients were followed up at 2, 6, and 12 weeks. Twenty‐eight patients required fistula creation twice, 16 patients thrice, and two patients underwent fistula creation four times. Of the total, 259 (68.8%) fistulae were radio‐cephalic while 99 (26.3%) and 18 (4.79%) were brachio‐cephalic and brachio‐basilic, respectively. A total of 207 (67%) patients were already on hemodialysis whereas 103 (33%) were planned for elective initiation after fistula maturation. Of the 211 (69%) patients who completed 3 months of follow‐up, 31 (15%) expired and 7 (3.3%) were lost to follow‐up. Primary failure was observed in 70 (33.2%) fistulae. Fifteen (7.1%) patients were noted to be COVID positive during the follow‐up. A total of 279 (90%) patients were alive at last follow‐up. Amongst 20 dialysis staffs with 10 nephrologists, only two have developed COVID. Both were having mild illness and recovered completely. This study demonstrates that AVF creation can be performed safely with careful screening and by using adequate personal protective equipment.
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Affiliation(s)
| | - Renju Binoy
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Neeraj Anant Inamdar
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Kushal D P
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Adarsh Kumar
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Navjot Kaur
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Mansi Singh
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Anamika Kumari
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Chandra Krishna
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Lalit Pursnani
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Speer C, Morath C, Töllner M, Buylaert M, Göth D, Nusshag C, Kälble F, Schaier M, Grenz J, Kreysing M, Reichel P, Hidmark A, Ponath G, Schnitzler P, Zeier M, Süsal C, Klein K, Benning L. Humoral Responses to Single-Dose BNT162b2 mRNA Vaccination in Dialysis Patients Previously Infected With SARS-CoV-2. Front Med (Lausanne) 2021; 8:721286. [PMID: 34485347 PMCID: PMC8415834 DOI: 10.3389/fmed.2021.721286] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/26/2021] [Indexed: 01/18/2023] Open
Abstract
Seroconversion rates following infection and vaccination are lower in dialysis patients compared to healthy controls. There is an urgent need for the characterization of humoral responses and success of a single-dose SARS-CoV-2 vaccination in previously infected dialysis patients. We performed a dual-center cohort study comparing three different groups: 25 unvaccinated hemodialysis patients after PCR-confirmed COVID-19 (Group 1), 43 hemodialysis patients after two-time BNT162b2 vaccination without prior SARS-CoV-2 infection (Group 2), and 13 single-dose vaccinated hemodialysis patients with prior SARS-CoV-2 infection (Group 3). Group 3 consists of seven patients from Group 1 and 6 additional patients with sera only available after single-dose vaccination. Anti-S1 IgG, neutralizing antibodies, and antibodies against various SARS-CoV-2 protein epitopes were measured 3 weeks after the first and 3 weeks after the second vaccination in patients without prior SARS-CoV-2 infection, 6 weeks after the onset of COVID-19 in unvaccinated patients, and 3 weeks after single-dose vaccination in patients with prior SARS-CoV-2 infection, respectively. Unvaccinated patients after COVID-19 showed a significantly higher neutralizing antibody capacity than two-time vaccinated patients without prior COVID-19 [median (IQR) percent inhibition 88.0 (71.5-95.5) vs. 50.7 (26.4-81.0); P = 0.018]. After one single vaccine dose, previously infected individuals generated 15- to 34-fold higher levels of anti-S1 IgG than age- and dialysis vintage-matched unvaccinated patients after infection or two-time vaccinated patients without prior SARS-CoV-2 infection with a median (IQR) index of 274 (151-791) compared to 18 (8-41) and 8 (1-21) (for both P < 0.001). With a median (IQR) percent inhibition of 97.6 (97.2-98.9), the neutralizing capacity of SARS-CoV-2 antibodies was significantly higher in single-dose vaccinated patients with prior SARS-CoV-2 infection compared to other groups (for both P < 0.01). Bead-based analysis showed high antibody reactivity against various SARS-CoV-2 spike protein epitopes after single-dose vaccination in previously infected patients. In conclusion, single-dose vaccination in previously infected dialysis patients induced a strong and broad antibody reactivity against various SARS-CoV-2 spike protein epitopes with high neutralizing capacity.
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Affiliation(s)
- Claudius Speer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit Heidelberg, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | | | - Mirabel Buylaert
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Daniel Göth
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Florian Kälble
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Schaier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Julia Grenz
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Martin Kreysing
- Department of Gastroenterology and Hepatology, University of Heidelberg, Heidelberg, Germany
| | - Paula Reichel
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Asa Hidmark
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Gerald Ponath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Virology, Department of Infectious Diseases, University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Caner Süsal
- Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany
| | - Katrin Klein
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Louise Benning
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
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11
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Grupper A, Sharon N, Finn T, Cohen R, Israel M, Agbaria A, Rechavi Y, Schwartz IF, Schwartz D, Lellouch Y, Shashar M. Humoral Response to the Pfizer BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis. Clin J Am Soc Nephrol 2021; 16:1037-1042. [PMID: 33824157 PMCID: PMC8425628 DOI: 10.2215/cjn.03500321] [Citation(s) in RCA: 234] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality in patients on maintenance hemodialysis. Patients on dialysis tend to have a reduced immune response to infection or vaccination. We aimed to assess, for the first time to the best of our knowledge, the humoral response following vaccination with the BNT162b2 vaccine in patients on maintenance hemodialysis and the factors associated with it. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The study included 56 patients on maintenance hemodialysis (dialysis group) and a control group composed of 95 health care workers. All participants had received two doses of the BNT162b2 (Pfizer-BioNTech) vaccine. The serology testing was done using Quant II IgG anti-Spike severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assay by Abbott a median of 30 days after receipt of the second dose of the vaccine. RESULTS All subjects in the control group developed an antibody response compared with 96% (54 of 56) positive responders in the dialysis group. The IgG levels in the dialysis group (median, 2900; interquartile range, 1128-5651) were significantly lower than in the control group (median, 7401; interquartile range, 3687-15,471). A Mann-Whitney U test indicated that this difference was statistically significant (U=1238; P<0.001). There was a significant inverse correlation of age and IgG levels in both groups. The odds of being in the lower quartile were significantly higher for older individuals (odds ratio, 1.11 per year of age; 95% confidence interval, 1.08 to 1.20; P=0.004) and for the dialysis group compared with the control group (odds ratio, 2.7; 95% confidence interval, 1.13 to 7.51; P=0.05). Within the dialysis group, older age and lower lymphocyte count were associated with antibody response in the lower quartile (odds ratio, 1.22 per 1-year older; 95% confidence interval, 1.13 to 1.68; P=0.03 and odds ratio, 0.83 per 10-e3/µl-higher lymphocyte count; 95% confidence interval, 0.58 to 0.97; P=0.05). CONCLUSIONS Although most patients on maintenance hemodialysis developed a substantial humoral response following the BNT162b2 vaccine, it was significantly lower than controls. Age was an important factor in the humoral response, regardless of chronic medical conditions.
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Affiliation(s)
- Ayelet Grupper
- Nephrology Department, Tel Aviv Medical Center Tel Aviv, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nechama Sharon
- Pediatric Hemato-Oncology Department, Laniado Hospital, Netanya, Israel
- Ruth and Bruce Rappoport Faculty of Medicine, Technion, Haifa, Israel
| | - Talya Finn
- Ruth and Bruce Rappoport Faculty of Medicine, Technion, Haifa, Israel
- Infectious Disease Unit, Laniado Hospital, Netanya, Israel
| | - Regev Cohen
- Ruth and Bruce Rappoport Faculty of Medicine, Technion, Haifa, Israel
- Infectious Disease Unit, Laniado Hospital, Netanya, Israel
| | - Meital Israel
- Ruth and Bruce Rappoport Faculty of Medicine, Technion, Haifa, Israel
- Nephrology Section, Laniado Hospital, Netanya, Israel
| | - Amir Agbaria
- Ruth and Bruce Rappoport Faculty of Medicine, Technion, Haifa, Israel
- Nephrology Section, Laniado Hospital, Netanya, Israel
| | - Yoav Rechavi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Hemato-Oncology Department, Laniado Hospital, Netanya, Israel
| | - Idit F. Schwartz
- Nephrology Department, Tel Aviv Medical Center Tel Aviv, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Schwartz
- Nephrology Department, Tel Aviv Medical Center Tel Aviv, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Lellouch
- Ruth and Bruce Rappoport Faculty of Medicine, Technion, Haifa, Israel
- Clinical Laboratories Department, Laniado Hospital, Netanya, Israel
| | - Moshe Shashar
- Nephrology Department, Tel Aviv Medical Center Tel Aviv, Tel Aviv, Israel
- Ruth and Bruce Rappoport Faculty of Medicine, Technion, Haifa, Israel
- Nephrology Section, Laniado Hospital, Netanya, Israel
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12
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Sakhi H, Dahmane D, Attias P, Kofman T, Bouvier M, Lapidus N, Fourati S, El Karoui K. Kinetics of Anti-SARS-CoV-2 IgG Antibodies in Hemodialysis Patients Six Months after Infection. J Am Soc Nephrol 2021; 32:1033-1036. [PMID: 33637518 PMCID: PMC8259690 DOI: 10.1681/asn.2020111618] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/24/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The humoral response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the hemodialysis population, including its dynamics over time, remains poorly understood. METHODS To analyze initial and long-term humoral responses against SARS-CoV-2 in a hemodialysis population, we retrospectively evaluated findings from SARS-CoV-2 IgG serologic assays targeting the nucleocapsid antigen or spike antigen up to 6 months of follow-up in patients on hemodialysis in the Paris, France, region who had recovered from coronavirus disease 2019 (COVID-19). RESULTS Our analysis included 83 patients (median age 65 years); 59 (71%) were male and 28 (34%) had presented with severe COVID-19. We observed positive initial SARS-CoV-2 IgG antinucleocapsid serology in 74 patients (89%) at a median of 67 days postdiagnosis. By multivariable analysis, immunocompromised status was the only factor significantly associated with lack of an IgG antinucleocapsid antibody response. Follow-up data were available at 6 months postdiagnosis for 60 of 74 patients (81%) with positive initial antinucleocapsid serology, and 15 (25%) of them had negative antinucleocapsid serology at month 6. In total, 14 of 15 sera were tested for antispike antibodies, 3 of 14 (21%) of which were also negative. Overall, 97% of antinucleocapsid-antibody-positive specimens were also antispike-antibody positive. Female sex, age >70 years, and nonsevere clinical presentation were independently associated with faster IgG antinucleocapsid titer decay in multivariable analysis. After adjustment for sex and age >70 years, nonsevere clinical presentation was the only factor associated with faster decay of IgG antispike antibodies. CONCLUSIONS This study characterizes evolution of the SARS-CoV-2 antibody response in patients on hemodialysis and identifies factors that are associated with lack of seroconversion and with IgG titer decay.
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Affiliation(s)
- Hamza Sakhi
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Department of Nephrology, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France,University Paris Est Créteil, Institut National de la Santé et de la Recherche Médical, (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Djamal Dahmane
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Department of Nephrology, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
| | - Philippe Attias
- Department of Nephrology and Dialysis, Hôpital Privé Nord Parisien, Sarcelles, France
| | - Thomas Kofman
- Association Néphrologique Développement Rein Artificiel, Unité de Dialyse des Buttes Chaumont, Paris, France
| | - Magali Bouvier
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Virologie, Centre National de Référence Hépatites B, C, et delta, Créteil, France.,Department of Virology, University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale, Créteil, France
| | - Nathanael Lapidus
- Public Health Department, Saint-Antoine Hospital, Paris, France,Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Slim Fourati
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Virologie, Centre National de Référence Hépatites B, C, et delta, Créteil, France.,Department of Virology, University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale, Créteil, France
| | - Khalil El Karoui
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Department of Nephrology, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France,University Paris Est Créteil, Institut National de la Santé et de la Recherche Médical, (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
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13
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Smolander J, Bruchfeld A. The COVID-19 Epidemic: Management and Outcomes of Hemodialysis and Peritoneal Dialysis Patients in Stockholm, Sweden. Kidney Blood Press Res 2021; 46:250-256. [PMID: 33774645 PMCID: PMC8089452 DOI: 10.1159/000514268] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 outbreak has been associated with a high morbidity, mortality, and a risk of long-term sequelae, and patients with severe COVID-19 are at increased risk of acute kidney injury. CKD patients are at high risk of being exposed to COVID-19 and suffer complications and poor outcome. In Sweden, mitigation strategies did not include lockdown. During March-April of 2020, wide-spread infection occurred in Stockholm. METHODS Management and outcomes in forty hemodialysis (HD) patients and 4 peritoneal dialysis (PD) patients, with symptomatic COVID-19 in greater Stockholm during March and April of 2020 are reported. RESULTS Twenty-four HD patients (60%) required medical care and hospitalization, whereas 16 patients (40%) were treated at home. Nine patients died (mortality rate of 22.5%), of whom 8 were men. The median age in non-survivors (78 years) was significantly higher than in survivors (p = 0.003). The median time in dialysis (11.5 years) was also significantly longer in non-survivors (p = 0.01). C-reactive protein (CRP) at diagnosis in 7 of non-survivors (median 213 mg/L, range 86-329 mg/L) was significantly higher than the CRP in 25 survivors (median 87 mg/L, range 1-328 mg/L) (p = 0.0003). Maximum CRP also indicated poorer outcome among hospitalized patients (p = 0.0004). The gender imbalance was striking with only men dying apart from 1 elderly woman. Only 4 PD patients were hospitalized with symptomatic COVID-19. One patient died, 2 were discharged, and 1 was treated at the intensive care unit and survived. CONCLUSION HD patients >70 years were reported with longer dialysis vintage, higher CRP, and males were at an increased risk of dying from COVID-19, whereas those <70 years seemed to have a milder disease. Mitigation strategies to reduce rates of infection in high-risk populations remain essential. Follow-up focusing on long-term prognosis for extrapulmonary manifestations is likely to be important also in dialysis patients.
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Affiliation(s)
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Renal Medicine, Karolinska University Hospital and CLINTEC KI, Stockholm, Sweden
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14
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Thadhani R, Willetts J, Wang C, Larkin J, Zhang H, Fuentes LR, Usvyat L, Belmonte K, Wang Y, Kossmann R, Hymes J, Kotanko P, Maddux F. Transmission of SARS-CoV-2 Considering Shared Chairs in Outpatient Dialysis: A Real-World Case-Control Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33655270 PMCID: PMC7924295 DOI: 10.1101/2021.02.20.21251855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: SARS-CoV-2 is primarily transmitted through aerosolized droplets; however, the virus can remain transiently viable on surfaces. Objective: We examined transmission within hemodialysis facilities, with a specific focus on the possibility of indirect patient-to-patient transmission through shared dialysis chairs. Design: We used real-world data from hemodialysis patients treated between February 1st and June 8th, 2020 to perform a case-control study matching each SARS-CoV-2 positive patient (case) to a non-SARS-CoV-2 patient (control) in the same dialysis shift and traced back 14 days to capture possible exposure from chairs sat in by SARS-CoV-2 patients. Cases and controls were matched on age, sex, race, facility, shift date, and treatment count. Setting: 2,600 hemodialysis facilities in the United States. Patients: Adult (age ≥18 years) hemodialysis patients. Measurements: Conditional logistic regression models tested whether chair exposure after a positive patient conferred a higher risk of SARS-CoV-2 infection to the immediate subsequent patient. Results: Among 170,234 hemodialysis patients, 4,782 (2.8%) tested positive for SARS-CoV-2 (mean age 64 years, 44% female). Most facilities (68.5%) had 0 to 1 positive SARS-CoV-2 patient. We matched 2,379 SARS-CoV-2 positive cases to 2,379 non-SARS-CoV-2 controls; 1.30% (95%CI 0.90%, 1.87%) of cases and 1.39% (95%CI 0.97%, 1.97%) of controls were exposed to a chair previously sat in by a shedding SARS-CoV-2 patient. Transmission risk among cases was not significantly different from controls (OR=0.94; 95%CI 0.57 to 1.54; p=0.80). Results remained consistent in adjusted and sensitivity analyses. Limitation: Analysis used real-world data that could contain errors and only considered vertical transmission associated with shared use of dialysis chairs by symptomatic patients. Conclusions: The risk of indirect patient-to-patient transmission of SARS-CoV-2 infection from dialysis chairs appears to be low. Primary Funding Source: Fresenius Medical Care North America; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK130067)
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Affiliation(s)
| | - Joanna Willetts
- Fresenius Medical Care, Global Medical Office, Waltham, United States
| | - Catherine Wang
- University of California-Santa Barbara, Santa Barbara, California, United States
| | - John Larkin
- Fresenius Medical Care, Global Medical Office, Waltham, United States
| | - Hanjie Zhang
- Renal Research Institute, New York, United States
| | | | - Len Usvyat
- Fresenius Medical Care, Global Medical Office, Waltham, United States
| | | | - Yuedong Wang
- University of California-Santa Barbara, Santa Barbara, California, United States
| | - Robert Kossmann
- Fresenius Medical Care North America, Medical Office, Waltham, United States
| | - Jeffrey Hymes
- Fresenius Medical Care, Global Medical Office, Waltham, United States
| | - Peter Kotanko
- Renal Research Institute, New York, United States.,Icahn School of Medicine at Mount Sinai, New York, United States
| | - Franklin Maddux
- Fresenius Medical Care AG & Co. KGaA, Global Medical Office, Bad Homburg, Germany
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15
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Kular D, Chis Ster I, Sarnowski A, Lioudaki E, Braide-Azikiwe DC, Ford ML, Makanjuola D, Rankin A, Cairns H, Popoola J, Cole N, Phanish M, Hull R, Swift PA, Banerjee D. The Characteristics, Dynamics, and the Risk of Death in COVID-19 Positive Dialysis Patients in London, UK. KIDNEY360 2020; 1:1226-1243. [PMID: 35372882 PMCID: PMC8815514 DOI: 10.34067/kid.0004502020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/08/2020] [Indexed: 04/23/2023]
Abstract
BACKGROUND Patients on dialysis with frequent comorbidities, advanced age, and frailty, who visit treatment facilities frequently, are perhaps more prone to SARS-CoV-2 infection and related death-the risk factors and dynamics of which are unknown. The aim of this study was to investigate the hospital outcomes in patients on dialysis infected with SARS-CoV-2. METHODS Data on 224 patients on hemodialysis between February 29, 2020 and May 15, 2020 with confirmed SARS-CoV-2 were analyzed for outcomes and potential risk factors for death, using a competing risk-regression model assessed by subdistribution hazards ratio (SHR). RESULTS Crude data analyses suggest an overall case-fatality ratio of 23% (95% CI, 17% to 28%) overall, but that varies across age groups from 11% (95% CI, 0.9% to 9.2%) in patients ≤50 years old and 32% (95% CI, 17% to 48%) in patients >80 years; with 60% of deaths occurring in the first 15 days and 80% within 21 days, indicating a rapid deterioration toward death after admission. Almost 90% of surviving patients were discharged within 28 days. Death was more likely than hospital discharge in patients who were more frail (WHO performance status, 3-4; SHR, 2.16 [95% CI, 1.25 to 3.74]; P=0.006), had ischemic heart disease (SHR, 2.28 [95% CI, 1.32 to 3.94]; P=0.003), cerebrovascular disease (SHR, 2.11 [95% CI, 1.20 to 3.72]; P=0.01), smoking history (SHR, 2.69 [95% CI, 1.33 to 5.45]; P=0.006), patients who were hospitalized (SHR, 10.26 [95% CI, 3.10 to 33.94]; P<0.001), and patients with high CRP (SHR, 1.35 [95% CI, 1.10 to 1.67]) and a high neutrophil:lymphocyte ratio (SHR, 1.03 [95% CI, 1.01 to 1.04], P<0.001). Our data did not support differences in the risk of death associated with sex, ethnicity, dialysis vintage, or other comorbidities. However, comparison with the entire dialysis population attending these hospitals, in which 13% were affected, revealed that patients who were non-White (62% versus 52% in all patients, P=0.001) and those with diabetes (54% versus 22%, P<0.001) were disproportionately affected. CONCLUSIONS This report discusses the outcomes of a large cohort of patients on dialysis. We found SARS-CoV-2 infection affected more patients with diabetes and those who were non-White, with a high case-fatality ratio, which increased significantly with age, frailty, smoking, increasing CRP, and neutrophil:lymphocyte ratio at presentation.
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Affiliation(s)
- Dalvir Kular
- Renal Unit, St Helier Hospital, Epsom and St Helier University Hospitals National Health Service Trust, Epsom, United Kingdom
| | - Irina Chis Ster
- Institute of Infection and Immunity, St George’s University of London, London, United Kingdom
| | - Alexander Sarnowski
- Renal and Transplantation Unit, St George’s University Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Eirini Lioudaki
- Renal Unit, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | | | - Martin L. Ford
- Renal Unit, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - David Makanjuola
- Renal Unit, St Helier Hospital, Epsom and St Helier University Hospitals National Health Service Trust, Epsom, United Kingdom
| | - Alexandra Rankin
- Renal Unit, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Hugh Cairns
- Renal Unit, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Joyce Popoola
- Renal and Transplantation Unit, St George’s University Hospital National Health Service Foundation Trust, London, United Kingdom
- Molecular and Clinical Sciences Research Institute, St George’s University of London, London, United Kingdom
| | - Nicholas Cole
- Renal Unit, St Helier Hospital, Epsom and St Helier University Hospitals National Health Service Trust, Epsom, United Kingdom
| | - Mysore Phanish
- Renal Unit, St Helier Hospital, Epsom and St Helier University Hospitals National Health Service Trust, Epsom, United Kingdom
| | - Richard Hull
- Renal and Transplantation Unit, St George’s University Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Pauline A. Swift
- Renal Unit, St Helier Hospital, Epsom and St Helier University Hospitals National Health Service Trust, Epsom, United Kingdom
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George’s University Hospital National Health Service Foundation Trust, London, United Kingdom
- Molecular and Clinical Sciences Research Institute, St George’s University of London, London, United Kingdom
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