Outcomes among Hospitalized Chronic Kidney Disease Patients with COVID-19

Outcome of COVID-19 infection and the impact of COVID-19 vaccination in chronic kidney disease patients: A single-center study

Introduction

Chronic kidney disease (CKD) patients have increased vulnerability to infections including Covid-19. There is limited availability of antiviral in CKD patients. All guidelines have prioritized vaccinations for CKD patients. The variability in immunogenic response is multifactorial in CKD group. We have tried to analyze the outcome of Covid-19 infection and the impact of COVID-19 vaccination [COVAXIN / COVISHIELD] in our cohort.

Materials Methods and Statistical Analysis

In a retrospective observational study, 73 cases of Covid-19 positive CKD patients were selected, who were managed as per MOFHW guidelines. The data of first laboratory values and radiological findings were evaluated. Their treatment outcome and stay during hospitalization were studied. All data were later analyzed using STATA 16.1 software.

Results

In this study, 73 cases of CKD with Covid-19 were included. There were 38 patients who were vaccinated with at least one dose of the Covid-19 vaccine, while there were 35 patients who were unvaccinated. Out of 38 patients, 20 were vaccinated with 2 doses of Covid-19 while 18 received only one dose. The unvaccinated group was having more hypoxia and raised inflammatory markers, and had more lung involvement [i.e. higher CT severity value] [p value for CTSS-0.0765]. There was a higher mortality rate observed in the unvaccinated group [i.e-65.71%] than the vaccinated group [39.47%] [p-value 0.0249]. Dialysis was needed in 57.50% of the study population either due to failure of conservative management for renal failure or due to maintenance dialysis. The mean duration of hospitalization was 11.47 days with a mortality rate of 52% which is much higher than the reported average data in CKD patients.

Conclusion

Vaccination seems to be very helpful in combating the adverse effect of Covid-19 in CKD patients. It also reduces mortality significantly in Covid-19 infected CKD patients.

Chronic hemodialysis patients with COVID-19 cared for by the public health system have higher mortality than those treated in private facilities: analysis of the Brazilian dialysis registry

PURPOSE

Brazil is the third country globally in dialysis patients. Little is known about the impact of the type of health insurance on the outcome of these patients after COVID-19.

METHODS

We analyzed comorbidities, sociodemographic factors, and dialysis-related parameters from a retrospective cohort study of 1866 Brazilian chronic hemodialysis patients with COVID-19 from Feb 2020-July 2021. We evaluated the influence of health insurance (private vs. public) on the intensive care unit admission and 90 day fatality risk.

RESULTS

From 1866 hemodialysis patients, 455 (24%) were admitted to the intensive care unit, and 350 (19%) died. The mean age was 57.5 years, 88% had public health insurance. Crude case-fatality rate was not different between groups (private vs. public risk ratio 1.11; 95% CI 0.82-1.52, p = 0.498). In fully adjusted multivariate models, patients with private health insurance did not have a higher chance to be admitted to an intensive care unit (odds ratio 0.97; 95% CI 0.63-1.50, p = 0.888), but they presented a lower death risk (hazard ratio 0.56; 95% CI 0.37-0.85, p = 0.006).

CONCLUSION

The type of health insurance did not influence the access of hemodialysis patients with COVID-19 to an intensive care unit, but patients with private health insurance had a lower mortality risk.

COVID-19 Booster Vaccine Hesitancy among Hemodialysis Patients in Saudi Arabia Using the Health Belief Model: A Multi-Centre Experience

OBJECTIVE

Vaccination hesitance for the COVID-19 booster dosage among hemodialysis patients is an important barrier in reducing morbidity and mortality linked to COVID-19 infection. Hence, this study aimed to explore the predictors of the third (booster) dose of COVID-19 vaccine intention among CKD patients on hemodialysis from the Kingdom of Saudi Arabia (KSA).

METHODS

This study was a multi-center cross-sectional study conducted at four dialysis centers in KSA from 13 February 2022 to 21 June 2022. The data was collected by the nephrologist in charge of the unit using a structured study questionnaire, which consisted of four parts; socio-demographic and clinical variables, questions about COVID-19 infection and subjective assessment of health state, COVID-19 booster dose vaccination intention and confidence in vaccines and preferences, and a health belief model. The study population consisted of 179 hemodialysis patients.

RESULTS

Participants in the study had conflicting health beliefs about their vulnerability to COVID-19 infection and the severity of the COVID-19 infection. Study participants expressed positive health beliefs about the advantages of the COVID-19 booster dose, and reported less perceived obstacles in receiving the vaccine. The influence of cues on action among the study population was high. A total of 140 (78.2%) hemodialysis patients expressed their intention to receive the COVID-19 booster dose. Patients who reported poor health in the self-rating of their health status had a substantially higher definite intention to take the COVID-19 booster dose, according to the chi-square test (11.16, df = 3, p = 0.01). There was a significant association between the constructs in the HBM model and COVID-19 vaccine (booster) intention. Marital status (OR = 1.67, CI 1.07-2.58) was found to be the strongest predictors of a definite intention to receive a COVID-19 booster dose. Confidence in the locally manufactured vaccine (OR = 0.33, CI 0.17-0.60), education (OR = 0.62, CI 0.41-0.93), and rating of health status (OR = 0.43 CI 0.25-0.74) were the strongest significant correlates of having no definite intention to take the COVID-19 vaccination.

CONCLUSIONS

HBM constructs were found to be significantly associated with vaccination intention, which can be considered while planning policies to promote COVID-19 booster vaccination among hemodialysis patients. The study results could be utilized in drafting policies to improve COVID-19 booster dose vaccination uptake among hemodialysis population.

Immune responses to SARS-CoV-2 in dialysis and kidney transplantation

Despite progressive improvements in the management of patients with coronavirus disease 2019 (COVID-19), individuals with end-stage kidney disease (ESKD) are still at high risk of infection-related complications. Although the risk of infection in these patients is comparable to that of the general population, their lower rate of response to vaccination is a matter of concern. When prevention strategies fail, infection is often severe. Comorbidities affecting patients on maintenance dialysis and kidney transplant recipients clearly account for the increased risk of severe COVID-19, while the role of uremia and chronic immunosuppression is less clear. Immune monitoring studies have identified differences in the innate and adaptive immune response against the virus that could contribute to the increased disease severity. In particular, individuals on dialysis show signs of T cell exhaustion that may impair antiviral response. Similar to kidney transplant recipients, antibody production in these patients occurs, but with delayed kinetics compared with the general population, leaving them more exposed to viral expansion during the early phases of infection. Overall, unique features of the immune response during COVID-19 in individuals with ESKD may occur with severe comorbidities affecting these individuals in explaining their poor outcomes.