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Pan Y, Li D, Zhang Z, Xu J, Sun X, Wang M, Ding J. Clinical characteristics and outcomes of maintenance hemodialysis patients with COVID-19 during the Omicron wave of the pandemic in Beijing: a single center retrospective study. BMC Nephrol 2024; 25:143. [PMID: 38649863 PMCID: PMC11036696 DOI: 10.1186/s12882-024-03575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The clinical manifestations and prognosis of hemodialysis patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during the Omicron wave of the pandemic infection were still unclear. This study investigated the clinical characteristics of patients undergoing maintenance hemodialysis (MHD) infected with it. METHODS This retrospective single-center study included 151 patients undergoing MHD. Healthcare workers were selected as control group were assessed from December 1, 2022 to March 31, 2023. Clinical data, laboratory test results, treatment protocols, and prognoses were collected and analyzed. RESULTS The study population included 146 patients with MHD, 93 (63.7%) of whom were infected with SARS-CoV-2. The number of non-severe, severe, and critical cases was 84 (90.3%), 4 (4.3%), and 5 (5.3%), respectively. Six patients (6.5%) died during the study period. The main symptoms of SARS-CoV-2 infection, including fever, cough, and fatigue, were less common in patients with MHD than the controls. During SARS-CoV-2 infection, the C-reactive protein (2.9 vs. 11.8 mg/dl, p < 0.0001) and ferritin levels(257.7 vs. 537 ng/l, p < 0.0001) were elevated. The hemoglobin(113vs 111 g/L, p = 0.0001) and albumin levels(39.4 vs. 36.1 g/L, p < 0.0001) decreased. Generally, it took two months for the hemoglobin levels to recover. Positivity rate for SARS-COV-2 serum immunoglobin G (IgG) antibodies and IgG titers were lower in dialysis patients than the controls. Age was positively associated with disease severity, while age and hyponatremia were associated with death. CONCLUSIONS Patients with MHD and COVID-19 were primarily classified as non-severe. SARS-CoV-2 infection would soon lead to the increase of inflammation related acute response protein in dialysis patients, and then lead to the decrease of hemoglobin and albumin. About 9.6% in HD patients were severe cases and had poor prognosis. Advanced age and hyponatremia were associated with disease severity and prognosis.
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Affiliation(s)
- Yujing Pan
- Nephrology Department, Peking University International Hospital, No. 1 Life Park Road, Life Science Park of Zhongguancun, Changping District, 102206, Beijing, P.R. China
| | - Dan Li
- Hemodialysis Center, Peking University International Hospital, 102206, Beijing, P.R. China
| | - Zhoucang Zhang
- Nephrology Department, Peking University International Hospital, No. 1 Life Park Road, Life Science Park of Zhongguancun, Changping District, 102206, Beijing, P.R. China
| | - Jing Xu
- Nephrology Department, Peking University International Hospital, No. 1 Life Park Road, Life Science Park of Zhongguancun, Changping District, 102206, Beijing, P.R. China
| | - Xinping Sun
- Department of Clinical Laboratory, Peking University International Hospital, 102206, Beijing, P.R. China
| | - Mei Wang
- Nephrology Department, Peking University International Hospital, No. 1 Life Park Road, Life Science Park of Zhongguancun, Changping District, 102206, Beijing, P.R. China
| | - Jiaxiang Ding
- Nephrology Department, Peking University International Hospital, No. 1 Life Park Road, Life Science Park of Zhongguancun, Changping District, 102206, Beijing, P.R. China.
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Kikuchi K, Nangaku M, Ryuzaki M, Yamakawa T, Ota Y, Hanafusa N, Sakai K, Kanno Y, Ando R, Shinoda T, Wakino S, Nakamoto H, Takemoto Y, Akizawa T. Efficacy of molnupiravir and sotrovimab in Japanese dialysis patients with COVID-19 in clinical practice during the Omicron (BA.1 and BA.2) pandemic. Ther Apher Dial 2023; 27:1064-1069. [PMID: 37395555 DOI: 10.1111/1744-9987.14033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION In the present study, the efficacy of sotrovimab and molnupiravir in dialysis patients with COVID-19 was investigated using a registry of COVID-19 in Japanese dialysis patients. METHODS Dialysis patients with confirmed SARS-CoV-2 during the COVID-19 (Omicron BA.1 and BA.2) pandemic were analyzed. Patients were classified into four treatment groups: molnupiravir monotherapy (molnupiravir group), sotrovimab monotherapy (sotrovimab group), molnupiravir and sotrovimab combination therapy (combination group), and no antiviral therapy (control group). The mortality rates in the four groups were compared. RESULTS A total of 1480 patients were included. The mortality of the molnupiravir, sotrovimab, and combination groups were significantly improved compared to the control group (p < 0.001). Multivariate analysis indicated that antiviral therapy improves the survival of dialysis patients with COVID-19 (hazard ratio was 0.184 for molnupiravir, 0.389 for sotrovimab, and 0.254 for combination groups, respectively). CONCLUSION Sotrovimab showed efficacy in Omicron BA.1 but attenuated in BA.2. Molnupiravir also showed efficacy in BA.2, suggesting administration of molnupiravir would be important.
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Affiliation(s)
- Kan Kikuchi
- Division of Nephrology, Shimoochiai Clinic, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Munekazu Ryuzaki
- Department of Nephrology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | | | | | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Sakai
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yoshihiko Kanno
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Ryoichi Ando
- Department of Nephrology, Medical Group Ishikawa, Tokyo, Japan
| | - Toshio Shinoda
- Advanced Course for Clinical Engineering, Teikyo University Junior College, Tokyo, Japan
| | - Shu Wakino
- Department of Nephrology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hidetomo Nakamoto
- Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Yoshiaki Takemoto
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Liu H, Jiang N, Min Y, Huang D, Liu H, Li H, Xiong F. Infection status and clinical characteristics of COVID-19 in maintenance hemodialysis patients in Wuhan during the omicron pandemic. Medicine (Baltimore) 2023; 102:e35063. [PMID: 37682194 PMCID: PMC10489297 DOI: 10.1097/md.0000000000035063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
Maintenance hemodialysis (MHD) patients are the high-risk population of infection and death of novel coronavirus disease 2019 (COVID-19), our study aimed to investigate the infection status and clinical characteristics of COVID-19 in MHD patients at a single-center in Wuhan during the Omicron pandemic. In this retrospective, single-center study, we analyzed the clinical data of all MHD patients in Hemodialysis Center of Wuhan No. 1 Hospital from December 2, 2022 to January 6, 2023 during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron pandemic outbreak. We analyzed the epidemiological and clinical characteristics of deaths and survivors of MHD patients. The infection rate of SARS-CoV-2 in MHD patients was 93.32% (573/614), mortality rate was 8.14% (50/614), hospitalization rate was 23.29% (143/614), and the vaccination rate of COVID-19 was 4.89% (30/614). The median survival time of dead patients was 11 days, the mortality rate of male MHD patients was significantly higher than female. Elderly MHD patients had a higher mortality rate, with a average age of death higher than 70 years old. Additionally, the mortality rate of MHD patients infected with SARS-CoV-2 was higher if the primary disease was hypertensive renal damage or diabetic nephropathy. Laboratory results showed that the lower the albumin level and the higher the C-reactive protein level of MHD patients who died of SARS-CoV-2 infection and severe and critical survival patients. In surviving MHD patients infected with SARS-CoV-2, the most common symptoms were hypodynamia (84.70%), decreased appetite (81.26%) and cough (80.69%). The symptoms of fever, chest tightness and panting, cough, pharyngalgia, hypodynamia, decreased appetite in surviving MHD patients with severe and critical type were significantly higher than those in patients with mild and moderate type. MHD patients are a highly vulnerable population at increased risk of mortality during the Omicron pandemic. Elderly, male, primary disease was hypertensive renal damage or diabetic nephropathy, hypoproteinemia and high C-reactive protein level, all of which will lead to increased mortality in MHD patients.
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Affiliation(s)
- Hong Liu
- Department of Nephrology, Wuhan No. 1 Hospital, Wuhan, China
| | - Nan Jiang
- Department of Nephrology, Wuhan No. 1 Hospital, Wuhan, China
| | - Yonglong Min
- Department of Nephrology, Wuhan No. 1 Hospital, Wuhan, China
| | - Dan Huang
- Department of Nephrology, Wuhan No. 1 Hospital, Wuhan, China
| | - Huizhen Liu
- Department of Nephrology, Wuhan No. 1 Hospital, Wuhan, China
| | - Hongbo Li
- Department of Nephrology, Wuhan No. 1 Hospital, Wuhan, China
| | - Fei Xiong
- Department of Nephrology, Wuhan No. 1 Hospital, Wuhan, China
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Mondal M, Islam MN, Ullah A, Haque MR, Rahman M, Bosak L, Rahman MF, Zaman SR, Rahman MM. Clinical manifestations and outcomes of COVID-19 in maintenance hemodialysis patients of a high infectious epidemic country: a prospective cross-sectional study. Ann Med Surg (Lond) 2023; 85:4293-4299. [PMID: 37663710 PMCID: PMC10473334 DOI: 10.1097/ms9.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/01/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The outbreak of COVID-19 poses great challenges for patients on maintenance haemodialysis. Here, we reported the clinical characteristics and laboratory features of maintenance haemodialysis (MHD) patients with COVID-19 in Bangladesh. Methods Altogether, 67 MHD patients were enroled in the study from two dedicated tertiary-level hospitals for COVID-19 after the prospective cross-sectional execution of selection criteria. Data were collected from medical records and interviews. Different statistical analysis was carried out in the data analysis. Results The mean age was 55.0±9.9 years, with 40 males (59.7%). The mean dialysis duration was 23.4±11.5 months. The most common symptoms were fever (82.1%), cough (53.7%), and shortness of breath (55.2%), while the common comorbid condition was hypertension (98.5%), followed by diabetes (56.7%). Among MHD patients, 52.2% to 79.1% suffered from severe to critical COVID-19, 48 patients (71.6%) had 26-75% lung involvement on high resolution computed tomography of the chest, 23 patients (34.3%) did not survive, 20 patients (29.9%) were admitted to ICU, and nine patients (13.4%) needed mechanical ventilation. Patients who did not survive were significantly older (mean age: 63.0 vs. 50.86 years, P=0.0001), had significantly higher cardiovascular risk factors (69.6% vs. 43.2%, P=0.04), severe shortness of breath (82.6% vs. 40.9%, P=0.0001), and longer hospital stays (mean days: 17.9 vs. 13.0, P=0,0001) compared to the survivor group. The white blood cell count, C-reactive protein, lactate dehydrogenase, pro-calcitonin, and thrombocytopenia were significantly (P<0.0001) higher, while the albumin level was significantly lower (P=0.0001) in non-survivor compared to patients who survived. Conclusion Maintenance haemodialysis patients had severe to critical COVID-19 and had a higher risk of non-survival if they were older and had comorbidities such as hypertension and diabetes. Therefore, MHD patients with COVID-19 need close monitoring to improve their outcomes.
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Affiliation(s)
- Mina Mondal
- Department of Nephrology, Khulna Medical College, Khulna
| | | | | | | | - Motiur Rahman
- Kalkini Upzilla Health Complex, Kalkini, Madaripur, Bangladesh
| | - Liza Bosak
- Basic Science Division, World University of Bangladesh
| | - Md. Foyzur Rahman
- Department of Community Medicine, National Institute of Preventive and Social Medicine (NIPSOM)
| | | | - Mohammad Meshbahur Rahman
- Department of Biostatistics, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka
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Bnaya A, Nacasch N, Einbinder Y, Shavit L, Erez D, Shashar M, Grupper A, Benchetrit S, Wand O, Cohen-Hagai K. Dialysis modality, humoral response to vaccine, and SARS-CoV-2 infection risk: Comparative prospective evaluation. Semin Dial 2023; 36:382-389. [PMID: 37042666 DOI: 10.1111/sdi.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND COVID-19 vaccinations have a central role in decreasing severe SARS-CoV-2 disease complications. This study investigated the long-term humoral immune response to BNT162b2 vaccine among hemodialysis (HD) versus peritoneal dialysis (PD) patients, and their relative risk for COVID-19 infection. METHODS This prospective, observational study included maintenance HD and PD patients who had received at least two BNT162b2 vaccine doses. Levels of antibodies targeting SARS-CoV-2 spike protein were measured 6 and 12 months after the first vaccine dose, and 2-3 weeks after the third and fourth vaccine doses. Patients were divided according to dialysis modality (HD or PD). Humoral response was evaluated at different time points among different vaccine regimens (two vs. three vs. four doses of vaccine). An adjusted multivariate model was used to assess cumulative risk for SARS-CoV-2 infection. RESULTS Eighty-seven HD and 36 PD patients were included. Among them, 106 (86%) received at least three vaccine doses. Both HD and PD patients demonstrated marked increases in humoral response 2-3 weeks after the third dose (mean anti-S antibody increased from 452 ± 501 AU/mL to 19,556 ± 14,949 AU/mL, p < 0.001). By 6 months after the third dose, antibody titers had declined significantly (mean anti-S antibody 9841 ± 10,493 AU/mL, p < 0.001). HD patients had higher risk for SARS-CoV-2 infection than PD patients (OR 4.4 [95% CI 1.4-13.6], p = 0.006). In multivariate analysis, the most important predictor for SARS-CoV-2 infection was dialysis modality. CONCLUSION This study found a high antibody response rate after the third and fourth doses of BNT162b2 vaccine among dialysis patients. Hemodialysis as dialysis modality is an important predictor of COVID-19 infection, despite similar humoral responses to vaccine in peritoneal dialysis.
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Affiliation(s)
- Alon Bnaya
- Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Shavit
- Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daniel Erez
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
| | - Ayelet Grupper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Wand
- Pulmonary Division, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ramdani M, Oujidi H, Elmaghraoui H, Abda N, Bentata Y. End-stage kidney disease patients with severe coronavirus disease: clinical characteristics, biological data, and mortality in nephrology unit, short communication. Ann Med Surg (Lond) 2023; 85:4182-4186. [PMID: 37554878 PMCID: PMC10406044 DOI: 10.1097/ms9.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/10/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Patients suffering from end-stage kidney disease (ESKD) are particularly vulnerable to SARS-CoV-2 infection, and their risk of death is higher than for the general population. The objective was to determine the epidemiologic profile at admission and mortality among patients presenting EKSD with severe coronavirus disease (COVID-19). METHODS A retrospective study was conducted in the Nephrology unit between October 2020 and February 2022. Were included all adult patients who presented ESKD on dialysis, or not on dialysis with an estimated glomerular filtration rate less than or equal to 15 ml/min/1.73 m2 and presenting a confirmed COVID-19. Patients with ESKD who were immediately admitted to the ICU were excluded. RESULTS Sixty-five patients' data were collected. The mean age was 58.9 ±16.7 years and 60% were males. Hypertension arterial and diabetes observed in 75% and 56.3% of cases, respectively. 52.3% were on haemodialysis, 4.6% were on peritoneal dialysis and 43.1% not were on dialysis. 94% of the patients were symptomatic of COVID-19, dominated by dyspnoea (87.5%), cough (65.6%), and fever (58.5%). More than half of patients (58.5%) showed signs of gravity and 62% required oxygen therapy. According to thoracic scan, 72.3% were classified COVID-19 Raw Data System 5 and 6. Most patients had severe anaemia (58.5%), lymphopenia (81.3%), and high levels of C-reactive protein (54%), D-Dimer (93.6%) and ferritin (91.2%). 38.5% of patients presented complications of whom 60% were transferred to ICU. Mortality was observed in 8% of cases. CONCLUSION Rigorous monitoring is necessary for patients in ESKD, particularly those with comorbidities, to reduce the risk of severe form of COVID-19.
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Affiliation(s)
- Malika Ramdani
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine Oujda
| | - Hanae Oujidi
- Nephrology—Dialysis and Kidney Transplantation Unit, University Hospital Mohammed VI, University Mohammed Premier, Oujda, Morocco
| | - Hicham Elmaghraoui
- Nephrology—Dialysis and Kidney Transplantation Unit, University Hospital Mohammed VI, University Mohammed Premier, Oujda, Morocco
| | - Naima Abda
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine Oujda
| | - Yassamine Bentata
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine Oujda
- Nephrology—Dialysis and Kidney Transplantation Unit, University Hospital Mohammed VI, University Mohammed Premier, Oujda, Morocco
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Puspitasari M, Sattwika PD, Rahari DS, Wijaya W, Hidayat ARP, Kertia N, Purwanto B, Thobari JA. Immunogenicity and safety of inactivated SARS-CoV-2 vaccine in haemodialysis patients: a prospective cohort study. Sci Rep 2023; 13:11557. [PMID: 37463975 PMCID: PMC10354113 DOI: 10.1038/s41598-023-38628-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
End-stage renal disease patients on haemodialysis (HD) have been largely excluded from SARS-CoV-2 vaccine trials due to safety reasons and shown to mount lower responses to vaccination. This study aims to evaluate the immunogenicity and safety of inactivated COVID-19 vaccine among HD patients compared to healthy controls. All subjects who received the primary inactivated COVID-19 vaccination had their blood samples tested 21 days after the second dose. We report the immunogenicity based on anti-RBD IgG titre (IU/mL), the inhibition rate of neutralizing antibodies (NAbs) (%) to RBD, and seroconversion rates. Adverse events were assessed within 30 min and on the 7th day after each dose. Among 75 HD patients and 71 healthy controls, we observed no significant difference in all immunogenicity measures: anti-RBD IgG GMT (277.91 ± 7.13 IU/mL vs. 315.50 ± 3.50 IU/mL, p = 0.645), NAbs inhibition rate (82% [53-96] vs. 84% [39-98], p = 0.654), and seroconversion rates (anti-RBD IgG: 86.7% vs. 85.9%, p = 0.895; NAbs: 45.3% vs. 60.6%, p = 0.065). The number of adverse events is not significantly different between the two groups. The primary inactivated SARS-CoV-2 vaccination elicits an adequate antibody response and can be safely administered in haemodialysis patients.
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Affiliation(s)
- Metalia Puspitasari
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
| | - Prenali D Sattwika
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
- Clinical Epidemiology and Biostatistics Unit, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Dzerlina S Rahari
- Clinical Epidemiology and Biostatistics Unit, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Wynne Wijaya
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Auliana R P Hidayat
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Nyoman Kertia
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Bambang Purwanto
- Department of Internal Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Jarir At Thobari
- Clinical Epidemiology and Biostatistics Unit, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
- Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Szu LY, Chang CH, Hsieh SI, Shih WM, Huang LM, Tsai MC, Tseng SM. Factors Related to Quality of Life of Hemodialysis Patients during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11081155. [PMID: 37107989 PMCID: PMC10137652 DOI: 10.3390/healthcare11081155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Taiwan had the second highest number globally of end-stage renal disease patients undergoing treatment in 2018. A meta-analysis of Chen et al. (2021) showed the incidence and mortality rates of COVID-19 were 7.7% and 22.4%, respectively. Few studies have explored the effects of patients' self-participation and perceptions of hemodialysis on their quality of life. This study aimed to explore the factors related to hemodialysis patients' quality of life during the COVID-19 pandemic. This study was a descriptive correlational study. Patients were recruited (n = 298) from the hemodialysis unit of a medical center in northern Taiwan. Variables included patients' sociodemographic, psychological, spiritual, and clinical characteristics (i.e., perceived health level, comorbidities, hemodialysis duration, weekly frequency, transportation, and accompaniment during hemodialysis), perceptions of hemodialysis, self-participation in hemodialysis, and health-related quality of life (KDQOL-36 scale). Data were analyzed using descriptive and bivariate and multivariate linear regression. Multivariate linear regression, after adjusting for covariates, showed that anxiety, self-perceived health status, two vs. four comorbidities, and self-participation in hemodialysis were significantly associated with quality of life. The overall model was significant and accounted for 52.2% (R2 = 0.522) of the variance in quality of life during hemodialysis (adjusted R2 = 0.480). In conclusion, the quality of life of hemodialysis patients with mild, moderate, or severe anxiety was poorer, whereas that of patients with fewer comorbidities, higher self-perceived health status, and higher self-participation in hemodialysis was better.
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Affiliation(s)
- Li-Yun Szu
- Department of Nursing, Taoyuan Chang Gung Memorial Hospital, Taoyuan City 33372, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City 33302, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Suh-Ing Hsieh
- Department of Nursing, Taoyuan Chang Gung Memorial Hospital, Taoyuan City 33372, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City 33302, Taiwan
| | - Whei-Mei Shih
- Graduate Institute of Health Care, Chang Gung University of Science and Technology, Taoyuan City 33302, Taiwan
| | - Lan-Mei Huang
- Hemodialysis Unit, Taoyuan Chang Gung Memorial Hospital, Taoyuan City 33372, Taiwan
| | - Mei-Chu Tsai
- Department of Nursing, Taoyuan Chang Gung Memorial Hospital, Taoyuan City 33372, Taiwan
| | - Su-Mei Tseng
- Department of Nursing, Taoyuan Chang Gung Memorial Hospital, Taoyuan City 33372, Taiwan
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9
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Cho YH, Cho J, Cho OH. Effects of self-management education on COVID-19 prevention in patients undergoing hemodialysis. Heliyon 2023; 9:e12931. [PMID: 36644679 DOI: 10.1016/j.heliyon.2023.e12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
Aim To develop self-management education for preventing coronavirus disease 2019 (COVID-19) in patients on hemodialysis and to verify its effects. Background During the current pandemic, studies on various areas, such as infection control in dialysis units, infection rates, clinical characteristics, treatment progress, and the emotional and psychological states of dialysis patients, have been actively reported. However, experimental research verifying the effects of interventions on infection prevention in hemodialysis patients is very rare. Methods This study included 34 patients on hemodialysis in a South Korean general hospital (18 in the experimental group and 16 in the control group). Data were collected from September to October 2021. The experimental group was provided with self-care behavior for infection prevention education for 8 weeks, and the control group was provided with usual nursing care. Results The patients on hemodialysis showed moderate fear of COVID-19, good compliance with patient role behavior and self-management efficacy, and poor handwashing practice. After the intervention, there were no significant differences concerning fear of COVID-19, compliance with patient role behavior, and self-management efficacy between the experimental and control groups. However, confidence in handwashing (subjective norm) and proper handwashing practice improved significantly in the experimental group compared with the control group. Conclusion The infection prevention education developed in this study positively affected confidence in handwashing and proper handwashing practice in patients undergoing hemodialysis. This intervention can be used in various clinical settings where care is provided for patients with chronic illness, including those on hemodialysis.
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do Nascimento Lima H, Nerbass FB, Neto OMV, Sesso R, Lugon JR; Covid19-HD Brazil Investigators. 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. Int Urol Nephrol 2023; 55:449-58. [PMID: 35994131 DOI: 10.1007/s11255-022-03289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/26/2022] [Indexed: 01/25/2023]
Abstract
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.
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Bao WJ, Fu SK, Zhang H, Zhao JL, Jin HM, Yang XH. Clinical characteristics and short-term mortality of 102 hospitalized hemodialysis patients infected with SARS-CoV-2 omicron BA.2.2.1 variant in Shanghai, China. New Microbes New Infect 2022; 49:101058. [PMCID: PMC9691279 DOI: 10.1016/j.nmni.2022.101058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Background The aim of this study was to analyze clinical features and short-term mortality in hemodialysis (HD) patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) omicron BA.2.2.1 variant. Methods In a retrospective single-center case series, 102 consecutive hospitalized HD patients infected with the coronavirus omicron variant were assessed at Pudong Hospital in Shanghai, China, from April 6 to April 18, 2022; the final date of follow-up was May 16, 2022. Clinical, laboratory, chest CT, and treatment data were collected and analyzed. The association between these factors and all-cause mortality was studied using univariate and multivariate analyses. The relationship between lymphocyte count and short-term mortality was based on receiver operating characteristic (ROC) curve analysis. Kaplan–Meier analysis was used to assess overall survival. Results In total, 102 patients were included in this study. The patients were divided into two groups: HD patients with pneumonia (N = 46) and without pneumonia (N = 56). Of the 102 patients, 12 (11.8%) died. Multivariate regression analysis revealed that all-cause mortality was correlated with lymphocyte counts and type B natriuretic peptide (BNP), C-reactive protein (CRP), and D-dimer levels (P < 0.05). The cut-off value of lymphocyte counts was 0.61 × 109/L for all-cause mortality. The overall survival rate was significantly different between HD patients with and without pneumonia (P < 0.05). Conclusions Lymphocyte counts are important for the prediction of short-term mortality in HD patients with SARS-CoV-2 infection. HD patients with lung involvement have poorer survival rates than those without lung involvement.
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Affiliation(s)
- Wen Jing Bao
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong New District, 2800 Gong Wei Road, Shanghai, China
| | - Shun Kun Fu
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong New District, 2800 Gong Wei Road, Shanghai, China
| | - Hua Zhang
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong New District, 2800 Gong Wei Road, Shanghai, China
| | - Jun Li Zhao
- Division of Nephrology, Zhoupu Hospital, Shanghai University, Pudong New District, 1500 Zhouyuan Road, Shanghai, China
- Corresponding author.
| | - Hui Min Jin
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong New District, 2800 Gong Wei Road, Shanghai, China
- Corresponding author.
| | - Xiu Hong Yang
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong New District, 2800 Gong Wei Road, Shanghai, China
- Corresponding author.
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Nassar MK, Salem KM, Elgamal M, Abdel-Gawad SM, Tharwat S. COVID-19 Vaccination Trends and Side Effects among Egyptian Hemodialysis Patients: A Multicenter Survey Study. Vaccines (Basel) 2022; 10:vaccines10101771. [PMID: 36298635 PMCID: PMC9611711 DOI: 10.3390/vaccines10101771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 01/24/2023] Open
Abstract
(1) Background: Vaccination may be a key intervention to prevent infection in chronic hemodialysis (CHD) patients. This study aimed to determine the COVID-19 vaccination status in Egyptian CHD patients and to analyze the safety and detailed side effect profile of the COVID-19 vaccine among these patients. (2) Methods: This survey-based study was conducted on 670 end-stage renal disease (ESRD) patients on CHD from 3 December 2021 to 5 February 2022. Subjects were asked about sociodemographic characteristics, clinical and therapeutic data, in addition to their COVID-19 vaccination status. If the subject had been vaccinated, we inquired about the type of vaccine and the side effects that occurred within a few days after administration of the first and second dose of the COVID-19 vaccine. Additionally, subjects were asked about the onset of side effects (days from vaccination), timing of maximum symptoms, intensity of symptoms and their effect on activity and need for medical attention. (3) Results: The study included 670 CHD patients with a mean age of 50.79 years; 58.1% were females. The vast majority (614; 91.6%) of the studied patients received two doses of the vaccine. Side effects were more commonly reported after the first dose than the second dose. The main side effects reported were generalized weakness/fatigue (56%), headache (43.8%) and fever (40.4%), and sore arm/pain was also reported (29.3%). Adverse events mostly occurred within one day after vaccination and the maximum symptoms usually happened on the second day. The median duration of symptoms was 3 days with a maximum duration up to 5 days. The univariate logistic regression analysis showed that male gender (OR 1.848; (95% CI, 1.242−2.749), p = 0.002), age (OR 0.981; (95% CI, 0.969−0.993), p = 0.003), smoking (OR 6.067; (95% CI, 3.514−10.475), p < 0.001), duration since starting HD (OR 0.998; (95% CI, 0.998−0.999), p < 0.001), associated comorbidities (OR 2.202; (95% CI, 1.478−3.281), p < 0.001) and prior COVID-19 infection (OR 3.318; (95% CI, 1.952−5.642), p < 0.001) were the main determinants of adverse events related to COVID-19 vaccination. (4) Conclusions: our preliminary findings support the favorable short-term safety profile of the COVID-19 vaccine among CHD patients, and hence can reassure both clinicians and patients, as well as further promote COVID-19 vaccine administration among these patients.
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Affiliation(s)
- Mohammed Kamal Nassar
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
| | - Karem Mohamed Salem
- Nephrology & Dialysis Unit, Department of Internal Medicine, Faculty of Medicine, Fayoum University, Fayoum 63511, Egypt
| | - Mohamed Elgamal
- Chest Department, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
| | - Sara M. Abdel-Gawad
- Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University, Mansoura 35511, Egypt
| | - Samar Tharwat
- Rheumatology & Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
- Correspondence: ; Tel.: +20-010-9178-4143
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Fadel FI, Sabry S, Mawla MAA, Galal REE, Salah DM, Helmy R, Ramadan Y, Elzayat W, Abdelfattah M, Abd Alazem EA. Covid-19 in Egyptian hemodialysis and kidney transplant children: retrospective analysis of single center experience. Ital J Pediatr 2022; 48:149. [PMID: 35986373 PMCID: PMC9389481 DOI: 10.1186/s13052-022-01345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic kidney disease stage 5 (CKD 5) populations have peculiar risk for severe Covid-19 infection. Moreover; pediatric data are sparse and lacking. The aim of this study is to report our experience in CKD 5 children treated by hemodialysis (CKD 5D) and CKD 5 children after kidney transplantation (KTR) during one year of Covid-19 pandemic. Methods Retrospective analysis of 57 CKD 5 children with Covid-19 like symptoms during 1 year pandemic was performed. A cohort of 19 confirmed patients (13 CKD 5D and 6 KTR) was analyzed in details as regard clinical, laboratory, radiological criteria, management and their short term outcome. Results Conclusion Pediatric patients on regular HD (CKD 5D) are at higher risk and worse outcome of Covid-19 infection than KT recipients (KTR). Pre-existing HTN and shorter duration after KT are potential risk factors. Reversible AGD after KT and CVC related infections in HD patients are additional presenting features of Covid-19 infection.
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Cappuccilli M, Semprini S, Fabbri E, Fantini M, Bruno PF, Spazzoli A, Righini M, Flachi M, La Manna G, Sambri V, Mosconi G. Antibody Responses after Two Doses of COVID-19 mRNA Vaccine in Dialysis and Kidney Transplantation Patients Recovered from SARS-CoV-2 Infection. Medicina (B Aires) 2022; 58:893. [PMID: 35888612 PMCID: PMC9317561 DOI: 10.3390/medicina58070893] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 02/07/2023] Open
Abstract
Background and Objectives: Hemodialysis patients (HD) and kidney transplant recipients (KTRs) have been heavily impacted by COVID-19, showing increased risk of infection, worse clinical outcomes, and higher mortality rates than the general population. Although mass vaccination remains the most successful measure in counteracting the pandemic, less evidence is available on vaccine effectiveness in immunodepressed subjects previously infected and recovered from COVID-19. Materials and Methods: This study aimed at investigating the ability to develop an adequate antibody response after vaccination in a 2-dose series against SARS-CoV-2 in HD patients and KTR that was administered after laboratory and clinical recovery from COVID-19. Results: Comparing SARS-CoV-2 S1/S2 IgG levels measured before and after 2 doses of mRNA vaccine (BNT162b2 vaccine, Comirnaty, Pfizer–BioNTech or mRNA-1273 vaccine, Spikevax, Moderna), highly significant increases of antibody titers were observed. The antibody peak level was reached at 3 months following second dose administration, regardless of the underlying cause of immune depression and the time of pre-vaccine serology assessment after negativization. Conclusions: Our data indicate that HD patients and KTR exhibit a satisfying antibody response to a 2-dose series of mRNA vaccine, even in cases when infection-induced humoral immunity was poor or rapidly fading. Further studies are needed to evaluate the role of booster doses in conferring effective and durable protection in weak patient categories.
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Dang LT, Luong TC, Nguyen DH, Hoang TA, Nguyen HT, Nguyen HC, Duong TH, Tran TT, Pham LV, Ngo TV, Nguyen HT, Trieu NT, Do TV, Trinh MV, Ha TH, Phan DT, Do BN, Yang SH, Wang TJ, Duong TV. The Associations of Suspected COVID-19 Symptoms with Anxiety and Depression as Modified by Hemodialysis Dietary Knowledge: A Multi-Dialysis Center Study. Nutrients 2022; 14:nu14122364. [PMID: 35745093 PMCID: PMC9230868 DOI: 10.3390/nu14122364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/22/2022] [Accepted: 06/02/2022] [Indexed: 02/06/2023] Open
Abstract
During the COVID-19 pandemic, it is essential to evaluate hemodialysis patients’ dietary knowledge, especially among those with COVID-19 related symptoms, in order to identify appropriate strategies in managing their mental health. The study’s purposes were to test the psychometric properties of the hemodialysis dietary knowledge (HDK) scale, and to investigate the modifying impact of HDK on the associations of suspected COVID-19 symptoms (S-COVID-19-S) with anxiety and depression among hemodialysis patients. A cross-sectional study was conducted from July 2020 to March 2021 at eight hospitals across Vietnam. Data of 875 hemodialysis patients were analyzed, including socio-demographic, anxiety (the generalized anxiety disorder scale, GAD-7), depression (the patient health questionnaire, PHQ-9), S-COVID-19-S, HDK, health literacy, and digital healthy diet literacy. Confirmatory factor analysis (CFA) and logistic regression models were used to analyze the data. The HDK scale demonstrates the satisfactory construct validity with good model fit (Goodness of Fit Index, GFI = 0.96; Adjusted Goodness of Fit Index, AGFI = 0.90; Standardized Root Mean Square Residual, SRMR = 0.05; Root Mean Square Error of Approximation, RMSEA = 0.09; Normed Fit Index, NFI = 0.96; Comparative Fit Index, CFI = 0.96, and Parsimony goodness of Fit Index, PGFI = 0.43), criterion validity (as correlated with HL (r = 0.22, p < 0.01) and DDL (r = 0.19, p < 0.01), and reliability (Cronbach alpha = 0.70)). In the multivariate analysis, S-COVID-19-S was associated with a higher likelihood of anxiety (odds ratio, OR, 20.76; 95% confidence interval, 95%CI, 8.85, 48.70; p < 0.001) and depression (OR, 12.95; 95%CI, 6.67, 25.14, p < 0.001). A higher HDK score was associated with a lower likelihood of anxiety (OR, 0.70; 95%CI, 0.64, 0.77; p < 0.001) and depression (OR, 0.72; 95%CI, 0.66, 0.79; p < 0.001). In the interaction analysis, the negative impacts of S-COVID-19-S on anxiety and depression were mitigated by higher HDK scores (p < 0.001). In conclusion, HDK is a valid and reliable tool to measure dietary knowledge in hemodialysis patients. Higher HDK scores potentially protect patients with S-COVID-19-S from anxiety and depression during the pandemic.
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Affiliation(s)
- Loan T. Dang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112-19, Taiwan;
- Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi 115-20, Vietnam
| | - Thuc C. Luong
- Director Office, Military Hospital 103, Hanoi 121-08, Vietnam;
- Department of Cardiology, Cardiovascular Center, Military Hospital 103, Hanoi 121-08, Vietnam
| | - Dung H. Nguyen
- Hemodialysis Department, Nephro-Urology-Dialysis Center, Bach Mai Hospital, Hanoi 115-19, Vietnam; (D.H.N.); (T.A.H.)
| | - Trung A. Hoang
- Hemodialysis Department, Nephro-Urology-Dialysis Center, Bach Mai Hospital, Hanoi 115-19, Vietnam; (D.H.N.); (T.A.H.)
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan;
| | - Hoai T. Nguyen
- Division of Military Scientific Information, Vietnam Military Medical University, Hanoi 121-08, Vietnam;
| | - Hoang C. Nguyen
- Director Office, Thai Nguyen National Hospital, Thai Nguyen 241-24, Vietnam; (H.C.N.); (T.H.D.)
- President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 241-17, Vietnam
| | - Thai H. Duong
- Director Office, Thai Nguyen National Hospital, Thai Nguyen 241-24, Vietnam; (H.C.N.); (T.H.D.)
- Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 241-17, Vietnam
| | - Tu T. Tran
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan;
- Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 241-17, Vietnam
| | - Linh V. Pham
- Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, Vietnam;
| | - Tuan V. Ngo
- Department of Hemodialysis, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, Vietnam;
| | - Hoi T. Nguyen
- Director Office, Hai Phong International Hospital, Hai Phong 047-08, Vietnam;
| | - Nga T. Trieu
- Hemodialysis Division, Hai Phong International Hospital, Hai Phong 047-08, Vietnam;
| | - Thinh V. Do
- Director Office, Bai Chay Hospital, Ha Long 011-21, Vietnam;
| | - Manh V. Trinh
- Director Office, Quang Ninh General Hospital, Ha Long 011-08, Vietnam;
| | - Tung H. Ha
- Director Office, General Hospital of Agricultural, Hanoi 125-16, Vietnam;
| | - Dung T. Phan
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi 116-22, Vietnam;
- Nursing Office, Thien An Obstetrics and Gynecology Hospital, Hanoi 112-06, Vietnam
| | - Binh N. Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi 121-08, Vietnam;
- Division of Military Science, Military Hospital 103, Hanoi 121-08, Vietnam
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan;
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 110-31, Taiwan
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei 110-31, Taiwan
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112-19, Taiwan;
- Correspondence: (T.-J.W.); (T.V.D.); Tel.: +886-2-2822-7101 (ext. 3118) (T.-J.W.); +886-2-2736-1661 (ext. 6545) (T.V.D.)
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan;
- Correspondence: (T.-J.W.); (T.V.D.); Tel.: +886-2-2822-7101 (ext. 3118) (T.-J.W.); +886-2-2736-1661 (ext. 6545) (T.V.D.)
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Chen CY, Liu KT, Shih SR, Ye JJ, Chen YT, Hsu CK, Pan HC, Hsu HJ, Sun CY, Lee CC, Wu CY, Lai CC, Wu IW. Adequacy of Hemodialysis Serves as an Independent Predictor of Humoral Response to ChAdOx1 Prime-Boost Vaccination in Hemodialysis Patients. Viruses 2022; 14. [PMID: 35746621 DOI: 10.3390/v14061149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/24/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Immune response assessed by the quantification of neutralizing antibodies (nAbs) and predictors associated with immunogenicity after the prime-boost ChAdOx1 (Oxford−AstraZeneca) COVID-19 vaccine in hemodialysis (HD) patients remains unclear. Methods: This prospective study enrolled 174 HD patients and 67 healthy subjects to evaluate antibodies against the spike protein 1 and receptor-binding domain of severe acute respiratory syndrome coronavirus type 2 after prime-booster vaccination, by using enzyme-linked immunosorbent assay and applied spline-based generalized additive model regression analysis to predict 50% neutralization titer (NT50). The correlation between HD parameters and NT50 was analyzed. Results: NT50 was lower in HD patients compared with healthy controls after the prime-boost dose (p < 0.001). The geometric mean titer ratios were higher in first-dose seronegative than in the seropositive subgroup in HD patients and healthy controls (6.96 vs. 2.36, p = 0.002, and 9.28 vs. 1.26, p = 0.011, respectively). After two doses of ChAdOx1, one-way ANOVA showed that Ca × P was positively associated with NT50 (p trend = 0.043) and multiple linear regression showed the similar results (p = 0.021). Kt/V (a quantification of dialysis adequacy) (OR = 20.295, p = 0.005) could independently predict seroconversion (NT50 ≥ 35.13 IU/mL). Conclusion: Adequacy of hemodialysis could independently predict seroconversion in HD subjects vaccinated with prime-boost doses of ChAdOx1.
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Napuri NI, Curcio D, Swerdlow DL, Srivastava A. Immune Response to COVID-19 and mRNA Vaccination in Immunocompromised Individuals: A Narrative Review. Infect Dis Ther 2022; 11:1391-1414. [PMID: 35614299 PMCID: PMC9132351 DOI: 10.1007/s40121-022-00648-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/21/2022] [Indexed: 01/04/2023] Open
Abstract
Immunocompromised individuals are at high risk of poor coronavirus disease 2019 (COVID-19) outcomes and demonstrate a lower immune response to COVID-19 vaccines, including to the novel mRNA vaccines that have been shown to elicit high neutralizing antibody levels. This review synthesized available data on the immune response to COVID-19 and critically assessed mRNA COVID-19 vaccine immunogenicity in this vulnerable subpopulation. Patients with various immunocompromising conditions exhibit diverse responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 severity and mortality, and available vaccines elicit lower immune responses, particularly in solid organ transplant recipients. Strategies to improve vaccine responses in immunocompromised individuals are being implemented in vaccine recommendations, including the use of a third and fourth vaccine dose beyond the two-dose series. Additional doses may enhance vaccine effectiveness and help provide broad coverage against emerging SARS-CoV-2 variants. Continued investigation of vaccines and dosing regimens will help refine approaches to help protect this vulnerable subpopulation from COVID-19.
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Affiliation(s)
| | | | | | - Amit Srivastava
- Vaccines, Medical Development, Scientific and Clinical Affairs, Pfizer Inc, 300 Technology Square, 3rd Floor, Cambridge, MA, 02139, USA.
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Moreno NF, Mcadams R, Goss JA, Galvan NTN. COVID-19 Vaccine Efficacy and Immunogenicity in End-Stage Renal Disease Patients and Kidney Transplant Recipients. Curr Transpl Rep. [PMID: 35506151 PMCID: PMC9051503 DOI: 10.1007/s40472-022-00366-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 01/06/2023]
Abstract
Purpose of Review To summarize the current literature with respect to COVID-19 vaccine efficacy patients with end-stage renal disease on dialysis and kidney transplant recipients. Recent Findings Immunosuppressed patients are at greater risk of morbidity and mortality from COVID-19 infection. Patients with ESRD and KTR are immunosuppressed and mount a weaker antibody response to COVID-19 mRNA vaccination, and factors including immunosuppressant medications have been implicated for this weakened response. Third and fourth doses of vaccine doses have been shown to increase seropositivity and antibody production in kidney transplant recipients and patients on dialysis. Retrospective studies have demonstrated decreased mortality in vaccinated, immunosuppressed patients. Summary ESRD and KTR patients have decreased antibody response to COVID-19 vaccines, but third and fourth doses have been shown to increase antibody production. Though a correlate of protection between antibody production and efficacy has yet to be fully established in this subset of the population, all US professional bodies who treat ESRD and KTR patients advocate for full vaccination against SARS-CoV-2 based on the data available. Studies demonstrating decreased mortality in vaccinated patients are promising on efficacy. Importantly, because KTR patients mount a weaker antibody response than ESRD patients, vaccination prior to kidney transplantation is critical.
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Sultan BO, Fouad AM, Zaki HM. Adherence to hemodialysis and medical regimens among patients with end-stage renal disease during COVID-19 pandemic: a cross-sectional study. BMC Nephrol 2022; 23:138. [PMID: 35397516 PMCID: PMC8994066 DOI: 10.1186/s12882-022-02756-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Adherence of patients with End-Stage Renal Disease (ESRD) to Hemodialysis (HD), prescribed medications, diet and fluid restrictions is essential to get the desirable outcome and prevent complications. During COVID-19 pandemic, ESRD patients became more concerned with attending the HD sessions and following the protective measures because of the potential for increased susceptibility to COVID-19. The aim of this study was to evaluate the impact of the pandemic on patients' adherence to HD and medical regimens.
Methods
Two hundred five ESRD patients on HD were interviewed with the ESRD Adherence Questionnaire (ESRD-AQ) and the Fear-of-COVID-19 Scale (FCV-19S). Clinical and laboratory correlates of adherence were retrieved from patients' records.
Results
Self-reported adherence to HD showed that 19.5% were not adherent to HD during the pandemic compared to 11.7% before the pandemic (p < 0.001), with a significant agreement with the actual attendance of HD sessions (Kappa = 0.733, p < 0.001). Twenty-five patients (12.2%) had a history of COVID-19. The FCV-19S had a mean score of 18.8 and showed significant positive correlations with the pre-dialysis phosphorus and potassium. Multivariate analysis showed that the main predictors of non-adherence were the history of COVID-19, understanding and perception scores, and the Fear-of-COVID score.
Conclusions
The COVID-19 pandemic adversely affected the adherence of ESRD patients to HD and medical regimen. Strategies to mitigate patients' fears of COVID-19 and improve their understanding and perceptions of adherence to HD and medical regimen should be adopted in HD centers during the pandemic.
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Steiger S, Rossaint J, Zarbock A, Anders HJ. Secondary Immunodeficiency Related to Kidney Disease (SIDKD)-Definition, Unmet Need, and Mechanisms. J Am Soc Nephrol 2022; 33:259-278. [PMID: 34907031 PMCID: PMC8819985 DOI: 10.1681/asn.2021091257] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Kidney disease is a known risk factor for poor outcomes of COVID-19 and many other serious infections. Conversely, infection is the second most common cause of death in patients with kidney disease. However, little is known about the underlying secondary immunodeficiency related to kidney disease (SIDKD). In contrast to cardiovascular disease related to kidney disease, which has triggered countless epidemiologic, clinical, and experimental research activities or interventional trials, investments in tracing, understanding, and therapeutically targeting SIDKD have been sparse. As a call for more awareness of SIDKD as an imminent unmet medical need that requires rigorous research activities at all levels, we review the epidemiology of SIDKD and the numerous aspects of the abnormal immunophenotype of patients with kidney disease. We propose a definition of SIDKD and discuss the pathogenic mechanisms of SIDKD known thus far, including more recent insights into the unexpected immunoregulatory roles of elevated levels of FGF23 and hyperuricemia and shifts in the secretome of the intestinal microbiota in kidney disease. As an ultimate goal, we should aim to develop therapeutics that can reduce mortality due to infections in patients with kidney disease by normalizing host defense to pathogens and immune responses to vaccines.
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Affiliation(s)
- Stefanie Steiger
- Division of Nephrology, Department of Medicine IV, Ludwig Maximilians University Hospital of Munich, Munich, Germany
| | - Jan Rossaint
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, Ludwig Maximilians University Hospital of Munich, Munich, Germany
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21
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Kolesnyk M, Stepanova N. Post-COVID syndrome in dialysis patients and kidney transplant recipients. Ukr J Nephrol and Dial 2022:90-98. [DOI: 10.31450/ukrjnd.1(73).2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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22
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Chen CY, Liu KT, Shih SR, Ye JJ, Chen YT, Pan HC, Hsu HJ, Sun CY, Lee CC, Wu CY, Lai CC, Wu IW. Neutralization Assessments Reveal High Cardiothoracic Ratio and Old Age as Independent Predictors of Low Neutralizing Antibody Titers in Hemodialysis Patients Receiving a Single Dose of COVID-19 Vaccine. J Pers Med 2022; 12:68. [PMID: 35055386 DOI: 10.3390/jpm12010068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Data are lacking regarding predictors of quantification of neutralizing antibodies (nAbs) based on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 50% neutralization titer (NT50) after a single dose of COVID-19 vaccine in hemodialysis (HD) patients. Methods: This prospective single-center study enrolled 200 HD patients and 82 healthy subjects to estimate antibodies against the SARS-CoV-2 viral spike protein 1 and receptor-binding domain after a first dose of a COVID-19 vaccine (ChAdOx1 or mRNA-1273), measured by enzyme-linked immunosorbent assay and applied spline-based generalized additive model regression analysis to predict NT50 converted to international units. Results: After the first dose of ChAdOx1, multiple linear regression showed that age (p = 0.011) and cardiothoracic ratio (p = 0.002) were negatively associated with NT50. Older age (OR = 0.958, p = 0.052) and higher cardiothoracic ratio (OR < 0.001, p = 0.037) could predict negative humoral response (NT50 < 35.13 IU/mL). NT50 was lower in HD patients compared with healthy controls receiving ChAdOx1 (10.68 vs. 43.01 IU/m, p < 0.001) or mRNA-1273 (36.39 vs. 262.2 IU/mL, p < 0.001). ChAdOx1 elicited lower GMTs than mRNA-1273 in the HD cohort (10.68 vs. 36.39 IU/mL, p < 0.001) and in healthy controls (43.01 vs. 262.22 IU/mL, p < 0.001). Conclusion: High cardiothoracic ratio and old age could independently predict a decline in nAb titers in an HD cohort vaccinated with a single dose of ChAdOx1.
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Abstract
Research indicates that severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection can impact every organ, and the effects can range from asymptomatic to severe disease. Since it was first discovered in December 2019, our understanding has grown about its impact on kidney disease. In general, children have less severe disease than adults, and this tendency appears to extend to special pediatric kidney populations (e.g., chronic kidney disease and immunosuppressed patients with solid organ transplants or nephrotic syndrome). However, in a fraction of infected children, SARS-CoV2 causes an array of kidney manifestations, ranging from acute kidney injury to thrombotic microangiopathy, with potential implications for increased risk of morbidity and mortality. Additional considerations surround the propensity for clotting extracorporeal circuits in children with SARS-CoV2 infection that are receiving kidney replacement therapy. This review provides an update on our current understanding of SARS-CoV2 for pediatric nephrologists and highlights knowledge gaps to be addressed by future research during this ongoing pandemic, particularly the social disparities magnified during this period.
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Affiliation(s)
- Erica C Bjornstad
- Department of Pediatrics, Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michael E Seifert
- Department of Pediatrics, Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keia Sanderson
- Department of Medicine, Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel I Feig
- Department of Pediatrics, Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
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Carriazo S, Mas-Fontao S, Seghers C, Cano J, Goma E, Avello A, Ortiz A, Gonzalez-Parra E. Increased one-year mortality in hemodialysis patients with COVID-19: a prospective, observational study. Clin Kidney J 2021; 15:432-441. [PMID: 35198156 PMCID: PMC8755355 DOI: 10.1093/ckj/sfab248] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background Dialysis confers the highest risk of coronavirus disease 2019 (COVID-19) death among
comorbidities predisposing to severe COVID-19. However, reports of COVID-19-associated
mortality frequently refer to mortality during the initial hospitalization or first
month after diagnosis. Methods In a prospective, observational study, we analysed the long-term (1-year follow-up)
serological and clinical outcomes of 56 haemodialysis (HD) patients who were infected by
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first pandemic
wave. COVID-19 was diagnosed by a positive polymerase chain reaction (PCR) test
(n = 37) or by the development of anti-SARS-CoV-2 antibodies
(n = 19). Results After >1 year of follow-up, 35.7% of HD patients infected by SARS-CoV-2 during the
first pandemic wave had died, 6 (11%) during the initial admission and 14 (25%) in the
following months, mainly within the first 3 months after diagnosis. Overall, 30% of
patients died from vascular causes and 40% from respiratory causes. In adjusted
analysis, a positive SARS-CoV-2 PCR test for diagnosis {hazard ratio [HR] 5.18
[interquartile range (IQR) 1.30–20.65], P = 0.020}, higher baseline C-reactive protein
levels [HR 1.10 (IQR 1.03–1.16), P = 0.002] and lower haemoglobin levels [HR 0.62 (IQR
0.45–0.86), P = 0.005] were associated with higher 1-year mortality. Mortality in the
144 patients who did not have COVID-19 was 21 (14.6%) over 12 months [HR of death for
COVID-19 patients 3.00 (IQR 1.62–5.53), log-rank P = 0.00023]. Over the first year, the
percentage of patients having anti-SARS-CoV-2 immunoglobulin G (IgG) decreased from
36/49 (73.4%) initially to 27/44 (61.3%) at 6 months and 14/36 (38.8%) at 12 months. Conclusions The high mortality of HD patients with COVID-19 is not limited to the initial
hospitalization. Defining COVID-19 deaths as those occurring within 3 months of a
COVID-19 diagnosis may better represent the burden of COVID-19. In HD patients, the
anti-SARS-CoV-2 IgG response was suboptimal and short-lived.
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Affiliation(s)
- Sol Carriazo
- Servicio de Nefrología e Hipertensión. Fundación Jiménez Díaz, IIS-FJD UAM, Madrid, Spain
| | - Sebastian Mas-Fontao
- Laboratorio de patología renal y diabetes, CIBERDEM. IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | - Clara Seghers
- Servicio de Nefrología e Hipertensión. Fundación Jiménez Díaz, IIS-FJD UAM, Madrid, Spain
| | - Jaime Cano
- Servicio de Nefrología e Hipertensión. Fundación Jiménez Díaz, IIS-FJD UAM, Madrid, Spain
| | - Elena Goma
- Servicio de Nefrología e Hipertensión. Fundación Jiménez Díaz, IIS-FJD UAM, Madrid, Spain
| | - Alejandro Avello
- Servicio de Nefrología e Hipertensión. Fundación Jiménez Díaz, IIS-FJD UAM, Madrid, Spain
| | - Alberto Ortiz
- Servicio de Nefrología e Hipertensión. Fundación Jiménez Díaz, IIS-FJD UAM, Madrid, Spain
| | - Emilio Gonzalez-Parra
- Servicio de Nefrología e Hipertensión. Fundación Jiménez Díaz, IIS-FJD UAM, Madrid, Spain
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25
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Wang F, Ao G, Wang Y, Liu F, Bao M, Gao M, Zhou S, Qi X. Risk factors for mortality in hemodialysis patients with COVID-19: a systematic review and meta-analysis. Ren Fail 2021; 43:1394-1407. [PMID: 34629011 PMCID: PMC8510603 DOI: 10.1080/0886022x.2021.1986408] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background New evidence from studies on risk factors for mortality in hemodialysis (HD) patients with COVID-19 became available. We aimed to review the clinical risk factors for fatal outcomes in these patients. Methods We performed meta-analysis using the PubMed, EMBASE, and Cochrane databases. A fixed- or random-effects model was used for calculating heterogeneity. We used contour-enhanced funnel plot and Egger’s tests to assess potential publication bias. Results Twenty-one studies were included. The proportion of males was lower in the survivor group than in the non-survivor group (OR = 0.75, 95% CI [0.61, 0.94]). The proportion of respiratory diseases was significantly lower in the survivor group than in the non-survivor group (OR = 0.42, 95% CI [0.29, 0.60]). The proportion of patients with fever, cough, and dyspnea was significantly lower in the survivor group (fever: OR = 0.53, 95% CI [0.31, 0.92]; cough: OR = 0.50, 95% CI [0.38, 0.65]; dyspnea: OR = 0.25, 95% CI [0.14, 0.47]) than in the non-survivor group. Compared with the non-survivor group, the survivor group had higher albumin and platelet levels and lower leucocyte counts. Conclusions Male patients might have a higher risk of developing severe COVID-19. Comorbidities, such as respiratory diseases could also greatly influence the clinical prognosis of COVID-19. Clinical features, such as fever, dyspnea, cough, and abnormal platelet, leucocyte, and albumin levels, could imply eventual death. Our findings will help clinicians identify markers for the detection of high mortality risk in HD patients at an early stage of COVID-19.
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Affiliation(s)
- Fengping Wang
- Department of Nephrology, Chengdu Second People's Hospital, Chengdu, PR China
| | - Guangyu Ao
- Department of Nephrology, Chengdu First People's Hospital, Chengdu, PR China
| | - Yushu Wang
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, PR China.,Chengdu West China Clinical Research Center Co., Ltd, Chengdu, PR China
| | - Fuqiang Liu
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, PR China
| | - Mulong Bao
- Department of Intensive Care Unit, Chengdu First People's Hospital, Chengdu, PR China
| | - Ming Gao
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, PR China
| | - Shulu Zhou
- Department of Nephrology, Chengdu First People's Hospital, Chengdu, PR China
| | - Xin Qi
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & the Third People's Hospital of Chengdu, Chengdu, PR China
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Chen CY, Ye JJ, Huang TS, Lee CC, Chen YT, Hsu CK, Hsu HJ, Sun CY, Pan HC, Chen KS, Kao HH, Ko CC, She YH, Wu CY, Lai CC, Hwang SJ, Wu IW. Effective Preventive Strategies to Prevent Secondary Transmission of COVID-19 in Hemodialysis Unit: The First Month of Community Outbreak in Taiwan. Healthcare (Basel) 2021; 9:healthcare9091173. [PMID: 34574947 PMCID: PMC8467394 DOI: 10.3390/healthcare9091173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Dialyzed patients are vulnerable to coronavirus infection disease 2019 (COVID-19). The incidence and outcome of COVID-19 in hemodialysis (HD) patients in Taiwan remain unclear. A series of preventive measures were executed to combat COVID-19 transmission among HD patients. Methods: We carried out a series of forward-looking and practical preventive strategies of COVID-19 control in our HD center. Incidences of COVID-19 of our HD unit were compared with those of national and local estimates from a community outbreak from 15 May to 30 June 2021. Prognostic factors associated with mortality were analyzed. Results: The national incidence of COVID-19 was 0.062%; being highest in Taipei City (0.173%), followed by New Taipei City (0.161%) and Keelung (0.083%). The overall incidence in Keelung HD patients was 0.666%. One patient of our HD center contracted COVID-19 from the household; however, we have contained secondary transmission in our HD center by implementing strict preventive measures. The mortality rate of HD patients in Keelung was 66.6%. The median Ct value of HD patients was 17.53 (11.75–27.90) upon diagnosis. The deceased patients had a higher cardiac/thoracic ratio than alive (0.61 vs. 0.55, p = 0.036). Conclusions: Taking aggressive and proactive infection preventive measures impedes the secondary transmission of COVID-19 in HD facilities. COVID-19-associated mortality was high in HD patients, being the high cardiac-thoracic ratio, an important prognostic factor for clinical outcome of infected HD patients.
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Affiliation(s)
- Chun-Yu Chen
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Jung-Jr Ye
- Department of Infectious Diseases, Chang Gung Memorial Hospital, Keelung 204, Taiwan;
| | - Ting-Shuo Huang
- Community Medicine Research Center, Department of General Surgery, Chang Gung Memorial Hospital, Keelung 204, Taiwan;
- Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chin-Chan Lee
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Yih-Ting Chen
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Cheng-Kai Hsu
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Heng-Jung Hsu
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chiao-Yin Sun
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Heng-Chih Pan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Kuo-Su Chen
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Hao-Hsi Kao
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chia-Chun Ko
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Yun-Hsuan She
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chun-Ying Wu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Keelung 204, Taiwan;
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Shang-Jyh Hwang
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - I-Wen Wu
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-Y.C.); (C.-C.L.); (Y.-T.C.); (C.-K.H.); (H.-J.H.); (C.-Y.S.); (H.-C.P.); (K.-S.C.); (H.-H.K.); (C.-C.K.); (Y.-H.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Correspondence: ; Tel.: +886-2-24313131-6211
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27
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Chung EY, Palmer SC, Natale P, Krishnan A, Cooper TE, Saglimbene VM, Ruospo M, Au E, Jayanti S, Liang A, Deng DJJ, Chui J, Higgins GY, Tong A, Wong G, Teixeira-Pinto A, Hodson EM, Craig JC, Strippoli GF. Incidence and Outcomes of COVID-19 in People With CKD: A Systematic Review and Meta-analysis. Am J Kidney Dis 2021; 78:804-815. [PMID: 34364906 PMCID: PMC8339603 DOI: 10.1053/j.ajkd.2021.07.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/29/2021] [Indexed: 01/08/2023]
Abstract
Rationale & Objective Coronavirus disease 2019 (COVID-19) disproportionately affects people with chronic diseases such as chronic kidney disease (CKD). We assessed the incidence and outcomes of COVID-19 in people with CKD. Study Design Systematic review and meta-analysis by searching MEDLINE, EMBASE, and PubMed through February 2021. Setting & Study Populations People with CKD with or without COVID-19. Selection Criteria for Studies Cohort and case-control studies. Data Extraction Incidences of COVID-19, death, respiratory failure, dyspnea, recovery, intensive care admission, hospital admission, need for supplemental oxygen, hospital discharge, sepsis, short-term dialysis, acute kidney injury, and fatigue. Analytical Approach Random-effects meta-analysis and evidence certainty adjudicated using an adapted version of GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results 348 studies (382,407 participants with COVID-19 and CKD; 1,139,979 total participants with CKD) were included. Based on low-certainty evidence, the incidence of COVID-19 was higher in people with CKD treated with dialysis (105 per 10,000 person-weeks; 95% CI, 91-120; 95% prediction interval [PrI], 25-235; 59 studies; 468,233 participants) than in those with CKD not requiring kidney replacement therapy (16 per 10,000 person-weeks; 95% CI, 4-33; 95% PrI, 0-92; 5 studies; 70,683 participants) or in kidney or pancreas/kidney transplant recipients (23 per 10,000 person-weeks; 95% CI, 18-30; 95% PrI, 2-67; 29 studies; 120,281 participants). Based on low-certainty evidence, the incidence of death in people with CKD and COVID-19 was 32 per 1,000 person-weeks (95% CI, 30-35; 95% PrI, 4-81; 229 studies; 70,922 participants), which may be higher than in people with CKD without COVID-19 (incidence rate ratio, 10.26; 95% CI, 6.78-15.53; 95% PrI, 2.62-40.15; 4 studies; 18,347 participants). Limitations Analyses were generally based on low-certainty evidence. Few studies reported outcomes in people with CKD without COVID-19 to calculate the excess risk attributable to COVID-19, and potential confounders were not adjusted for in most studies. Conclusions The incidence of COVID-19 may be higher in people receiving maintenance dialysis than in those with CKD not requiring kidney replacement therapy or those who are kidney or pancreas/kidney transplant recipients. People with CKD and COVID-19 may have a higher incidence of death than people with CKD without COVID-19.
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Affiliation(s)
- Edmund Ym Chung
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Patrizia Natale
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anoushka Krishnan
- Department of Nephrology, Sir Charles Gairdner Hospital, Nedlands, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Tess E Cooper
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Valeria M Saglimbene
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Marinella Ruospo
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Eric Au
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Sumedh Jayanti
- Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Amy Liang
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | | | - Juanita Chui
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Gail Y Higgins
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Germaine Wong
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | | | - Elisabeth M Hodson
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Giovanni Fm Strippoli
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Sydney School of Public Health, The University of Sydney, Sydney, Australia
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