The present vascular calcification scoring represents a simple tool for the assessment of cardiovascular risk related with vascular calcifications in chronic HD patients.

Higher SVCS, PWV and PP were associated with higher mortality in this population. SVCS was associated with arterial stiffness. Simple and inexpensive methods such as PP or SVCS may be used to detect mortality risk and to provide important information that may be relevant for guiding therapeutic intervention in dialysis patients.

Background Experiences from the first wave of the 2019 coronavirus disease (COVID-19) pandemic can aide in the development of future preventive strategies. To date, risk prediction models for COVID-19-related incidence and outcomes in haemodialysis (HD) patients are missing. Methods We developed risk prediction models for COVID-19 incidence and mortality among HD patients. We studied 38 256 HD patients from a multi-national dialysis cohort between March 3rd and July 3rd 2020. Risk prediction models were developed and validated, based on predictors readily available in outpatient haemodialysis units. We compared mortality among patients with and without COVID-19, matched for age, sex, and diabetes. Results During the observational period, 1 259 patients (3.3%) acquired COVID-19. Of these, 62% were hospitalised or died. Mortality was 22% among COVID-19 patients with odds ratios 219.8 (95% CI 80.6-359) to 342.7 (95% CI 60.6-13595.1), compared to matched patients without COVID-19. Since the first wave of the pandemic affected mostly European countries during the study, the risk prediction model for incidence of COVID-19 was developed and validated in European patients only (N = 22 826, AUCDev 0.64, AUCVal 0.69). The model for prediction of mortality was developed in all COVID-19 patients (AUCDev 0.71, AUCVal 0.78). Angiotensin receptor blockers were independently associated with a lower incidence of COVID-19 in European patients. Conclusions We identified modifiable risk factors for COVID-19 incidence and outcome in HD patients. Our risk prediction tools can be readily applied in clinical practice. The current study can aid in the development of preventive strategies for future waves of COVID-19.

Background Dialysis patients are at risk for lower SARS-CoV-2-vaccine immunogenicity than the normal population. We assessed immunogenicity to a first mRNA- or vector-based SARS-CoV-2-vaccination dose in dialysis patients. Methods In a multicenter observational pilot study, 2 weeks after a first vaccination (BNT162b2/Pfizer-BioNTech [Comirnaty] or ChAdOx1 nCoV-19/Oxford-Astra-Zeneca [Vaxzevria]), hemodialysis patients (N = 23), peritoneal dialysis patients (N = 4) and healthy staff (N = 14) were tested for SARS-CoV-2-spike IgG/IgM, Nucleocapsid-protein-IgG-antibodies and plasma ACE2-receptor-binding-inhibition capacity. Hemodialysis patients who had had prior COVID-19 infection (N = 18) served as controls. Both response to first SARS-CoV-2 vaccination and IgG spike-positivity following prior COVID-19 infection were defined as SARS-CoV-2 spike IgG levels ≥ 50 AU/mL. Results Vaccination responder rates were 17.4% (4/23) in hemodialysis patients, 100% (4/4) in peritoneal dialysis patients and 57.1% (8/14) in staff (HD vs. PD: p = 0.004, HD vs. staff: p = 0.027). Among hemodialysis patients, type of vaccine (Comirnaty N = 11, Vaxzevria N = 12, 2 responders each) did not appear to influence antibody levels (IgG spike: Comirnaty median 0.0 [1.–3. quartile 0.0–3.8] versus Vaxzevria 4.3 [1.6–20.1] AU/mL, p = 0.079). Of responders to the first dose of SARS-CoV-2 vaccination among hemodialysis patients (N = 4/23), median IgG spike levels and ACE2-receptor-binding-inhibition capacity were lower than that of IgG spike-positive hemodialysis patients with prior COVID-19 infection (13/18, 72.2%): IgG spike: median 222.0, 1.–3. quartile 104.1–721.9 versus median 3794.6, 1.–3. quartile 793.4–9357.9 AU/mL, p = 0.015; ACE2-receptor-binding-inhibition capacity: median 11.5%, 1.–3. quartile 5.0–27.3 versus median 74.8%, 1.–3. quartile 44.9–98.1, p = 0.002. Conclusions Two weeks after their first mRNA- or vector-based SARS-CoV-2 vaccination, hemodialysis patients demonstrated lower antibody-related response than peritoneal dialysis patients and healthy staff or unvaccinated hemodialysis patients following prior COVID-19 infection. Graphic abstract

Patency of the left superior vena cava, although uncommon, is the most frequent anomaly of the thoracic vessels. It has been diagnosed in 0.3–0.5% of the general population. A persistent left superior vena cava (PLSVC) results from the abnormal persistence of an embryological vessel that normally involutes into the coronary sinus during fetal life. Catheterization of this vessel, including hemodialysis (HD) catheter placement, appears to be safe if adequate drainage of the PLSVC to the right atrium exists. We present the case of a 50-year-old HD patient in which the placement of a catheter through the left internal jugular vein, needed for HD treatment, revealed a PLSVC. After the demonstration of adequate draining of the vessel into the right atrium, replacement of this catheter for a cuffed tunneled HD catheter was done, which has since been used successfully for HD.