Background There is scarce evidence on fourth doses of SARS-CoV-2 vaccines in chronic kidney disease (CKD) patients. We have evaluated the humoral response and effectivity of the fourth dose in the CKD spectrum: non-dialysis CKD (ND-CKD), hemodialysis (HD), peritoneal dialysis (PD) and kidney transplant (KT) recipients. Methods This is a prespecified analysis of the prospective, observational, multicentric SENCOVAC study. In patients with CKD who had received a complete initial vaccination and one or two boosters and had anti-Spike antibody determinations 6 and 12 months after the initial vaccination, we analyzed factors associated to persistent negative humoral response and to higher anti-Spike antibody titers as well as the efficacy of vaccination on COVID-19 severity. Results Of 2186 patients (18% KT, 8% PD, 69% HD and 5% ND-CKD), 30% had received a fourth dose. The fourth dose increased anti-Spike antibody titers in HD (P = 0.001) and ND-CKD (P = 0.014) patients and seroconverted 72% of previously negative patients. Higher anti-Spike antibody titers at 12 months were independently associated to repeated exposure to antigen (fourth dose, previous breakthrough infections), previous anti-Spike antibody titers and not being a KT. Breakthrough COVID-19 was registered in 137 (6%) patients, of whom 5% required admission. Admitted patients had prior titers below 620 UI/ml and median values were lower (P = 0.020) than in non-admitted patients. Conclusions A fourth vaccine dose increased anti-Spike antibody titers or seroconverted many CKD patients, but those with the highest need for a vaccine booster (i.e. those with lower pre-booster antibody titers or KT recipients) derived the least benefit in terms of antibody titers. Admission for breakthrough COVID-19 was associated with low anti-Spike antibody titers.
Background: Acute kidney injury (AKI) during hospitalisation is frequent and associated with adverse outcomes.Aims: To evaluate the association between renal function recovery after AKI and short-term post-discharge mortality.Methods: This is a retrospective study of all AKI episodes codified in the electronic records of a single centre in 2013 and 2014. Epidemiological data and comorbidities at baseline and laboratory values at admission and discharge were collected. Persistent kidney dysfunction after AKI was defined as a last serum creatinine equal or above 1.2-fold over baseline level. Patients were followed for 30 days after discharge.Results: Out of 1720 evaluated patients, 1541 (89%) were analysed. Of them, 869 (56%) recovered renal function. Independent predictors of renal function recovery after AKI were lower baseline estimated glomerular filtration rate (eGFR) (P < 0.001), higher admission eGFR (P < 0.001) and haemoglobin (P = 0.016), milder AKI (P = 0.037), absence of a history of heart failure (P < 0.001) and lower admission blood pressure (P < 0.001). After discharge, 46 (3%) patients died in the first 30 days. Persistent kidney dysfunction was associated (P = 0.01) with and independently predicted (odds ratio 2.6; 95% confidence interval 1.2-5.4; P = 0.01) short-term post-discharge mortality.Conclusions: Persistent kidney dysfunction after an AKI episode is an independent predictor of 30-day post-discharge mortality. This information might help select AKI patients who require closer follow up and monitoring after discharge.
Background Kidney replacement therapy (KRT) confers the highest risk of death from COVID-19. However, most data refer to the early pandemic waves. Whole year analysis in comparison with prior secular trends are scarce. Methods We present the 2020 REMER Madrid KRT registry, corresponding to the Spanish Region hardest hit by COVID-19. Results In 2020, KRT incidence decreased 12% versus 2019 while KRT prevalence decreased (−1.75%) for the first time since records began and the number of kidney transplants (KT) decreased by 16%. Mortality on KRT was 10.2% (34% higher than the mean for 2008–2019). The 2019 to 2020 increase in mortality was larger for KT (+68%) than for HD (+24%) or PD (+38%). The most common cause of death was infection (n = 419, 48% of deaths), followed by cardiovascular (200, 23%). Deaths from infection increased by 167% year over year and accounted for 95% of excess deaths in 2020 over 2019. COVID-19 was the most common cause of death (68% of infection deaths, 33% of total deaths). The bulk of COVID-19 deaths (209/285, 73%) occurred during the first COVID-19 wave, which roughly accounted for the increased mortality in 2020. Being a KT recipient was an independent risk factor for COVID-19 death. Conclusions COVID-19 negatively impacted the incidence and prevalence of KRT, but the increase in KRT deaths was localized to the first wave of the pandemic. The increased annual mortality argues against COVID-19 accelerating death of patients with short life expectancy and the temporal pattern of COVID-19 mortality suggests that appropriate healthcare may improve outcomes.
Background and Aims The incidence of acute kidney injury (AKI) during a hospitalization is frequent and worsen the prognosis. Recovery of renal function after AKI has been lightly studied and cut-off for establishing full recovery has not been determined. The aim of the present study is to evaluate the association between different degrees of renal function recovery after AKI and short-term mortality post-discharge. Method This is a retrospective study that included all the AKI codified in the electronic records of our center in 2013 and 2014. We collect epidemiological data and comorbidities at baseline and laboratory values at admission and discharge. To analyze the impact of recovery of renal function after AKI we performed a univariate logistic regression with different cutoff of creatinine after 7 days of the AKI in comparison to baseline. We used the most sensitive cutoff to define recovery and evaluated associated factors (figure 1). Patients were followed during 30 days to assess associated factors to prognosis after AKI. Results We included 1720 patients in this study. After the hospitalization due to AKI, 1194 (69%) entered in the final analysis. Of them 869 (73%) recovered renal function. Factors associated to recovery were age (p=0.01), presence of CKD (p=0.04), basal renal function (p<0.001), history of heart failure (p=0.02), having cognitive impairment (p=0.01), dependence (using Barthel index, p=0.002), renal function at admission (p<0.001), severity of AKI (p<0.001), blood pressure at admission (p=0.02) and hemoglobin at admission (p=0.04). Independent predictors of recovery were basal CKD-EPI (p<0.001), CKD-EPI at admission (p<0.001), severity of AKI (p=0.037), hemoglobin at admission (p=0.016), blood pressure at admission (p<0.001) and history of heart failure (0.001). After discharge, 46 (3%) patients died in the first 30 days. Associated factors to mortality were history of neoplasia (p=0.02), cognitive impairment (p<0.001), Barthel index (p<0.001) and the absence of renal recovery after AKI (defined as reaching a creatinine above 1.2 times of the baseline) (p=0.01). In an adjusted model, renal function recovery independently predicted short term mortality (HR 2.6, 95%CI [1.2-5.4], p=0.01). Conclusion The absence of recovery after an AKI is an independent predictor of 30-day mortality.
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