Background COVID-19 patients on hemodialysis (HD) have high mortality. We investigated the value of RT-PCR and the dynamic changes of antibodies (ELISA IgM+IgA and IgG) in a large HD cohort. Methods Prospective observational study in ten Madrid HD centers. Infection rate, anti- SARS-CoV-2 body dynamics and the incidence of asymptomatic SARS-CoV-2 infection (defined by positive RT-PCR, IgM-IgA or IgG) were assessed. Results From March 1 to April 15, 2020, 136 (16.8%) of 808 HD patients were diagnosed of symptomatic COVID-19 by nasopharyngeal RT-PCR and 42/136 (31%) died. In the second fortnight of April, RT-PCR and anti-SARS-CoV-2 antibodies were assessed on 763 of the surviving patients. At this point, 69/91 (75,8%) symptomatic COVID-19 patients had anti-SARS-CoV-2 antibodies. Four weeks later, 15.4% (10/65) of initially antibody positive patients had become negative. Among patients without prior symptomatic COVID-19, 9/672 (1.3%) were RT-PCR positive and 101/672 patients (15.0%) were antibody positive. Four weeks later, 6224/86 (72.1%) of initially antibody positive patients had become negative. Considering only IgG tittles, serology remained positive after four weeks in 90% (54/60) of patients with symptomatic COVID-19 and in 52.5% (21/40) of asymptomatic patients. The probability of an adequate serologic response (defined as the development of anti-SARS-CoV2 antibodies that persisted at 4 weeks) was higher in patients who had symptomatic COVID-19 than in asymptomatic SARS-CoV2 infection (OR 4.04 [2.04-7.99] corrected for age, Charlson score and time on HD. Living in a nursing home (5.9 [2.3-15.1]) was the main risk factors for SARS-CoV2 infection Conclusion The anti-SARS-CoV-2 antibody immune response in HD patients depends on clinical presentation and the antibody titers decay earlier than previously reported for the general population. This inadequate immune response raises questions about the efficacy of future vaccines.

A prospective observational study for justification, safety, and efficacy of a third dose of mRNA vaccine in patients receiving maintenance hemodialysis. Kidney Int 101: [390][391][392][393][394][395][396][397][398][399][400][401][402] 2022

<b><i>Background:</i></b> CKD is a risk factor for severe COVID-19. However, the clinical spectrum of COVID-19 in hemodialysis patients is still poorly characterized. <b><i>Objective:</i></b> To analyze the clinical spectrum of COVID-19 on hemodialysis patients. <b><i>Method:</i></b> A retrospective observational study was conducted on 66 hemodialysis patients. Nasopharyngeal swab PCR and serology for SARS-CoV-2, blood analysis, chest radiography, treatment, and outcomes were assessed. <b><i>Results:</i></b> COVID-19 was diagnosed in 50 patients: 38 (76%) were PCR-positive and 12 (24%) were PCR-negative but developed anti-SARS-CoV-2 antibodies. By contrast, 17% of PCR-positive patients failed to develop detectable antibodies against SARS-CoV-2. Among PCR-positive patients, 5/38 (13%) were asymptomatic, while among PCR-negative patients 7/12 (58%) were asymptomatic (<i>p</i> = 0.005) for a total of 12/50 (24%) asymptomatic patients. No other differences were found between PCR-positive and PCR-negative patients. No differences in potential predisposing factors were found between asymptomatic and symptomatic patients except for a lower use of ACE inhibitors among asymptomatic patients. Asymptomatic patients had laboratory evidence of milder disease such as higher lymphocyte counts and oxygen saturation and lower troponin I and interleukin-6 levels than symptomatic patients. Overall mortality was 7/50 (14%) and occurred only in symptomatic PCR-positive patients in whom mortality was 7/33 (21%). <b><i>Conclusions:</i></b> Asymptomatic SARS-CoV-2 infection is common in hemodialysis patients, especially among patients with initial negative PCR that later seroconvert. Thus COVID-19 mortality in hemodialysis patients may be lower than previously estimated based on PCR tests alone.

Introduction Patients on hemodialysis are at high-risk for complications derived from coronavirus disease-19 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity three months after the booster dose. Methods This is a multicentric and prospective study assessing IgG anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Results A total of 711 patients (67% male, 67 [20-89] years) were included. Of which, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, p = 0.001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, p = 0.693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated to mRNA-1273 booster (p = 0.001), lower time from booster (p = 0.043) and past breakthrough SARS-CoV-2 infection (p&lt;0.001). Conclusions In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated to mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infection.

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Background The COVID pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies has proposed deferring the creation of an elective vascular access (VA) (autologous or prosthetic arteriovenous fistula (AVF or AVG) in incident patients on hemodialysis (HD) in the era of a COVID pandemic. The aim of this study is to examine the impact of COVID pandemic on VA creation and the CVC-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of 3 different regions. Methods We compared retrospectively two periods of time: the pre-COVID (January 1th 2019-March 11th 2020) and the COVID era (March 12th 2020-June 30th 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centers. The variables analyzed were: type of VA (central venous catheter-CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC-HD sessions that did not reach the goal of KT(KT&gt; 45) as marker of HD adequacy. Results 1791 VA for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during COVID period compared to those who did not were significantly younger and a significant decrease of surgical activity to create AVFs and AVGs in older HD patients (&gt; 75 and &gt; 85 years) was observed in COVID period compared to Pre-COVID period. There was a significant increase in CVC placement (from 59.7% to 69.5%) (p&lt;0.001) from the pre-COVID to the COVID time-period. During COVID pandemic a significantly higher number of patients started HD through a CVC (80.3% vs. 69.1%, p&lt;0.001) The percentage of CVC in prevalent HD patients has not decreased 19 months after the start of the pandemic (414 CVC/1058 prevalent patients (39.4%). No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In COVID period a significant increase in catheter replacement and in the percentage of HD session that not reach the HD dose objective (KT&gt; 45) was observed. Conclusions COVID has presented a public health system crisis that has influenced VA for HD with an increase of CVC relative to AVF. A decrease in HD session that not reach the HD dose objective was observed in COVID period compared to preCOVID period.

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