The coronavirus virus disease 2019 (COVID-19) pandemic has impacted the global healthcare system. In Thailand, the first and most available vaccines were inactivated and viral vector vaccines. We reported the impact of those vaccines in preventing severe disease and death in kidney transplant recipients. This retrospective study comprised 45 kidney transplant recipients with COVID-19 infection, classified by vaccination status. Outcomes of interest were death, pneumonia, and allograft dysfunction. There were 23 patients in vaccinated group and 22 patients in unvaccinated group. All baseline characteristics were similar except mean age was older in vaccinated group, 55 vs. 48 years. Total 11 patients (24%) died (13% vaccinated vs. 36% unvaccinated RR, 0.56; 95% CI, 0.29–0.83; p = 0.03). Multivariate analysis showed that vaccination significantly decrease mortality (odds ratio, 0.54; 95% CI, 0.10–0.94; p = 0.03). Pneumonia developed equally in both groups (70%). There was a trend toward less oxygen requirement as well as ventilator requirement in vaccinated group. The rate of allograft dysfunction was similar (47%). Inactivated and viral vector COVID-19 vaccines have beneficial effect on mortality reduction in kidney transplant recipients. Even partial vaccination can exert some protection against death. However, full vaccination should be encouraged to achieve better prevention.
The mortality rate after novel coronavirus infection, which causes severe acute respiratory distress syndrome (SARS-CoV-2), is much higher in kidney transplant recipients (KTRs) compared to the general population. Seroconversion after vaccination is also lower, and breakthrough infection is much higher. Many studies reported seroconversion rate after a booster (third) dose of vaccine but clinical outcomes received less attention. Here, we reported the impact of an mRNA vaccine booster dose on clinical outcomes of KTRs with SARS-CoV-2 infection. A total of 183 KTRs with SARS-CoV-2 infection were identified. Of 183 KTRs, 146 KTRs had sufficient data for analysis and were included in this study. Forty-eight patients (32.9%) received zero to 1 doses of vaccine (Group 1), thirty-one (21.2%) received two doses (Group 2), and sixty-seven (45.9%) received a booster dose (Group 3). Pneumonia developed in 50%, 23%, and 10% in Group 1, 2, and 3 (p < 0.001). Hospital admission requirement was 81%, 48%, and 12% (p < 0.001). Mortality rate was 26%, 3%, and 3% (p = 0.001). A multivariate analysis showed that only diabetes adversely affects mortality while the booster dose of the vaccine significantly reduced mortality. The booster dose of the vaccine is strongly recommended in all KTRs especially those with diabetes. Our study also suggested the timing of the booster dose vaccine to be administered within 4 months after the second dose.
Objective: To determine the association between AGE accumulation detected by skin-autofluorescence (SAF) and hospitalization among ESKD patients.Materials and Methods: 196 ESKD patients from two hemodialysis (HD) units in Bangkok were enrolled in this retrospective study from November 2015 to March 2016. Before HD treatment, AGEs were measured with the SAF device on the area with intact skin on the volar surface of the non-fistula arm. The study concluded in December 2020, and the number of and causes of hospitalization were reviewed. A logistic regression model was used to determine the association between SAF level and patient hospitalization.Results: Of the 196 patients enrolled in the study, SAF was measured in 165 patients with a mean (SD) age of 69.2 (13.0) years. Most of the participants were non-smokers who had hypertension and diabetes and were on high-flux dialyzers. The average weekly spKt/V was 2.1, and the mean (SD) SAF was 3.05 (0.81) AU. The group with high SAF consisted of older patients and had a higher proportion of diabetics and smokers, but this was not statistically significant when compared to the low SAF group. In the multivariable analysis model, SAF greater or equal to 3.05 AU (OR = 2.28; 95% CI, 1.05–4.94; P < 0.05) and increased age (OR = 1.05; 95% CI, 1.01–1.09; P < 0.05) were associated with an increased risk of hospitalization.Conclusion: Higher values of age and SAF were independently associated with increased risk of hospitalization among ESKD patients.
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