US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States

Johansen, Kirsten L.; Chertow, Glenn M.; Foley, Robert N.; Gilbertson, David T.; Herzog, Charles A.; Ishani, Areef; Israni, Ajay K.; Ku, Elaine; Tamura, Manjula Kurella; Li, Shuling; Li, Suying; Liu, Jiannong; Obrador, Gregorio T.; O’Hare, Ann M.; Peng, Yen‐Chun; Powe, Neil R.; Roetker, Nicholas S.; Peter, Wendy L. St.; Abbott, Kevin C.; Chan, Kee; Schulman, Ivonne H; Snyder, Jon J.; Solid, Craig A.; Weinhandl, Eric D.; Winkelmayer, Wolfgang C.; Wetmore, James B.

doi:10.1053/j.ajkd.2021.01.002

Cited by 418 publications

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“…1 Confirmatory data from the US Renal Data System found mortality among hemodialysis patients in early 2020 was 16-37% higher than in 2017-2019. 3 Dialysis patients frequently have diminished immune response to vaccination compared with the general population, as observed during hepatitis B vaccination. 4 Studies of natural COVID-19 infection in dialysis patients found waning antibody concentrations by three months, raising the possibility that dialysis patients may not develop an adequate vaccination response.…”

Section: Introductionmentioning

confidence: 99%

The Humoral Response to the BNT162b2 Vaccine in Hemodialysis Patients

Yau

Abe

Naimark

et al. 2021

Preprint

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Importance: Hemodialysis patients have an exceptionally high mortality from COVID-19 and this patient population often has a poor response to vaccinations. Randomized controlled trials for COVID-19 vaccines included few patients with kidney disease, therefore vaccine immunogenicity is uncertain in this population. Objective: Evaluate the SARS-CoV-2 antibody response in chronic hemodialysis patients following one versus two doses of BNT162b2 COVID-19 vaccination compared to health care worker controls and convalescent serum. Design: Prospective observational cohort study. Setting: Single centre study in Toronto, Ontario, Canada. Participants: 142 in-centre hemodialysis patients and 35 health care worker controls. Exposure: BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. Main Outcomes and Measures: SARS-CoV-2 IgG antibodies to the spike protein (anti-spike), receptor binding domain (anti-RBD), and nucleocapsid protein (anti-NP) were measured in 66 hemodialysis patients receiving one vaccine dose following a public health policy change, 76 patients receiving two vaccine doses, and 35 health care workers receiving two vaccine doses. Results: Detectable anti-NP suggestive of natural SARS-CoV-2 infection was detected in 15/142 (11%) of patients at baseline while only three patients had prior RT-PCR confirmed COVID-19. Two additional patients contracted COVID-19 after receiving two doses of vaccine. In patients receiving a single BNT162b2 dose, seroconversion occurred in 53/66 (80%) for anti-spike and 35/66 (55%) for anti-RBD by 28 days post dose, but only 15/66 (23%) and 4/66 (6%), respectively attained a robust response as defined by reaching the median level of anti-spike and anti-RBD in convalescent serum from COVID-19 survivors. In patients receiving two doses of BNT162b2 vaccine, seroconversion occurred in 69/72 (96%) for anti-spike and 63/72 (88%) for anti-RBD by 2 weeks following the second dose while 52/72 (72%) and 43/76 (41%) reached the median convalescent serum level of anti-spike and anti-RBD, respectively. In contrast, 35/35 (100%) of health care workers exceeded the median level of anti-spike and anti-RBD found in convalescent serum 2-4 weeks after the second dose. Conclusions and Relevance: This study confirms poor immunogenicity 28 days following a single dose of BNT162b2 vaccine in the hemodialysis population, supporting adherence to recommended vaccination schedules, and avoiding delay of the second dose in these at-risk individuals.

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Section: Introductionmentioning

confidence: 99%

The Humoral Response to the BNT162b2 Vaccine in Hemodialysis Patients

Yau

Abe

Naimark

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Although ‘fistula first’ strategy was recommended and the long-term CVC use was discouraged by the previous Kidney Disease Outcomes Quality Initiative vascular access guideline [ 21 ], the newer guideline recognized that CVCs may be appropriate for certain circumstances, such as in an older hemodialysis patients with limited life expectance or those with poor vascular access sites [ 22 ]. With this change in strategy for vascular access considering end-stage kidney disease life-plan and the increase of proportion of elderly dialysis patients, the high prevalence of CVC insertion for initial vascular access has hardly changed for 10 years [ 23 , 24 ]. Nevertheless, current guidelines for the management of vascular access for dialysis in the United States [ 21 , 22 ], Australia [ 25 ], and Europe [ 26 ] do not clearly define or describe all potential risks associated with CVC insertion, such as severe bleeding and air embolism; they describe only the risk of infection.…”

Section: Discussionmentioning

confidence: 99%

Medical malpractice related to dialysis and vascular access: An analysis of lawsuit judgements in South Korea

et al. 2021

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Background Hemodialysis is a life-saving renal replacement treatment for patients with chronic kidney disease, but various complications occur during hemodialysis and associated procedures. This study was conducted to analyze the specific characteristics of hemodialysis-related complications and malpractice that have led to legal disputes. Methods Judgments from cases litigated between 1991 and 2019 due to complications related to hemodialysis or vascular access were analyzed using the database of the Korean Supreme Court Judgment System. Results Of 32 dialysis-related litigation cases, 14 cases were dismissed and malpractice was recognized in 18 cases. Among all cases and those in which malpractice was recognized, the most common clinical complication was associated with central venous catheter (CVC) insertion (25.0% and 42.9%, respectively). In 22 of 32 (68.8%) cases, complications occurred before or after (not during) dialysis, and performance error was the most common clinical error leading to legal disputes (58.3%). Complications resulted in death in 59.4% of cases, and CVC-related complications were associated with the largest proportion (63.2%) of deaths. Conclusions Hemodialysis was implicated in various medical disputes, and CVC-related complications were the most common and serious adverse events. Clinicians’ awareness of the incidence and severity of possible complications of hemodialysis procedures should be increased.

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“…According to the United States Renal Data System (USRDS), the number of people with end stage kidney disease (ESKD) in the United States has increased every year between 1980 and 2018. 1 , 2 Between 1980 and 2000, increasing prevalence mostly reflected rapidly increasing incidence of ESKD. Since 2000, increasing prevalence has shifted toward improved survival among patients on maintenance dialysis, as well as those with a functioning kidney transplant.…”

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confidence: 99%

“…During the early part of the pandemic, all-cause mortality was 17% and 30% higher than expected among dialysis and transplant patients, respectively, while the number of patients who initiated kidney replacement therapy (KRT) declined sharply. 2 , 4 Considering that the rate of COVID-19 hospitalization was approximately 40 times higher among dialysis patients than in the general population, 4 it is likely that substantial mortality also occurred during the past winter. In this report, we quantified the impact of COVID-19 on the size of the ESKD population at one year after the declaration of a national emergency.…”

mentioning

confidence: 99%

“…Nevertheless, with essentially static adjusted incidence of ESKD and likely expansion of sodium-glucose cotransporter-2 inhibitor utilization, it is also possible that the number of dialysis patients in the country is nearing an apex, thus providing an opportunity for the ESKD population to shift away from its long-standing mixture of 70% of patients undergoing dialysis and 30% of patients with a functioning transplant. 2 However, the future is admittedly uncertain. Whether the number of people with advanced CKD and high risk of progression to ESKD has declined during the past year is unknown.…”

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confidence: 99%

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US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States

Cited by 418 publications

References 0 publications

The Humoral Response to the BNT162b2 Vaccine in Hemodialysis Patients

The Humoral Response to the BNT162b2 Vaccine in Hemodialysis Patients

Medical malpractice related to dialysis and vascular access: An analysis of lawsuit judgements in South Korea

COVID-19−Associated Decline in the Size of the End-Stage Kidney Disease Population in the United States

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