COVID-19 Prevalence and Mortality in Chronic Dialysis Patients

Hoxha, Elion; Suling, Anna; Turner, Jan Eric; Haubitz, Marion; Floege, Jürgen; Huber, Tobias B.; Galle, Jan

doi:10.3238/arztebl.m2021.0160

Cited by 14 publications

(15 citation statements)

References 3 publications

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“…Among these, end-stage renal disease patients (ESRD) on thrice weekly hemodialysis have been identified as an especially vulnerable patient population due to reduced possibility of self-isolation and the well-known impaired immune competence. Correspondingly high mortality rates between 16 and 37% have already been reported in this population from various countries and healthcare systems [ 4 , 5 ]. Although seroconversion rates in hemodialysis patients after two doses of SARS-CoV-2 vaccination have been reported well above the success rates of other conventional vaccination schemes e.g., for hepatitis B in this patient population, these response rates are still below those of the normal population [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 84%

Evolution of SARS-CoV-2-Neutralizing Antibodies after Two Standard Dose Vaccinations, Risk Factors for Non-Response and Effect of a Third Dose Booster Vaccination in Non-Responders on Hemodialysis: A Prospective Multi-Centre Cohort Study

Tillmann¹,

Figiel²,

Ricken

et al. 2021

JCM

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The aim of this investigation was to determine the effect of SARS-Cov-2 vaccination in hemodialysis patients, search for risk factors for non- or low-response, and to measure the effect of a third booster vaccination in non- or low-responders. Methods SARS-CoV-2 IgG antibodies and the virus-neutralizing capacity were measured 4–5 weeks after a full standard vaccination in 95 chronic hemodialysis patients and 60 controls. IgG titers > 30 AU/mL served to classify participants as responders. Multivariable binary logistic regression analysis was used to search for risk factors of reduced vaccination success. Patients with vaccination failure were offered a third booster dosage. Results 82.1% of the patient cohort as compared to 98.3% of the healthy control group were able to mount SARS-CoV-2 titers above 30 AU/mL after two standard vaccine doses. Mean IgG antibody titers were lower in hemodialysis patients than controls (78 ± 35 vs. 90 ± 20 AU/mL, p = 0.002). Multivariable binary logistic regression analysis showed age and immunosuppressive medication as major risk factors for vaccination failure with a decreased probability of successful vaccination of −6.1% (95% CI −1.2 to −10.9) per increase in age of one year and −87.4% (95% CI −98.0 to −21.5) in patients on immunosuppressive therapy (crude odds ratio for vaccination failure for immunosuppressive therapy 6.4). Ten out of 17 patients with non-response to vaccination were offered a third dose. Booster vaccination after the second dose induced an increase in effective antibody titers of >30 AU/mL in seven out of ten patients 4–5 weeks later (70%). Conclusion Standard SARS-CoV-2 vaccination schemes are highly effective in mounting protective neutralizing IgG antibodies in chronic hemodialysis patients. Nevertheless, response to vaccination is diminished as compared to a healthy control group. Major risk factors for vaccination failure are older age and immunosuppressive therapy. In non- or low-responders to standard vaccination a third booster vaccination was able to induce effective antibody titers in about 70% of patients, indicating that a third booster vaccination might be preferable to decreasing immunosuppressive therapy.

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Section: Introductionmentioning

confidence: 84%

Evolution of SARS-CoV-2-Neutralizing Antibodies after Two Standard Dose Vaccinations, Risk Factors for Non-Response and Effect of a Third Dose Booster Vaccination in Non-Responders on Hemodialysis: A Prospective Multi-Centre Cohort Study

Tillmann¹,

Figiel²,

Ricken

et al. 2021

JCM

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“…For example, the rate of vaccination failure for hepatitis B vaccination was 28.3% of hemodialysis patients, but < 10% in the normal population [ 4 ]. Hemodialysis patients also have a higher risk of becoming infected with COVID-19 and, when infected, have a higher associated mortality rate than the normal population [ 5 , 6 ]. The immunogenicity and tolerability of SARS-CoV-2 vaccines may also differ in hemodialysis patients compared to the general population.…”

Section: Introductionmentioning

confidence: 99%

Humoral immunogenicity and tolerability of heterologous ChAd/BNT compared with homologous BNT/BNT and ChAd/ChAd SARS-CoV-2 vaccination in hemodialysis patients

Haase

Lesny²,

Anderson

et al. 2022

J Nephrol

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Background After the reports of severe adverse reactions to the AstraZeneca ChAdOx1-S-nCoV-19 vaccine, patients who had received one dose of ChAdOx1-S-nCoV-19 vaccine were recommended a second dose of Pfizer’s BNT162b2 vaccine. In hemodialysis patients, we compared the humoral immunogenicity and tolerability of homologous vaccination with ChAdOx1-nCoV-19/ChAdOx1-nCoV-19 (ChAd/ChAd) and BNT162b2/BNT162b2 (BNT/BNT) with heterologous vaccination of first dose of ChAdOx1-nCoV-19 and a second dose with BNT162b2 (ChAd/BNT). Methods In a multicenter prospective observational study, SARS-CoV-2 spike-IgG antibody levels, Nucleocapsid-protein-IgG-antibodies, and vaccine tolerability were assessed 6 weeks after second SARS-CoV-2 vaccination in 137 hemodialysis patients and 24 immunocompetent medical personnel. Results In COVID-19-naïve hemodialysis patients, significantly higher median SARS-CoV-2-spike IgG levels were found after ChAd/BNT (N = 16) compared to BNT/BNT (N = 100) or ChAd/ChAd (N = 10) (1744 [25th–75th percentile 276–2840] BAU/mL versus 361 [25th–75th percentile 120–936] BAU/mL; p = 0.009; 1744 [25th–75th percentile 276–2840] BAU/mL versus 100 [25th–75th percentile 41–346] BAU/mL; p = 0.017, respectively). Vaccinated, COVID-19-naïve medical personnel had median SARS-CoV-2 spike-IgG levels of 650 (25th–75th percentile 217–1402) BAU/mL and vaccinated hemodialysis patients with prior COVID-19 7047 (25th–75th percentile 685–10,794) BAU/mL (N = 11). In multivariable regression analysis, heterologous vaccination (ChAd/BNT) of COVID-19-naïve hemodialysis patients was independently associated with SARS-CoV-2 spike-IgG levels. The first dose of ChAd and the second dose of BNT after the first vaccination with ChAd (heterologous vaccination, ChAd/BNT) were associated with more frequent but manageable side effects compared with homologous BNT. Conclusions Within the limitations of this study, heterologous vaccination with ChAd/BNT appears to induce stronger humoral immunity and more frequent but manageable side effects than homologous vaccination with BNT/BNT or with ChAd/ChAd in COVID-19-naïve hemodialysis patients. Graphical abstract

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“…stark variieren können. Vor diesem Hintergrund etablierte die Deutsche Gesellschaft für Nephrologie (DGfN) im März 2020 ein bundesweites Register, um Anzahl und Prognose der an COVID-19 erkrankten Dialysepatienten in Deutschland zu erfassen und auszuwerten [ 18 ].…”

Section: Hintergrundunclassified

„Coronavirus-disease-2019“-Pandemie aus nephrologischer Perspektive

et al. 2021

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Hintergrund Die Coronavirus-disease-2019(COVID-19)-Pandemie hat auch die Nephrologie weltweit vor große Herausforderungen gestellt. Zum einen stellen Patienten mit Nierenerkrankungen in diesem Zusammenhang eine besonders vulnerable Patientengruppe dar, und zum anderen sind die Nieren bei schweren COVID-19-Verläufen nach den Lungen am häufigsten vom Organversagen betroffen. Material und Methoden Um zuverlässige Daten zu COVID-19-Prävalenz und -Mortalität bei Dialysepatienten in Deutschland zu erheben, hat die Deutsche Gesellschaft für Nephrologie bereits während der 1. Welle der Pandemie im Frühjahr 2020 ein Register aufgebaut. Wöchentlich wurden Angaben zu Anzahl und Verlauf der COVID-19-Dialysepatienten in Deutschland erhoben und ausgewertet. Ergebnisse Die Prävalenz von COVID-19 bei Dialysepatienten in Deutschland zeigte einen doppelgipfligen Verlauf ähnlich wie in der Allgemeinbevölkerung. Während diese im Frühjahr bei Dialysepatienten auf 1,4 % stieg, fiel sie im Sommer deutlich ab und erreichte im Dezember im Rahmen der 2. Pandemiewelle einen Wert von ca. 1,9 %, trotz mittlerweile flächendeckend eingeführter umfangreicher Hygienemaßnahmen in den Dialysezentren. Ähnlich wie in anderen Industriestaaten weisen auch Dialysepatienten in Deutschland eine sehr hohe COVID-19-Letalität von etwa 20 % auf. Schlussfolgerung Aus der ermittelten Letalität bei Dialysepatienten lassen sich unmittelbare Konsequenzen für Hygienemaßnahmen in den Dialyseeinrichtungen sowie zu Impfstrategie und -priorisierung dieser Patientengruppe und des sie behandelnden Personals ableiten. Eine Konsequenz des häufigen Befalls der Niere im Rahmen einer Infektion mit dem „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2) bei zuvor noch nicht an einer fortgeschrittenen Nierenerkrankung leidenden Patienten sollte die konsequente nephrologische Nachsorge sein.

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COVID-19 Prevalence and Mortality in Chronic Dialysis Patients

Cited by 14 publications

References 3 publications

Evolution of SARS-CoV-2-Neutralizing Antibodies after Two Standard Dose Vaccinations, Risk Factors for Non-Response and Effect of a Third Dose Booster Vaccination in Non-Responders on Hemodialysis: A Prospective Multi-Centre Cohort Study

Evolution of SARS-CoV-2-Neutralizing Antibodies after Two Standard Dose Vaccinations, Risk Factors for Non-Response and Effect of a Third Dose Booster Vaccination in Non-Responders on Hemodialysis: A Prospective Multi-Centre Cohort Study

Humoral immunogenicity and tolerability of heterologous ChAd/BNT compared with homologous BNT/BNT and ChAd/ChAd SARS-CoV-2 vaccination in hemodialysis patients

„Coronavirus-disease-2019“-Pandemie aus nephrologischer Perspektive

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