Hepatitis B related dilemmas in the renal unit

Holt, Stephen G; Locarnini, Stephen; Sasadeusz, Joe

doi:10.1111/nep.13815

Cited by 5 publications

(9 citation statements)

References 25 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As multiple COVID-19 vaccines have been approved for use, we are hoping that dialysis patients will develop protective immunity but we are however cognisant of the fact that many vaccines, for example hepatitis B are relatively less effective in the dialysis population [25] than with those without renal impairment, so we are likely to need special seroconversion studies in this population. It is important that we collect data to understand how patients on dialysis and with renal transplants respond to standard vaccination schedules.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of patients with end stage kidney disease on dialysis with COVID-19 in Abu Dhabi, United Arab Emirates; from PCR to antibody

et al. 2021

View full text Add to dashboard Cite

Background Individuals with end-stage kidney disease (ESKD) on dialysis are vulnerable to contracting COVID-19 infection, with mortality as high as 31 % in this group. Population demographics in the UAE are dissimilar to many other countries and data on antibody responses to COVID-19 is also limited. The objective of this study was to describe the characteristics of patients who developed COVID-19, the impact of the screening strategy, and to assess the antibody response to a subset of dialysis patients. Methods We retrospectively examined the outcomes of COVID19 infection in all our haemodialysis patients, who were tested regularly for COVID 19, whether symptomatic or asymptomatic. In addition, IgG antibody serology was also performed to assess response to COVID-19 in a subset of patients. Results 152 (13 %) of 1180 dialysis patients developed COVID-19 during the study period from 1st of March to the 1st of July 2020. Of these 81 % were male, average age of 52 years and 95 % were on in-centre haemodialysis. Family and community contact was most likely source of infection in most patients. Fever (49 %) and cough (48 %) were the most common presenting symptoms, when present. Comorbidities in infected individuals included hypertension (93 %), diabetes (49 %), ischaemic heart disease (30 %). The majority (68 %) developed mild disease, whilst 13 % required critical care. Combinations of drugs including hydroxychloroquine, favipiravir, lopinavir, ritonavir, camostat, tocilizumab and steroids were used based on local guidelines. The median time to viral clearance defined by two negative PCR tests was 15 days [IQR 6–25]. Overall mortality in our cohort was 9.2 %, but ICU mortality was 65 %. COVID-19 IgG antibody serology was performed in a subset (n = 87) but 26 % of PCR positive patients (n = 23) did not develop a significant antibody response. Conclusions Our study reports a lower mortality in this patient group compared with many published series. Asymptomatic PCR positivity was present in 40 %. Rapid isolation of positive patients may have contributed to the relative lack of spread of COVID-19 within our dialysis units. The lack of antibody response in a few patients is concerning.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcomes of patients with end stage kidney disease on dialysis with COVID-19 in Abu Dhabi, United Arab Emirates; from PCR to antibody

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Vaccination in dialysis patients is generally less successful, and circulating antibody response less durable, in renal patients as exemplified by the increased dosing requirements and boosters for hepatitis B vacation. 13 …”

Section: Introductionmentioning

confidence: 99%

“…12 Vaccination in dialysis patients is generally less successful, and circulating antibody response less durable, in renal patients as exemplified by the increased dosing requirements and boosters for hepatitis B vacation. 13 Many studies have reported showing that standard COVID vaccination antibody response with the Pfizer/BioNTech, Astra-Zenica vaccine in haemodialysis (HD) patients was suboptimal but provides good antibody responses in a number of patients. 14 Yet there is little data on the efficacy of the Sinopharm vaccine, nor on its protective effects.…”

Section: Introductionmentioning

confidence: 99%

An analysis of antibody responses and clinical sequalae of the Sinopharm HB02 COVID19 vaccine in dialysis patients in the United Arab Emirates

Holt

Mahmoud²,

Ahmed

et al. 2021

Nephrology

Self Cite

View full text Add to dashboard Cite

Aim To establish the responses to the Sinopharm HB02 COVID‐19 vaccination in the dialysis population, which are not well established. We examined the humoral responses to the Sinopharm COVID vaccine in haemodialysis patients. Methods Standard vaccinations (two doses at interval of ~21 days) were given to all consenting haemodialysis patients on dialysis ( n = 1296). We measured the antibody responses at 14–21 days after the second vaccine to define the development of anti‐spike antibodies >15 AU/ml after vaccination and observed the clinical effects of vaccination. Results Vaccination was very well tolerated with few side‐effects. In those who consented to antibody measurements, ( n = 446) baseline sampling showed 77 had positive antibodies, yet received full vaccination without any apparent adverse events. Positive anti‐spike antibodies developed in 50% of the 270 baseline negative patients who had full sampling, compared with 78.1% in the general population. COVID infection continues to occur in both vaccinated and unvaccinated individuals, but in the whole group vaccination appears to have been associated with a reduction in the case fatality rate. Conclusion The humoral immune responses to standard HB02 vaccination schedules are attenuated in a haemodialysis cohort, but likely the vaccine saves lives. We suggest that an enhanced HB02 vaccination course or antibody checking may be prudent to protect this vulnerable group of patients. We suggest a booster dose of this vaccine at 3 months should be given to all dialysis patients, on the grounds that it is well tolerated even in those with good antibody levels and there may be a survival advantage.

show abstract

“…Most important in the context of a dialysis unit, absence of HBV DNA detection in a chronic patient indicates a very low risk of viral transmission. 31 …”

Section: Discussionmentioning

confidence: 99%

Serological and molecular characterization of hepatitis B virus infection in chronic kidney disease patients from Rio de Janeiro, Brazil

Villar

Fraga²,

Mendonça³

et al. 2022

The Brazilian Journal of Infectious Diseases

View full text Add to dashboard Cite

Hepatitis B related dilemmas in the renal unit

Cited by 5 publications

References 25 publications

Outcomes of patients with end stage kidney disease on dialysis with COVID-19 in Abu Dhabi, United Arab Emirates; from PCR to antibody

Outcomes of patients with end stage kidney disease on dialysis with COVID-19 in Abu Dhabi, United Arab Emirates; from PCR to antibody

An analysis of antibody responses and clinical sequalae of the Sinopharm HB02 COVID19 vaccine in dialysis patients in the United Arab Emirates

Serological and molecular characterization of hepatitis B virus infection in chronic kidney disease patients from Rio de Janeiro, Brazil

Contact Info

Product

Resources

About