Infection In Dialysis Patients Research Articles

Diagnosis of cytomegalovirus infections in dialysis patients: A comparison of serological and molecular methods

Diagnosis of cytomegalovirus infections in dialysis patients: A comparison of serological and molecular methods

The Assessment of Infection Risk in Patients with Vitiligo Undergoing Dialysis for End-Stage Renal Disease: A Retrospective Cohort Study.

Vitiligo is an autoimmune condition that causes patchy skin depigmentation. Although the mechanism by which vitiligo induces immunocompromise is unclear, other related autoimmune diseases are known to predispose those affected to infection. Individuals with vitiligo exhibit epidermal barrier disruption, which could potentially increase their susceptibility to systemic infections; patients with renal disease also show a predisposition to infection. Nevertheless, there is little research addressing the risk of infection in dialysis patients with vitiligo in comparison to those without it. A retrospective analysis was performed on patients with end-stage renal disease (ESRD) in the United States Renal Data System who started dialysis between 2004 and 2019 to determine if ESRD patients with vitiligo are at an increased risk of bacteremia, cellulitis, conjunctivitis, herpes zoster, or septicemia. Multivariable logistic regression modeling indicated that female sex, black compared to white race, Hispanic ethnicity, hepatitis C infection, and tobacco use were associated with an enhanced risk of vitiligo, whereas increasing age and catheter, versus arteriovenous fistula, and access type were associated with a decreased risk. After controlling for demographics and clinical covariates, vitiligo was found to be significantly associated with an increased risk of bacteremia, cellulitis, and herpes zoster but not with conjunctivitis and septicemia.

An optimized machine learning model for predicting hospitalization for COVID-19 infection in the maintenance dialysis population

COVID-19 has a high rate of infection in dialysis patients and poses a serious risk to human health. Currently, there are no dialysis centers in China that have analyzed the prevalence of COVID-19 infection in dialysis patients and the mortality rate. Although machine learning-based disease prediction methods have proven to be effective, redundant attributes in the data and the interpretability of the predictive models are still worth investigating. Therefore, this paper proposed a wrapper feature selection classification model to achieve the prediction of the risk of COVID-19 infection in dialysis patients. The method was used to optimize the feature set of the sample through an enhanced JAYA optimization algorithm based on the dispersed foraging strategy and the greedy levy mutation strategy. Then, the proposed method combines fuzzy K-nearest neighbor for classification prediction. IEEE CEC2014 benchmark function experiments as well as prediction experiments on the uremia dataset are used to validate the proposed model. The experimental results showed that the proposed method has a high prediction accuracy of 95.61% for the prevalence risk of COVID-19 infection in dialysis patients. Furthermore, it was shown that proalbumin, CRP, direct bilirubin, hemoglobin, albumin, and phosphorus are of great value for clinical diagnosis. Therefore, the proposed method can be considered as a promising method.

Response to Immunization against SARS-CoV-2 and Risk of Omicron Infection in Dialysis Patients: A Prospective Cohort Study.

It is not well established to what extent previous immunizations offer protection against infections with the SARS-CoV-2 Omicron variant in dialysis patients. We aimed to define the relevant humoral response in dialysis patients using a SARS-CoV-2 IgG chemiluminescence microparticle immunoassay (CMIA) compared to the activity of neutralizing antibodies assessed by a virus neutralization test. Next, we aimed to determine differences in humoral and cellular response levels over time among patients infected or not infected by the Omicron variant of SARS-CoV-2. Immunological parameters of cellular and humoral response to SARS-CoV-2 were analyzed at baseline and after 3 (T3), 6 (T6) and 14 months (T14). In this monocentric cohort study, we followed 110 dialysis patients (mean age 68.4 ± 13.7 years, 60.9% male) for a median of 545 days. We determined an anti-SARS-CoV-2 IgG level of 56.7 BAU/mL as an ideal cut-off value with a J-index of 90.7. Patients infected during the Omicron era had significantly lower (p < 0.001) mean antibody levels at T0 (3.5 vs. 111.2 BAU/mL), T3 (269.8 vs. 699.8 BAU/mL) and T6 (260.2 vs. 513.9 BAU/mL) than patients without Omicron infection. Patients who developed higher antibody levels at the time of the basic immunizations were less likely to become infected with SARS-CoV-2 during the Omicron era. There is a need to adjust the cut-off values for anti-SARS-CoV-2 IgG levels in dialysis patients.

Expression of Interferon Regulatory Factor 8 (IRF8) and Its Association with Infections in Dialysis Patients.

Patients on dialysis have dysfunctions of innate and adaptive immune system responses. The transcriptional factor IRF8 (interferon regulatory factor 8) is primarily expressed in plasmacytoid cells (pDCs) and myeloid dendritic cells (mDCs), playing a crucial role in the maturation of dendritic cells, monocytes, and macrophages, and contributing to protection against bacterial infections. The current study analyzed the expression patterns of IRF8 and assessed its association with the risk of infections in 79 dialysis patients compared to 44 healthy controls. Different subsets of leukocytes and the intracellular expression of IRF8 were measured using flow cytometry. Compared to the healthy controls, the dialysis patients showed significantly reduced numbers of pDCs and significantly increased numbers of natural killer cells and classical and intermediate monocytes. The dialysis patients exhibited decreased numbers of IRF8-positive dendritic cells (pDC p < 0.001, mDC1 p < 0.001, mDC2 p = 0.005) and increased numbers of IRF8-positive monocytes (p < 0.001). IRF8 expression in pDC, mDC, and classical monocytes was lower in the dialysis patients than in the controls. Dialysis patients who required hospitalization due to infections within one year of follow-up displayed significantly reduced IRF8 expression levels in pDCs compared to patients without such infections (p = 0.04). Our results suggest that reduced IRF8 expression in pDCs is a potential risk factor predisposing dialysis patients to serious infections.

Clinical manifestations of COVID-19 infection in dialysis patients and protective effect of COVID-19 vaccine.

COVID-19 infection poses a special challenge to patients with dialysis patients. The purpose of this study was to evaluate the clinical manifestations of dialysis patients with COVID-19 and the protective effect of the vaccine. We included 41 studies based on big data, mainly analyzing the clinical symptoms of dialysis patients with COVID-19, the proportion of severe patients before and after vaccination, and the humoral reaction of vaccine in the body. 6.1% to 35.7% of dialysis patients with COVID-19 developed respiratory distress symptoms and needed to be admitted to an intensive care unit for mechanical ventilation. The incidence and mortality of COVID-19 in dialysis patients before vaccination were 5.5% and 1.1%, respectively, and decreased to 4.5% and 0.6% in breakthrough infected patients. There was no statistical difference in serum conversion rates between dialysis patients and healthy controls, but the neutralizing antibody titer in the control group was 1922 (IQR 533 to 3186) AU/mL, and the neutralizing antibody titer in dialysis patients significantly decreased to 367 (IQR 171 to 1650) AU/mL (P=0.046). Dialysis is associated with an increased risk of severe COVID-19, and generally has a poor seroconversion response to vaccines. It also confirms the protective effect of vaccines on high-risk populations such as dialysis.

Risk factors and prognosis for latent tuberculosis infection in dialysis patients: A retrospective cohort study at a single tertiary care center.

Recent studies report that latent tuberculosis infection (LTBI) may lead to an increased risk of cardiovascular disease (CVD) that led us to hypothesize that LTBI may play an important role in major adverse cardiovascular events (MACE) in dialysis patients. A single-center retrospective cohort study was conducted. A total of 270 patients undergoing hemodialysis or peritoneal dialysis more than 3 months were included. The interferon enzyme-linked immunospot (IFN-γ ELISPOT) assay was used for the diagnosis of LTBI. Primary endpoints were MACE, including all-cause death and acute coronary syndrome (ACS). The association between LTBI and MACE was examined using multivariate Cox proportional hazards regression after adjusting for covariates and Kaplan-Meier survival analysis. In our study, the patients were classified into LTBI (n =47) or non-LTBI (n =223) groups. Independent risk factors for LTBI in dialysis population were prior tuberculosis (TB) history (odds ratio [OR] 4.817 [1.064-22.306]), tobacco use (OR 2.903 [1.155-7.299]), and older age (OR 1.027 [1.002-1.053]). After a median follow-up of 39 months, the incidence of active TB was 6.4% versus 0% in dialysis patients with and without LTBI, respectively (p = 0.005). Multivariate Cox analysis showed that LTBI was significantly associated with MACE (hazardratio[HR] 2.540 [1.490-4.350]) after adjustment for potential confounders. Prior TB history, tobacco use, and the elderly can be used to select cost-effective LTBI screening target groups in dialysis patients. LTBI is not only closely related to active TB but also an independent risk factor for higher incidence of MACE in dialysis population.

COVID-19 Infection in Dialysis Patients: Efficacy of Vaccination

COVID-19 Infection in Dialysis Patients: Efficacy of Vaccination

Dysnatremia and risk of bloodstream infection in dialysis patients

Emerging data suggest that sodium disarrays including hyponatremia are potential risk factors for infection ensuing from impairments in host immunity, which may be exacerbated by coexisting conditions (i.e. mucosal membrane and cellular edema leading to breakdown of microbial barrier function). While dysnatremia and infection-related mortality are common in dialysis patients, little is known about the association between serum sodium levels and the risk of bloodstream infection in this population. Among 823 dialysis patients from the national Biospecimen Registry Grant Program who underwent serum sodium testing over the period January 2008-December 2014, we examined the relationship between baseline serum sodium levels and subsequent rate of bloodstream infection. Bloodstream infection events were directly ascertained using laboratory blood culture data. Associations between serum sodium level and the incidence of bloodstream infection were estimated using expanded case mix-adjusted Poisson regression models. In the overall cohort, ∼10% of all patients experienced one or more bloodstream infection events during the follow-up period. Patients with both lower sodium levels <134mEq/l and higher sodium levels ≥140mEq/l had higher incident rate ratios (IRRs) of bloodstream infection in expanded case mix analyses (reference 136-<138mEq/l), with adjusted IRRs of 2.30 [95% confidence interval (CI) 1.19-4.44], 0.77 (95% CI 0.32-1.84), 1.39 (95% CI 0.78-2.47), 1.88 (95% CI 1.08-3.28) and 1.96 (95% CI 1.08-3.55) for sodium levels <134, 134-<136, 138-<140, 140-<142 and ≥142Eq/l, respectively. Both lower and higher baseline serum sodium levels were associated with a higher rate of subsequent bloodstream infections in dialysis patients. Further studies are needed to determine whether correction of dysnatremia ameliorates infection risk in this population.

Prevalence of HCV Infection Among Hemodialysis Patients in Lanzhou of Northwestern China

ObjectiveTo investigate the prevalence of hepatitis C virus (HCV) infection among hemodialysis (HD) patients in Lanzhou of Northwestern China, we interviewed 565 patients from five randomly sampled HD centers in Lanzhou with a structured questionnaire including sociodemographic characteristics, past medical history and HD-related factors.MethodsThe testing results of anti-HCV and HCV-RNA in a recent HD from clinical information system were collected. A generalized estimated equation (GEE) logistic regression model was used to identify the determinants of HCV infection among HD patients.ResultsThe prevalence of anti-HCV or HCV-RNA infection among HD patients was 1.77% or 1.42% respectively. GEE model showed that history of kidney transplantation (HCV-RNA: OR=19.79, 95%CI: 12.69–30.85) could dramatically increase the risk of current HCV infection in dialysis patients. Compared with never using of blood products, using of blood products (anti-HCV: OR=2.38, 95%CI: 1.22–4.64; HCV-RNA: OR=15.23, 95%CI: 1.79–129.49) could increase the risk of HCV infection in dialysis patients. Moreover, with the increase of HD duration, the risk increased one time or so (anti-HCV: OR=1.83, 95%CI: 1.22–2.72; HCV-RNA: OR=2.00, 95%CI: 1.11–3.61). Furthermore, dialysis in multiple hospitals possessed more than three times risk of HCV infection (anti-HCV: OR=3.56, 95%CI: 3.11–4.08; HCV-RNA: OR=3.35, 95%CI: 1.88–5.96). Besides, HD patients having the history of acupuncture (HCV-RNA: OR=5.56; 95%CI: 1.16–26.67) or surgery (HCV-RNA: OR=6.39; 95%CI: 2.86–14.29) caused an about-six-times risk of current infections.ConclusionIt could be concluded that the prevalence of HCV infection was mild and using of blood products or kidney transplantation, long dialysis duration, dialysis in multiple hospitals, surgery or acupuncture treatment were some risk factors of HCV infection among HD patients in Lanzhou of Northwestern China.

COVID-19 Infection in Hemodialysis Patients, Incidence, Risk Factors and Mortality. Single Centre Study

Background: Hemodialysis patients are not only prone to acquire COVID-19 infection but also more likely to suffer a higher rate of morbidity and mortality. This study aims to report the incidence and mortality rate of COVID-19 infection in our hemodialysis patients and to determine risk factors. Methods: This is an observational, retrospective study conducted in the dialysis unit of Dubai Hospital. Our target population was hemodialysis patients who tested positive for COVID infection (PCR assay of the nasopharyngeal swab) from 1st April 2020 to 31st August 2021. Our primary outcome was to study the mortality rate associated with COVID-19 infection in dialysis patients in Dubai hospital. Our secondary objectives were to study the incidence and determine risk factors for the severity of infection. Patient demographics and clinical features were collected from medical record software, i.e., EPIC. Univariate Cox regression analysis was performed to evaluate potential risk factors for mortality in our cohort. Results: 72 out of 250 (28.8%) hemodialysis patients acquired COVID infection during the study period, the median age was 54.32 (15-93) years, and 56.94% (n=41) were male. The most common comorbid was hypertension (59.72%), while the main symptom at presentation was shortness of breath (25%). One-third of patients required a different form of oxygen therapy, and 11.11% of patients were mechanically ventilated. The mortality rate was 16.6%. High median age, ischemic heart disease, low absolute lymphocyte count, and high levels of ferritin, LDH, and procalcitonin, as well as mechanical ventilation, were statistically significant risk factors associated with mortality. Conclusion: The overall outcome of COVID infection in our hemodialysis patients was better compared to the hemodialysis population from other parts of the world.

The effect of prescribing vitamin D analogues and serum vitamin D status on both contracting COVID-19 and clinical outcomes in kidney dialysis patients'.

AimsVitamin D plays a role in innate immune system activation, and deficiency increases susceptibility to respiratory infections and disease severity including COVID‐19. We determined whether vitamin D levels and medications were associated with contracting COVID‐19, and disease severity defined by hospitalisation and dialysis patient mortality.MethodsWe reviewed serum vitamin D levels, and prescription of cholecalciferol and alfacalcidol along with corresponding medical records of adult dialysis patients from a United Kingdom tertiary centre between March 2020 and May 2021. COVID‐19 infection was determined by polymerase chain reaction (PCR) results.Results362 (35%) of 1035 dialysis patients tested PCR positive for COVID‐19. COVID‐19 positive patients had lower native median vitamin D (65 (39–95) versus 74 (40.5–101) nmol/L (p = .009) despite greater prescription of cholecalciferol (median 20 000 (20000‐20 000) versus 20 000 (0–20 000) IU/week), p < .001, but lower prescription of alfacalcidol 0 (0–3.0) versus 2.0 (0.–5.0) ug/week, p < .001. On multivariate logistic regression COVID‐19 infection was associated with haemodialysis versus peritoneal dialysis (p < .001), cholecalciferol dose (p < .001) and negatively with alfacalcidol (p < .001). However, serum vitamin D levels and alfacalcidol dosages were not significantly different for those requiring hospitalisation compared to those managed at home, although those who died were prescribed lower alfacalcidol dosages.ConclusionDialysis patients who contracted COVID‐19 had lower levels of native vitamin D prior to COVID‐19 and were prescribed lower dosages of alfacalcidol. However, there was no association between vitamin D status and disease severity. This retrospective observational analysis supports a potential role for vitamin D and susceptibility to COVID‐19 infection in dialysis patients.

MO872: Relationship Between Vitamin D Levels And SARS-COV-2 Infection in Dialysis Patients

Abstract BACKGROUND AND AIMS Hypovitaminosis D is highly prevalent in patients with Chronic Kidney Disease (CKD). This is considered a consequence of a decreased renal mass and a reduction in the number of proximal tubular cells, which absorb the filtered native vitamin D and then be hydroxylated to its active form by 1α-hydroxylase. Hypovitaminosis D is defined as serum levels of 25-hydroxy-vitamin D3 lower than 30 ng/mL. The decrease in vitamin D causes bone and mineral abnormalities and can also play a role in various pathologies, such as cardiovascular disease, insulin resistance, diabetes, autoimmune diseases and infections. Clinical practice guidelines recommend treating hypovitaminosis D. The role of vitamin D in acute respiratory tract infections and other viral infections has been widely studied. It has an immunomodulatory role due to the expression of the enzyme 1α-hydroxylase by the epithelium of the respiratory tract, dendritic cells and lymphocytes, which is essential for the activation of vitamin D in the lungs. In this way, an influence is created on the lung capacity to fight infections and respond to allergic stimuli. Vitamin D has the potential to influence the severity and outcomes of COVID-19. In fact, several studies have established a consistent relationship between hypovitaminosis D and the severity of COVID-19. We have a population of dialysis patients with a tendency to hypovitaminosis D and, on the other hand, an influence of hypovitaminosis D in respiratory infections such as SARS-CoV-2 infection. Thus, we consider it interesting to study whether the incidence of hypovitaminosis D is higher in dialysis patients with SARS-CoV-2 infection than in those who do not. METHOD An observational, analytical, ambispective, multicentre study was carried out under normal clinical practice conditions. The study subjects are patients on haemodialysis program of the province of Santa Cruz de Tenerife, in the period between January 2021 and January 2022. As variables we selected age, sex, personal history, haemodialysis time, serum levels of 25-hydroxy-vitD3, treatment with native vitamin D, presence of SARS-CoV-2 infection diagnosed by RT-PCR in nasopharyngeal swab, vaccination. The information collected is organized in a database of the SPSS Statistics v22 program. For quantitative variables, the comparison between groups is made by means of an analysis with the Student's t-test for independent samples. Qualitative variables are analyzed using the Chi-squared test or Fisher's exact test. All data were analyzed using the SPSS Statistics v22 program. The level of significance is established for a value of P &amp;lt; 0.05. RESULTS A total of 60 haemodialysis patients were included, 36 men (60%) and 24 women (40%). The mean age was 64 years. The most common cause of kidney disease was diabetic nephropathy (35%). The median time on dialysis was 24.5 months. 73.3% of the patients presented hypovitaminosis D and 35% received treatment with vitamin D. 23 patients had SARS-CoV-2 infection (38.3%). 2 patients (3.3%) died of COVID-19. There were no significant differences between the two comparison groups (patients with and without SARS-CoV-2 infection) in relation to sex, age, cause of kidney disease, diabetes, time on dialysis, vitamin D intake. We also did not observe significant differences in relation to vitamin D levels or the presence of hypovitaminosis D. There are significant differences in relation to vaccination (p 0.00). 39.1% of the patients with SARS-CoV-2 infection were not vaccinated. 90% of all unvaccinated patients had SARS-CoV-2 infection. 97.3% of the uninfected patients were vaccinated. CONCLUSION Hypovitaminosis D is very common in CKD patients on dialysis, however, despite its immunomodulatory role, we did not find a higher incidence of hypovitaminosis D in dialysis patients with SARS-CoV-2 infection. In our series, we have not found factors associated with SARS-CoV-2 infection in dialysis patients, with the exception of vaccination. Therefore, vaccination in our dialysis patients is being essential to prevent a higher number of cases of SARS-CoV-2 infection.

MO828: The Humoral Response of SARS-COV-2 Vaccine in Haemodialysis

BACKGROUND AND AIMSAlthough vaccination against COVID-19 infection in dialysis patients is an urgent issue of worldwide concern, literature data regarding the antibody level and their kinetics over time and the efficacy towards complete COVID-19 vaccination and booster dose in these patients is inconclusive.METHODWe retrospectively assessed the response to COVID-19 vaccination, after the completion of vaccine series and after a booster dose in haemodialysis (HD) patients. IgG antibodies to the spike protein S1 subunit of SARS-CoV-2 were measured using ELISA at least 15 days after completion of a vaccination series, 1 month and finally 15–30 days after the booster dose.RESULTSAmong the 28 vaccinated HD patients (mean age = 59.8 years, 100% male) with two doses of mRNA vaccine, a seroconversion was documented in all the patients (100%) with a median antibody titre of 3270.6 U/mL (IQR: 94–40.000). We recorded 9 out of 28 early responders (peak level at 2 weeks) and 19/28 late responders (peak level at 1 month). The early responders were younger (56.25 years versus 61.63; P = 0.07), without cardiovascular history (88% versus 44%; P = 0.042) or diabetes (100% versus 63%; P = 0.042), compared with late responders. On multivariate analysis, combined haemoperfusion and haemodialysis (HR = 0.167, 95% confidence interval: 0.034–0.826; P = 0.028) was an independent prognostic factor for early responders. After 6 months, all the patients received a booster mRNA dose. The patients presented median antibody levels of 33.939 U/mL (IQR: 1112–181.223), much higher titre than the first peak. Finally, four patients, all from the late responders group, presented COVID-19 infection during the vaccination period (two patients in the early period <1 month and two patients in the late period >5 months).CONCLUSIONHD patients develop a substantial humoral response against SARS-CoV2 and the booster dose much higher response. The early responders presented more rapidly and more efficacious antibody levels, while the combined haemoperfusion and haemodialysis emerged as a positive predictor factor.

Longevity and Clinical Effectiveness of the Humoral and Cellular Responses to SARS-CoV-2 Vaccination in Hemodialysis Patients

Longevity and Clinical Effectiveness of the Humoral and Cellular Responses to SARS-CoV-2 Vaccination in Hemodialysis Patients

Risks of central nervous system infections and related mortality in patients undergoing dialysis.

This study aimed to investigate the risks of central nervous system (CNS) infections and related mortality in patients with end-stage renal disease (ESRD) undergoing dialysis. Incident dialysis patients were identified from 2000 to 2013. The risks of CNS infection and related mortality were analyzed. The adjusted hazard ratio (HR) of CNS infection in the ESRD group compared with the control group was 3.46 (95% confidence interval [CI] 2.75-4.35). The adjusted odds ratio (OR) of 90-day mortality following CNS infections in the ESRD group in comparison with the control group was 5.99 (95% CI 2.78-12.9). The adjusted HR of overall CNS infection for the peritoneal dialysis (PD) group in comparison with the hemodialysis (HD) group was 1.07 (95% CI 0.63-1.82). Influenza vaccination was associated with a lower risks of CNS infection in dialysis patients (adjusted HR: 0.38, 95% CI 0.30-0.48). The adjusted OR of 90-day mortality following CNS infection for the PD group in comparison with the HD group was 1.01 (95% CI 0.55-1.87). The risks of CNS infections and related mortality were remarkably high in dialysis patients with no significant difference between patients with ESRD under HD and PD treatment.

Causes and Risk Factors of Hemodialysis Catheter Infection in Dialysis Patients: A Prospective Study

Objectives: Infectious central venous catheter (CVC) complications, including mortality and care and hospitalization costs, are still a major clinical concern. This study aimed to determine the prevalence of hemodialysis catheter infection and its risk factors among hemodialysis patients. Methods: The present research was a descriptive, prospective cross-sectional study on hemodialysis patients in Babol hospitals during 2020 - 21. The participants' demographic information and some relevant data on clinical variables (namely underlying diseases, cause of dialysis, and cause of catheter removal) and catheter-related variables (namely catheter location, frequency of catheter placement, and apparent signs of catheter site) were collected and recorded directly and systematically during surgery post-surgery. Results: One hundred and twenty-two patients with temporary double-lumen acute hemodialysis catheters for dialysis, including 56 women (45.9%), were included in this study, the mean age of whom was 58.9 ± 16.4 years. Twenty-two patients (18%) developed a catheter-induced systemic infection. There was no significant relationship between the catheter site and its removal inducing infection (P &gt; 0.05). The frequencies of microorganisms causing catheter infection included gram-positive Staphylococcus epidermis (59%) and Staphylococcus aureus (31.8%). Moreover, there was no significant correlation between demographic variables and clinical history with systemic infection induced by catheterization. Conclusions: The rate of catheter-induced infection is relatively high among patients since sterile instructions were observed during catheterization; therefore, it is recommended to pay more attention to the care and dressing of the catheter site.

Impact of a National Multicentric Strategy to Support Kidney Transplant Patients During the COVID-19 Pandemic in Latin America: FUTAC Team Creation and Activities.

Impact of a National Multicentric Strategy to Support Kidney Transplant Patients During the COVID-19 Pandemic in Latin America: FUTAC Team Creation and Activities.

Mortality and associated risk factors of COVID-19 infection in dialysis patients in Qatar: A nationwide cohort study.

Patients on maintenance dialysis are more susceptible to COVID-19 and its severe form. We studied the mortality and associated risks of COVID-19 infection in dialysis patients in the state of Qatar. This was an observational, analytical, retrospective, nationwide study. We included all adult patients on maintenance dialysis therapy who tested positive for COVID-19 (PCR assay of the nasopharyngeal swab) during the period from February 1, 2020, to July 19, 2020. Our primary outcome was to study the mortality of COVID-19 in dialysis patients in Qatar and risk factors associated with it. Our secondary objectives were to study incidence and severity of COVID-19 in dialysis patients and comparing outcomes between hemodialysis and peritoneal dialysis patients. Patient demographics and clinical features were collected from a national electronic medical record. Univariate Cox regression analysis was performed to evaluate potential risk factors for mortality in our cohort. 76 out of 1064 dialysis patients were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). During the study period, 7.1% of all dialysis patients contracted COVID-19. Male dialysis patients had double the incidence of COVID-19 than females (9% versus 4.5% respectively; p<0.01). The most common symptoms on presentation were fever (57.9%), cough (56.6%), and shortness of breath (25%). Pneumonia was diagnosed in 72% of dialysis patients with COVID-19. High severity manifested as 25% of patients requiring admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes. The mean length of hospital stay was 19.2 ± -12 days. Mortality due to COVID-19 among our dialysis cohort was 15%. Univariate Cox regression analysis for risk factors associated with COVID-19-related death in dialysis patients showed significant increases in risks with age (OR 1.077, CI 95%(1.018-1.139), p = 0.01), CHF and COPD (both same OR 8.974, CI 95% (1.039-77.5), p = 0.046), history of DVT (OR 5.762, CI 95% (1.227-27.057), p = 0.026), Atrial fibrillation (OR 7.285, CI 95%(2.029-26.150), p = 0.002), hypoxia (OR: 16.6; CI 95%(3.574-77.715), p = <0.001), ICU admission (HR30.8, CI 95% (3.9-241.2), p = 0.001), Mechanical ventilation (HR 50.07 CI 95% (6.4-391.2)), p<0.001) and using inotropes(HR 19.17, CI 95% (11.57-718.5), p<0.001). In a multivariate analysis, only ICU admission was found to be significantly associated with death [OR = 32.8 (3.5-305.4), p = 0.002)]. This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high incidence of COVID-19 infection and related mortality compared to previous reports of the general population in the state of Qatar (7.1% versus 4% and 15% versus 0.15% respectively). We also observed a strong association between death related to COVID-19 infection in dialysis patients and admission to ICU.

COVID-19 vaccination and dialysis patients: why the variable response.

Uremia affects all parts of the immune system. Since hemodialysis patients travel to the dialysis center three times per week and are surrounded by many other patients and staffs, these could predispose them to a greater risk of coronavirus disease of 2019 (COVID-19) infection. Mortality associated with COVID-19 infection is high in patients receiving dialysis. Currently, the World Health Organization has approved six types of vaccines (ChAdOx1-S, Ad26.COV2.S, BNT162b2, mRNA-1273, BBIBP-CorV and CoronaVac) for COVID-19. Literature data regarding the response rate toward COVID-19 vaccination in dialysis patients is inconclusive. The published response rates varied from 29.6% to 96.4%. The variable response rates across these clinical trials may be explained by different vaccine types, vaccine doses, criteria for positive immune response, timings of antibody detection, races and ethnicities. Side effects of COVID-19 vaccination comprise of pain at injection site, fatigue, myalgia, headache, low fever, syncope, pericarditis, etc. Clinical predictors of positive response toward COVID-19 vaccination include age, previous infection, immunosuppressive therapy, body mass index and serum albumin level. No one is safe until everyone is safe. Therefore, vaccination against COVID-19 infection in dialysis patients is an urgent issue of worldwide concern.