NKF Clinical Digest - COVID 19

NKF Clinical Digest COVID-19 is an ongoing compilation of the latest clinical information regarding COVID-19. Our goal is to streamline the search for the current data regarding the implications of COVID-19 for clinicians caring for people with kidney diseases during the pandemic.

Access the Clinical Digest-COVID-19 Now The latest articles include:

• Antibody Response to COVID-19 mRNA Vaccine Series in Transplant Recipients: A prospective cohort study of 658 transplant recipients (168 were kidney transplant recipients) who received 2 doses of SARS-CoV-2 mRNA vaccine indicates most patients had detectable antibody responses after the second dose. Patients that did not have a response after the first dose had low antibody levels. Those receiving antimetabolite maintenance immunosuppression were less likely to respond.

• AKI and Advanced Kidney Disease in the COVID-19 Pandemic: Proceedings from a NKF Symposium: This review addresses major findings an NKF CME symposium. These findings include: (1) severe COVID-19 infection has been associated with AKI, (2) it is essential to prevent and actively manage AKI to decrease mortality in these critically ill patients, (3) management of patients with advanced kidney disease should be geared toward minimizing their risk for exposure while making sure they are receiving adequate treatments, and (4) patients with kidney disease, especially ones in advanced stages, should be prioritized for vaccination.

• Humoral Response to the BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis: This study aimed to assess the humoral response following vaccination with the BNT162b2 vaccine in patients on maintenance hemodialysis and the factors associated with it. The study found that although most patients on maintenance hemodialysis developed a substantial humoral response following the BNT162b2 vaccine, it was significantly lower than controls. Age was an important factor in the humoral response, regardless of chronic medical conditions.

• Experience with SARS-CoV-2 BNT162b2 mRNA Vaccine in Dialysis Patients: This study investigated dialysis patients and a control group who had completed 2 doses of vaccination with the mRNA BNT162b2 vaccine for anti–spike protein antibody response and observed them for up to 10 weeks. A total of 160 chronic dialysis patients (127 hemodialysis and 33 peritoneal dialysis patients) and 132 control group persons were analyzed. The study’s main findings were (i) a lower response rate to the vaccine, (ii) a lower anti–spike antibody level, and (iii) a higher rate of COVID-19 infection after vaccination in the dialysis group.

• Seroprevalence of antibody to S1 spike protein following vaccination against COVID-19 in patients receiving hemodialysis: a call to arms: A cohort of 94 maintenance hemodialysis patients in the United Kingdom were studied for their antibody response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein 28 days after the first dose of either the BNT162b2 vaccine or the AZD1222 vaccine. The mean time between vaccination and antibody testing was 27.8 ± 4.2 days. SARS-CoV-2 neutralizing antibodies against the receptor binding domain of the S1 spike protein were detected in 75 patients (79.8%) and were not detected in 19 patients (20.2%).

• Dietary Advice in HD Patients: Impact of a Telehealth Approach During the COVID-19 Pandemic: The purpose of this study was to assess the effect of a telehealth-delivered nutritional intervention via telephone in maintenance hemodialysis (HD) patients during the coronavirus outbreak. The results suggest that telehealth-delivered dietary interventions can improve the clinical and nutritional parameters of HD patients. This was a multicenter, observational, prospective, and longitudinal study of 156 patients undergoing maintenance HD from 15 dialysis units conducted during the COVID-19 pandemic. A statistically significant reduction in serum potassium and phosphorus levels was observed in patients receiving counseling for hyperkalemia and hyperphosphatemia.

• Delaying Second COVID Vaccine Dose May Prevent Deaths: Simulation Modeling Study: The objective of this study was to measure the impact of delayed second dose vaccine policies on infections, hospital admissions, and deaths compared with the current on-schedule two dose regimen. Using a simulation model based on a “real-world” sample population of 100,000 adults, researchers ran a series of scenarios to forecast potentially infectious interactions under different conditions over a six-month period. The results suggest that under specific conditions a decrease in cumulative mortality, infections, and hospital admissions can be achieved when the second vaccine dose is delayed. The delayed second dose strategy is optimal for vaccination rates at or lower than 0.3% population per day if the vaccine efficacy from one dose is 80% or greater. In addition, the delayed second dose strategy for people under 65 performed consistently well under all vaccination rates tested, resulting in absolute cumulative mortality reductions up to an estimated 48 per 100,000.