Pub Date : 2023-06-14DOI: 10.33696/nephrology.3.009
Vuha Reddi, O. Sostin, Georgina Carlson, Polina R. Pinkhasova, Gustavo Alday
{"title":"A Quality Improvement Initiative to Reduce Catheter-Associated Urinary Tract Infections by Decreasing Unnecessary Foley Catheter Use in Hospitalized Patients","authors":"Vuha Reddi, O. Sostin, Georgina Carlson, Polina R. Pinkhasova, Gustavo Alday","doi":"10.33696/nephrology.3.009","DOIUrl":"https://doi.org/10.33696/nephrology.3.009","url":null,"abstract":"","PeriodicalId":93732,"journal":{"name":"Archives of nephrology and renal studies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87881634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-07DOI: 10.33696/nephrology.2.007
{"title":"Peritoneal Imaging may be the Last Piece of the Puzzle for Precision Evaluation of Peritoneal Function","authors":"","doi":"10.33696/nephrology.2.007","DOIUrl":"https://doi.org/10.33696/nephrology.2.007","url":null,"abstract":"","PeriodicalId":93732,"journal":{"name":"Archives of nephrology and renal studies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75965059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-07DOI: 10.33696/nephrology.2.008
{"title":"Review of Renal Transplantation of Hepatitis C Viremic Donor Organs into Aviremic Recipients","authors":"","doi":"10.33696/nephrology.2.008","DOIUrl":"https://doi.org/10.33696/nephrology.2.008","url":null,"abstract":"","PeriodicalId":93732,"journal":{"name":"Archives of nephrology and renal studies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78469632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-24DOI: 10.33696/nephrology.2.006
Tiffany L. Damm, R. Mathews
The Randomized intervention for Vesicoureteral Reflux (RiVUR) study was an effort by the National Institute of Health to identify the most significant question on the management of vesicoureteral reflux (VUR), i.e. Did antibiotic prophylaxis reduce the incidence of recurrent urinary tract infections (UTI) in children with VUR? During the initial phases of the RiVUR study, several similar studies were performed that seemed to indicate a lack of benefit of antibiotic prophylaxis in VUR. However, few of these studies had the rigorous methodology and true randomization of the pediatric cohort that was studied in RiVUR. Additionally, many of these studies included children of wide age ranges and inconsistent assessments were used for identification of UTI and VUR. In 2011, the American Academy of Pediatrics (AAP) published a guideline statement for the evaluation of initial UTI in febrile children aged 2 to 24 months, which recommended against performing a Voiding Cystourethrogram (VCUG) in all children with a confirmed UTI. The goal of the AAP guidelines was to reduce the number of VCUGs being performed and potentially to reduce the number of children diagnosed with low grade VUR that seems to have low potential to cause renal injury. The RiVUR study included over 600 children identified with VUR after a 1st or 2nd febrile UTI randomized to prophylaxis with trimethoprim/sulfamethoxazole (TMP/SMZ), or placebo and followed over a study timeline for 2 years. Overall, a 50% reduction was noted in the incidence of recurrent febrile UTI with the utilization of prophylaxis as compared to placebo. Additional sub-group analyses have been performed on the cohorts of the study; these are also evaluated in this review to determine the overall impact of the RiVUR study on the current management of VUR.
{"title":"The RiVUR Study Outcomes and Implications on the Management of Vesicoureteral Reflux","authors":"Tiffany L. Damm, R. Mathews","doi":"10.33696/nephrology.2.006","DOIUrl":"https://doi.org/10.33696/nephrology.2.006","url":null,"abstract":"The Randomized intervention for Vesicoureteral Reflux (RiVUR) study was an effort by the National Institute of Health to identify the most significant question on the management of vesicoureteral reflux (VUR), i.e. Did antibiotic prophylaxis reduce the incidence of recurrent urinary tract infections (UTI) in children with VUR? During the initial phases of the RiVUR study, several similar studies were performed that seemed to indicate a lack of benefit of antibiotic prophylaxis in VUR. However, few of these studies had the rigorous methodology and true randomization of the pediatric cohort that was studied in RiVUR. Additionally, many of these studies included children of wide age ranges and inconsistent assessments were used for identification of UTI and VUR. In 2011, the American Academy of Pediatrics (AAP) published a guideline statement for the evaluation of initial UTI in febrile children aged 2 to 24 months, which recommended against performing a Voiding Cystourethrogram (VCUG) in all children with a confirmed UTI. The goal of the AAP guidelines was to reduce the number of VCUGs being performed and potentially to reduce the number of children diagnosed with low grade VUR that seems to have low potential to cause renal injury. The RiVUR study included over 600 children identified with VUR after a 1st or 2nd febrile UTI randomized to prophylaxis with trimethoprim/sulfamethoxazole (TMP/SMZ), or placebo and followed over a study timeline for 2 years. Overall, a 50% reduction was noted in the incidence of recurrent febrile UTI with the utilization of prophylaxis as compared to placebo. Additional sub-group analyses have been performed on the cohorts of the study; these are also evaluated in this review to determine the overall impact of the RiVUR study on the current management of VUR.","PeriodicalId":93732,"journal":{"name":"Archives of nephrology and renal studies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89016371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Randomized intervention for Vesicoureteral Reflux (RiVUR) study was an effort by the National Institute of Health to identify the most significant question on the management of vesicoureteral reflux (VUR), i.e. Did antibiotic prophylaxis reduce the incidence of recurrent urinary tract infections (UTI) in children with VUR? During the initial phases of the RiVUR study, several similar studies were performed that seemed to indicate a lack of benefit of antibiotic prophylaxis in VUR. However, few of these studies had the rigorous methodology and true randomization of the pediatric cohort that was studied in RiVUR. Additionally, many of these studies included children of wide age ranges and inconsistent assessments were used for identification of UTI and VUR. In 2011, the American Academy of Pediatrics (AAP) published a guideline statement for the evaluation of initial UTI in febrile children aged 2 to 24 months, which recommended against performing a Voiding Cystourethrogram (VCUG) in all children with a confirmed UTI. The goal of the AAP guidelines was to reduce the number of VCUGs being performed and potentially to reduce the number of children diagnosed with low grade VUR that seems to have low potential to cause renal injury. The RiVUR study included over 600 children identified with VUR after a 1st or 2nd febrile UTI randomized to prophylaxis with trimethoprim/sulfamethoxazole (TMP/SMZ), or placebo and followed over a study timeline for 2 years. Overall, a 50% reduction was noted in the incidence of recurrent febrile UTI with the utilization of prophylaxis as compared to placebo. Additional sub-group analyses have been performed on the cohorts of the study; these are also evaluated in this review to determine the overall impact of the RiVUR study on the current management of VUR.
{"title":"The RiVUR Study Outcomes and Implications on the Management of Vesicoureteral Reflux.","authors":"Tiffany Damm, Ranjiv Mathews","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Randomized intervention for Vesicoureteral Reflux (RiVUR) study was an effort by the National Institute of Health to identify the most significant question on the management of vesicoureteral reflux (VUR), i.e. Did antibiotic prophylaxis reduce the incidence of recurrent urinary tract infections (UTI) in children with VUR? During the initial phases of the RiVUR study, several similar studies were performed that seemed to indicate a lack of benefit of antibiotic prophylaxis in VUR. However, few of these studies had the rigorous methodology and true randomization of the pediatric cohort that was studied in RiVUR. Additionally, many of these studies included children of wide age ranges and inconsistent assessments were used for identification of UTI and VUR. In 2011, the American Academy of Pediatrics (AAP) published a guideline statement for the evaluation of initial UTI in febrile children aged 2 to 24 months, which recommended against performing a Voiding Cystourethrogram (VCUG) in all children with a confirmed UTI. The goal of the AAP guidelines was to reduce the number of VCUGs being performed and potentially to reduce the number of children diagnosed with low grade VUR that seems to have low potential to cause renal injury. The RiVUR study included over 600 children identified with VUR after a 1<sup>st</sup> or 2<sup>nd</sup> febrile UTI randomized to prophylaxis with trimethoprim/sulfamethoxazole (TMP/SMZ), or placebo and followed over a study timeline for 2 years. Overall, a 50% reduction was noted in the incidence of recurrent febrile UTI with the utilization of prophylaxis as compared to placebo. Additional sub-group analyses have been performed on the cohorts of the study; these are also evaluated in this review to determine the overall impact of the RiVUR study on the current management of VUR.</p>","PeriodicalId":93732,"journal":{"name":"Archives of nephrology and renal studies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9348554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40583676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-21DOI: 10.33696/nephrology.1.002
Hatem Ali, Mohammed A Elshafey, Mahmoud M Mohamed
Introduction: Our modern world is facing extraordinary circumstances while passing through a serious pandemic caused by the novel coronavirus (COVID-19) which may lead to multi-organ system failure & death. B cell depletion could compromise antiviral immunity, which makes the safety of rituximab use in the COVID 19 era unclear. Methods: All patients who had renal transplant from the 1st of March 2020 till 30th of July 2020 and registered in the OPTN were retrospectively reviewed. Patients were followed up to September 2020. We included patients who received rituximab induction therapy during this period. Exclusion criteria were patients who did not receive rituximab induction therapy, and patients with missing data about rituximab induction therapy. Measured outcome centered on patient survival until the end of the follow-up period. Results: During the first wave of COVID-19 pandemic from the 1st of March 2020 till 31st of July 2020, 9,095 patients had renal transplant and were registered in OPTN database. 8,770 patients had single organ transplant (kidney transplant) and 325 patients had dual organ transplant (kidney and pancreas). Out of this cohort, 114 patients received rituximab induction therapy. The total number of deaths was 127 patients (1.39%). Among those who received rituximab induction agent, only one patient died during the follow-up period. The cause of death for this patient was unknown. Conclusion: Our study showed that it is safe to use Rituximab as an important therapeutic agent during COVID-19 pandemic. However, special precautions and shielding are needed.
{"title":"Safety of Using Rituximab Therapy During COVID-19 Pandemic","authors":"Hatem Ali, Mohammed A Elshafey, Mahmoud M Mohamed","doi":"10.33696/nephrology.1.002","DOIUrl":"https://doi.org/10.33696/nephrology.1.002","url":null,"abstract":"Introduction: Our modern world is facing extraordinary circumstances while passing through a serious pandemic caused by the novel coronavirus (COVID-19) which may lead to multi-organ system failure & death. B cell depletion could compromise antiviral immunity, which makes the safety of rituximab use in the COVID 19 era unclear. Methods: All patients who had renal transplant from the 1st of March 2020 till 30th of July 2020 and registered in the OPTN were retrospectively reviewed. Patients were followed up to September 2020. We included patients who received rituximab induction therapy during this period. Exclusion criteria were patients who did not receive rituximab induction therapy, and patients with missing data about rituximab induction therapy. Measured outcome centered on patient survival until the end of the follow-up period. Results: During the first wave of COVID-19 pandemic from the 1st of March 2020 till 31st of July 2020, 9,095 patients had renal transplant and were registered in OPTN database. 8,770 patients had single organ transplant (kidney transplant) and 325 patients had dual organ transplant (kidney and pancreas). Out of this cohort, 114 patients received rituximab induction therapy. The total number of deaths was 127 patients (1.39%). Among those who received rituximab induction agent, only one patient died during the follow-up period. The cause of death for this patient was unknown. Conclusion: Our study showed that it is safe to use Rituximab as an important therapeutic agent during COVID-19 pandemic. However, special precautions and shielding are needed.","PeriodicalId":93732,"journal":{"name":"Archives of nephrology and renal studies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85246567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-21DOI: 10.33696/nephrology.1.005
Ricardo Peralta, Rui Sousa, Bruno Pinto, P. Gonçalves, Carla Felix, João Fazendeiro, Matos
One of the most important renal nursing procedures is the cannulation of a vascular access (VA), a procedure that is carried out on every single dialysis treatment. VA cannulation method is still a procedure that reflects local unit practices and the skill of the individual nurse. Despite the impact needling has on VA survival and patient outcome, no universal or standardized method has been proposed for cannulation [1]. Observational data reveals a large variation in how different cannulation techniques are applied in clinical practice. Techniques such as buttonhole (BH), rope ladder (RL), and area cannulation (AC) are often applied in different ways, resulting in different results, which confounds interpretation of the available evidence [2]. For example, in several randomized controlled trials (RCT) [3-5] comparing RL and BH cannulation techniques, researchers described the implementation of BH in some detail but did not define how they implemented RL. What is known is that RL consists of using the entire length of the available vessel through progressive rotation with equal distribution of the cannulation sites at each dialysis session, following a diagram showing the characteristics of each individual arteriovenous fistula (AVF) [6]. BH technique requires different skills from RL, as the AVF needs to be repeatedly cannulated at exactly the same site, using the same insertion angle and the same depth of penetration every time. The available literature does not currently recommend the routine use of BH in all AVF, due to the high risk of infection, but BH may be appropriate for patients with a short cannulation segment [7]. Cannulators using AC also create new puncture sites each time, but with all sites placed in the same area, one rarely larger than 2–3 cm in diameter. The different cannulation techniques (CT) have been investigated, with guidelines stating AC should not be used because of the increased risk of complications such as aneurysms and hemorrhage [8]. VA CT have not seen any development in recent years and in the most recently updated KDOQI [9] guidelines state that rigorous studies assessing cannulation practices to achieve zero complications are necessary. To answer this challenge, a new approach to fistula cannulation with apparent benefits for patients has been used since 2013, the Multiple Single cannulation Technique (MuST) [6,10].
最重要的肾脏护理程序之一是血管通道插管(VA)，这是在每次透析治疗中进行的程序。VA插管方法仍然是一个程序，反映了当地单位的做法和个别护士的技能。尽管针刺对VA存活和患者预后有影响，但尚未提出通用或标准化的插管方法[1]。观察数据显示，不同的插管技术在临床实践中的应用存在很大差异。扣眼(BH)、绳梯(RL)和区域套管(AC)等技术通常以不同的方式应用，导致不同的结果，这混淆了对现有证据的解释[2]。例如，在几项比较RL和BH插管技术的随机对照试验(RCT)[3-5]中，研究人员详细描述了BH的实施，但没有定义他们如何实施RL。已知的是，RL包括在每次透析过程中通过渐进旋转均匀分布插管位置来使用可用血管的整个长度，遵循显示每个单独的动静脉瘘(AVF)特征的图表[6]。BH技术与RL技术要求不同，因为AVF需要在完全相同的位置重复插管，每次使用相同的插入角度和相同的穿透深度。由于感染风险高，现有文献目前不建议在所有AVF中常规使用BH，但BH可能适用于插管段较短的患者[7]。使用交流电的穿刺器每次也会产生新的穿刺点，但所有的穿刺点都位于同一区域，直径很少大于2-3厘米。不同的插管技术(CT)已被研究，指南指出AC不应使用，因为会增加并发症的风险，如动脉瘤和出血[8]。近年来VA CT没有任何发展，在最近更新的KDOQI[9]指南中指出，有必要进行严格的研究，评估插管实践以实现零并发症。为了应对这一挑战，自2013年以来，一种对患者明显有益的瘘管插管新方法被采用，即多重单管插管技术(Multiple Single cannulation Technique, MuST)[6,10]。
{"title":"Commentary on: “Multiple Single Cannulation Technique of Arteriovenous Fistula: A Randomised Controlled Trial”","authors":"Ricardo Peralta, Rui Sousa, Bruno Pinto, P. Gonçalves, Carla Felix, João Fazendeiro, Matos","doi":"10.33696/nephrology.1.005","DOIUrl":"https://doi.org/10.33696/nephrology.1.005","url":null,"abstract":"One of the most important renal nursing procedures is the cannulation of a vascular access (VA), a procedure that is carried out on every single dialysis treatment. VA cannulation method is still a procedure that reflects local unit practices and the skill of the individual nurse. Despite the impact needling has on VA survival and patient outcome, no universal or standardized method has been proposed for cannulation [1]. Observational data reveals a large variation in how different cannulation techniques are applied in clinical practice. Techniques such as buttonhole (BH), rope ladder (RL), and area cannulation (AC) are often applied in different ways, resulting in different results, which confounds interpretation of the available evidence [2]. For example, in several randomized controlled trials (RCT) [3-5] comparing RL and BH cannulation techniques, researchers described the implementation of BH in some detail but did not define how they implemented RL. What is known is that RL consists of using the entire length of the available vessel through progressive rotation with equal distribution of the cannulation sites at each dialysis session, following a diagram showing the characteristics of each individual arteriovenous fistula (AVF) [6]. BH technique requires different skills from RL, as the AVF needs to be repeatedly cannulated at exactly the same site, using the same insertion angle and the same depth of penetration every time. The available literature does not currently recommend the routine use of BH in all AVF, due to the high risk of infection, but BH may be appropriate for patients with a short cannulation segment [7]. Cannulators using AC also create new puncture sites each time, but with all sites placed in the same area, one rarely larger than 2–3 cm in diameter. The different cannulation techniques (CT) have been investigated, with guidelines stating AC should not be used because of the increased risk of complications such as aneurysms and hemorrhage [8]. VA CT have not seen any development in recent years and in the most recently updated KDOQI [9] guidelines state that rigorous studies assessing cannulation practices to achieve zero complications are necessary. To answer this challenge, a new approach to fistula cannulation with apparent benefits for patients has been used since 2013, the Multiple Single cannulation Technique (MuST) [6,10].","PeriodicalId":93732,"journal":{"name":"Archives of nephrology and renal studies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90434273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-21DOI: 10.33696/nephrology.1.001
K. Maciolek, N. Schenkman
With readily available cross-sectional imaging, asymptomatic localized renal masses (LRMs) are often incidentally found. The standard management for LRM has been surgical resection, however, detection of masses that are benign or with low metastatic risk has led to interest in minimally invasive alternatives such as percutaneous thermal ablation (TA) or active surveillance. The increasing adoption of TA heralds more data and novel uses. Our previous article by Mershon et al. highlighted the safety and efficacy of TA for treatment of LRMs in select patients [1]. In this presentation, we update that work and discuss new frontiers for TA including patient selection, procedural improvements, and outcomes.
{"title":"Percutaneous Ablation of Localized Renal Masses: An Updated Review","authors":"K. Maciolek, N. Schenkman","doi":"10.33696/nephrology.1.001","DOIUrl":"https://doi.org/10.33696/nephrology.1.001","url":null,"abstract":"With readily available cross-sectional imaging, asymptomatic localized renal masses (LRMs) are often incidentally found. The standard management for LRM has been surgical resection, however, detection of masses that are benign or with low metastatic risk has led to interest in minimally invasive alternatives such as percutaneous thermal ablation (TA) or active surveillance. The increasing adoption of TA heralds more data and novel uses. Our previous article by Mershon et al. highlighted the safety and efficacy of TA for treatment of LRMs in select patients [1]. In this presentation, we update that work and discuss new frontiers for TA including patient selection, procedural improvements, and outcomes.","PeriodicalId":93732,"journal":{"name":"Archives of nephrology and renal studies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87518809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-21DOI: 10.33696/nephrology.1.004
F. Carrera, J. Costa, L. Pereira, M. A. Marques, B. Spencer, F. Ferrer
Background: Hemodialysis patients as well as healthcare workers are considered to be in a high-risk category for SARS-CoV-2 infection and a priority for vaccination. Methods: In a single-center out-patient hemodialysis unit, 46 healthcare workers and 216 patients were vaccinated simultaneously with BNT162b2 (BioNTech-Pfizer) vaccine. They received two doses, 21 days apart. The primary objectives were to evaluate the safety and efficacy of the vaccine. Results: There were no major adverse events in either group. Lymphadenopathy was reported by some health workers. All (100%) individuals in the healthcare workers group developed a positive antibody response (anti-S IgG) after the second dose compared with 91.7% of patients. Among patients there was a significant negative correlation between anti-S levels and age after both, the first dose (R= -0.176, p=0.01) and the second dose (R= -0.193, p=0.005);there was also a significant negative correlation between anti-S and Charlson Comorbidity Index adjusted for age after both, the first dose (R= -0.150, p=0.028) and the second dose (R= -0.163, p=0.018). Finally, a negative correlation between anti-S and Body Mass Index was found after the first dose (R= -0.140, p=0.04). No correlations were found with dialysis vintage, Kt/V, or diabetes. Conclusions: Following vaccination, patients had a significantly lower anti-S response than healthcare workers. Age, Charlson Comorbidity Index and Body Mass Index negatively impacted the humoral response. However, with more than 91% response we believe that vaccination can be recommended strongly in the hemodialysis population.
{"title":"How Well Do Hemodialysis Patients Respond to the BNT162b2 mRNA COVID-19 Vaccine?","authors":"F. Carrera, J. Costa, L. Pereira, M. A. Marques, B. Spencer, F. Ferrer","doi":"10.33696/nephrology.1.004","DOIUrl":"https://doi.org/10.33696/nephrology.1.004","url":null,"abstract":"Background: Hemodialysis patients as well as healthcare workers are considered to be in a high-risk category for SARS-CoV-2 infection and a priority for vaccination. Methods: In a single-center out-patient hemodialysis unit, 46 healthcare workers and 216 patients were vaccinated simultaneously with BNT162b2 (BioNTech-Pfizer) vaccine. They received two doses, 21 days apart. The primary objectives were to evaluate the safety and efficacy of the vaccine. Results: There were no major adverse events in either group. Lymphadenopathy was reported by some health workers. All (100%) individuals in the healthcare workers group developed a positive antibody response (anti-S IgG) after the second dose compared with 91.7% of patients. Among patients there was a significant negative correlation between anti-S levels and age after both, the first dose (R= -0.176, p=0.01) and the second dose (R= -0.193, p=0.005);there was also a significant negative correlation between anti-S and Charlson Comorbidity Index adjusted for age after both, the first dose (R= -0.150, p=0.028) and the second dose (R= -0.163, p=0.018). Finally, a negative correlation between anti-S and Body Mass Index was found after the first dose (R= -0.140, p=0.04). No correlations were found with dialysis vintage, Kt/V, or diabetes. Conclusions: Following vaccination, patients had a significantly lower anti-S response than healthcare workers. Age, Charlson Comorbidity Index and Body Mass Index negatively impacted the humoral response. However, with more than 91% response we believe that vaccination can be recommended strongly in the hemodialysis population.","PeriodicalId":93732,"journal":{"name":"Archives of nephrology and renal studies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87424777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-21DOI: 10.33696/nephrology.1.003
F. Ionescu, Saima Mansuri
With the advent of the direct oral anticoagulants (DOACs), patients requiring anticoagulation for common conditions such as atrial fibrillation and venous thromboembolism no longer need to worry about dietary restrictions or regular monitoring of the international normalized ratio which complicated warfarin treatment. Switching from warfarin to apixaban, a DOAC, has been shown to improve patient satisfaction by reducing treatment burden [1]. The clotting factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban) and the direct thrombin inhibitors (argatroban and dabigatran) have shown non-inferiority in preventing thromboembolic events and a superior safety profile in terms of bleeding in several trials when compared to warfarin [2-6]. Furthermore, apixaban and dabigatran have even shown superiority in preventing stroke or systemic embolism [3,6].
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