Data_Sheet_1_Humoral Response to mRNA-1273 SARS-CoV-2 Vaccine in Peritoneal Dialysis Patients: Is Boostering After Six Months Adequate?.PDF

In dialysis patients the humoral response to anti-SARS-CoV-2 vaccines is attenuated and rapidly declines over time. However, data on the persistence of the immune response in peritoneal dialysis (PD) patients are scarce, particularly after a third (booster) dose with mRNA-1273 vaccine. In this prospective cohort study, we report anti-SARS-CoV-2 antibody levels in PD patients before and after the third dose of mRNA-1273 vaccine. Six months after the second dose, anti-SARS-CoV-2 antibodies were detected in all patients (n = 34). However, within this time period antibodies substantially declined in 31 of 34 patients (4.5-fold, median = 192 BAU/mL, p = 1.27 × 10–9) and increased in three patients. In accordance with government regulations, a third dose of mRNA-1273 vaccine (50 μg) was given to 27 PD patients 6 months after the second dose which induced a significant increase of anti-SARS-CoV-2 antibody titers (58.6-fold, median = 19405 BAU/mL, p = 1.24 × 10–29). A mixed model analysis showed that a lower Davies Comorbidity Score and a higher GFR were associated with higher antibody titers (p = 0.03 and p = 0.02). The most common adverse events after the third dose were pain at the injection site (77.8%) and fatigue (51.9%). No hospitalizations were reported. In conclusion, 6 months after the second dose of mRNA-1273 vaccine, anti-SARS-CoV-2 antibodies substantially decreased in PD patients, whereas a well-tolerated third dose induced a robust humoral response. Our data suggest that the administration of a booster dose within a shorter interval than 6 months should be considered in PD patients in order to maintain high anti-SARS-CoV-2 antibody levels and assure protection from severe COVID-19 disease.</p

Data_Sheet_1_Challenges to dialysis treatment during the COVID-19 pandemic: a qualitative study of patients’ and experts’ perspectives.docx

BackgroundThe global COVID-19 pandemic transformed healthcare services in ways that have impacted individual physical and psychological health. The substantial health challenges routinely faced by dialysis-dependent patients with advanced kidney disease have increased considerably during the ongoing COVID-19 pandemic but remain inadequately investigated. We therefore decided to analyze and compare the perspectives of dialysis patients on their own needs and challenges during the COVID-19 pandemic with those of their professional healthcare providers through interviews with both groups.MethodsQualitative study of seven in-center hemodialysis patients, seven peritoneal dialysis patients, seven dialysis nurses, and seven physicians at the Medical University of Vienna between March 2020 and February 2021, involving content analysis of semi-structured interviews supported by a natural language processing technique.ResultsAmong the main themes emerging from interviews with patients were: (1) concerns about being a ‘high-risk patient’; (2) little fear of COVID-19 as a patient on hemodialysis; (3) questions about home dialysis as a better choice than in-center dialysis. Among the main themes brought up by physicians and nurses were: (1) anxiety, sadness, and loneliness of peritoneal dialysis patients; (2) negative impact of changes in clinical routine on patients’ well-being; (3) telehealth as a new modality of care.ConclusionPreventive measures against COVID-19 (e.g., use of facemasks, distancing, isolation), the introduction of telemedicine, and an increase in home dialysis have led to communication barriers and reduced face-to-face and direct physical contact between healthcare providers and patients. Physicians did not perceive the full extent of patients’ psychological burdens. Selection/modification of dialysis modality should include analysis of the patient’s support network and proactive discussion between dialysis patients and their healthcare providers about implications of the ongoing COVID-19 epidemic. Modification of clinical routine care to increase frequency of psychological evaluation should be considered in anticipation of future surges of COVID-19 or currently unforeseen pandemics.</p

Hospitalization days before and after the initiation of PD (n = 40).

Variables are displayed as mean and SEM. Differences between the variables were compared using the Wilcoxon test. ** indicates statistical significance with p<0.01 and *** with p<0.001.</p

Changes of parameters after initiation of PD in patients with an overall survival ≥ 2 years (n = 14).

Variables are displayed as Tukey boxplots. Differences between the variables were compared using the Wilcoxon test. * indicates statistical significance with p<0.05 and ** with p<0.01.</p

Biometric variables for patients with peritoneal dialysis with successful therapy (n = 18) or surviving ≥ 2 years (n = 14).

Variables are given as medians and inter-quartile ranges (IQR). Differences between the variables days before and after the initiation of PD are calculated using the Wilcoxon test.</p

Baseline characteristics of the peritoneal dialysis patient cohort (n = 40) and comparison of variables for the subgroups with successful treatment and 2 years survival.

Continuous variables are given as medians and inter-quartile ranges (IQR), counts are given as numbers and percentages. Variables were compared by the means of the Mann-Whitney-U test or the Chi-square test.</p

Hospitalization days for patients on peritoneal dialysis (PD) before and after starting the therapy (n = 40).

Total hospitalization days, hospitalization days due to cardiovascular (CV) reasons and unplanned hospitalization days are given as medians and inter-quartile ranges (IQR). Differences between hospitalization days before and after the initiation of PD are calculated using the Wilcoxon test.</p

Reasons for death at 3 years (n = 29).

Reasons for death at 3 years (n = 29).</p

Baseline echocardiographic parameters of the peritoneal dialysis patient cohort (n = 40) and comparison of variables for the subgroups with successful treatment and 2 years survival.

Continuous variables are given as medians and inter-quartile ranges (IQR), counts are given as numbers and percentages. Variables were compared by the means of the Mann-Whitney-U test or the Chi-square test.</p

Baseline kidney related and peritoneal dialysis related parameters of the peritoneal dialysis patient cohort (n = 40) and comparison of variables for the subgroups with successful treatment and 2 years survival.

Continuous variables are given as medians and inter-quartile ranges (IQR), counts are given as numbers and percentages. Variables were compared by the means of the Mann-Whitney-U test or the Chi-square test.</p