According to preliminary data, seroconversion after mRNA SARS‐CoV‐2 vaccination might be unsatisfactory in Kidney Transplant Recipients (KTRs). However, it is unknown if seronegative patients develop ...at least a cellular response that could offer a certain grade of protection against SARS‐CoV‐2. To answer this question, we prospectively studied 148 recipients of either kidney (133) or kidney‐pancreas (15) grafts with assessment of IgM/IgG spike (S) antibodies and ELISpot against the nucleocapside (N) and the S protein at baseline and 2 weeks after receiving the second dose of the mRNA‐1273 (Moderna) vaccine. At baseline, 31 patients (20.9%) had either IgM/IgG or ELISpot positivity and were considered to be SARS‐CoV‐2‐pre‐immunized, while 117 (79.1%) patients had no signs of either cellular or humoral response and were considered SARS‐CoV‐2‐naïve. After vaccination, naïve patients who developed either humoral or cellular response were finally 65.0%, of which 29.9% developed either IgG or IgM and 35.0% S‐ELISpot positivity. Factors associated with vaccine unresponsiveness were diabetes and treatment with antithymocytes globulins during the last year. Side effects were consistent with that of the pivotal trial and no DSAs developed after vaccination. In conclusion, mRNA‐1273 SARS‐CoV‐2 vaccine elicits either cellular or humoral response in almost two thirds of KTRs.
Stable kidney or kidney‐pancreas transplant recipients exhibit lower than expected rates of cellular and humoral responses to the
Here, we report a case of a patient with cloudy effluent that was initially diagnosed as bacterial peritonitis. The persistence of a cloudy effluent despite antibiotic therapy led to an extensive ...peritoneal dialysis (PD) effluent analysis, with the final diagnosis being high-grade B-cell lymphoma. This case will increase the awareness of this rare presentation of a lymphoproliferative disorder reminding clinicians to consider this diagnosis as a part of the differential diagnosis PD effluent.
La encefalopatía por contraste es una complicación neurológica relacionada con el contraste utilizado en procedimientos endovasculares o tomografía computarizada (TC). Los principales factores de ...riesgo son la hipertensión arterial, la diabetes mellitus, la enfermedad renal crónica (ERC), contrastes hiperosmolares, cantidad de contraste infundida y su infusión directa en el territorio cerebral posterior, o patologías que cursen con daño de barrera hematoencefálica. La sintomatología es inespecífica y puede presentarse como alteración del nivel de conciencia, focalidad neurológica o crisis comiciales. El diagnóstico es de exclusión tras haber descartado los accidentes cerebrovasculares (ACV) isquémicos o hemorrágicos; el TC o la resonancia magnética (RM) son de utilidad para su diferenciación. Generalmente aparece poco tiempo tras la exposición y la sintomatología dura 48-72 h con recuperación completa, aunque se han descrito casos con persistencia de los síntomas o mayor duración. El tratamiento es la monitorización con medidas de soporte y la terapia de sustitución renal con hemodiálisis (HD) en aquellos pacientes en programa crónico. Es importante que el nefrólogo conozca esta entidad, dada la susceptibilidad del paciente en HD, así como su potencial papel terapéutico en estos pacientes.
Contrast-induced encephalopathy is a neurological complication related to contrast used in endovascular procedures or computed tomography (CT). The main risk factors are arterial hypertension, diabetes mellitus, chronic kidney disease (CKD), hyperosmolar contrasts, the amount of infused contrast and its direct infusion in the posterior cerebral territory, or pathologies with blood–brain barrier damage. Symptomatology is non-specific and may present as altered level of consciousness, neurological focality or seizures. Diagnosis is done by exclusion after ischemic or hemorrhagic stroke has been ruled out; CT or MRI are useful for differentiation. Generally, it appears shortly after exposure and the symptoms lasts 48–72 h with complete recovery, although cases with persistence of symptoms or longer duration have been described. Treatment consists of monitoring, supportive measures and renal replacement therapy (RRT) with hemodialysis (HD) in patients in chronic RRT program. It is important for the nephrologist to be aware of this entity given the susceptibility of the patient on HD as well as its potential therapeutic role in these patients.
Background.
In kidney transplant recipients, there is discordance between the development of cellular and humoral response after vaccination against SARS-CoV-2. We sought to determine the interplay ...between the 2 arms of adaptive immunity in a 3-dose course of mRNA-1273 100 μg vaccine.
Methods.
Humoral (IgG/IgM) and cellular (N- and S-ELISpot) responses were studied in 117 kidney and 12 kidney-pancreas transplant recipients at the following time points: before the first dose, 14 d after the second dose‚ and before and after the third dose, with a median of 203 and 232 d after the start of the vaccination cycle, respectively.
Results.
After the second dose, 26.7% of naive cases experienced seroconversion. Before the third dose and in the absence of COVID-19, this percentage increased to 61.9%. After the third dose, seroconversion occurred in 80.0% of patients. Naive patients who had at any time point a detectable positivity for S-ELISpot were 75.2% of the population, whereas patients who maintained S-ELISpot positivity throughout the study were 34.3%. S-ELISpot positivity at 42 d was associated with final seroconversion (odds ratio‚ 3.14; 95% confidence interval‚ 1.10-8.96;
P
= 0.032). Final IgG titer was significantly higher in patients with constant S-ELISpot positivity (
P
< 0.001).
Conclusions.
A substantial proportion of kidney transplant recipients developed late seroconversion after 2 doses. Cellular immunity was associated with the development of a stronger humoral response.
Objective: Cardiovascular diseases are the leading cause of mortality and morbidity worldwide. Moreover, chronic kidney disease (CKD) patients exhibit significantly higher incidence and prevalence of ...cardiovascular events. In this population, used to a high burden of pills, the importance of a polypill-based treatment strategy increases to simplify treatment and ensure adherence. The cardiovascular polypill composition includes a lipid-lowering drug, antihypertensive agent, and antiplatelet therapy and is marketed in Spain since 2015 with the name of Trinomia. This report aims to obtain real-life data to evaluate ifTrinomia improves the standard of care. Design and method: Prospective, single-center, observational study of a cohort of CKD patients under the standard of care starting any combination of Trinomia in secondary prevention. Patient demographics, clinical history, blood pressure, and analysis of blood lipids, albumin-to-creatinineratio, and estimated glomerular filtration rate were measured at baseline and 6 and 12 months after starting treatment Results: A total of 49 patients (35 males) were included, with a mean age of 78,83 years (range 51–95). 91,83% had hypertension, 63,26% with type 2 diabetes and 2,04% with type 1 diabetes. Regarding the cause of secondary prevention, 75,4% had cardiovascular disease, 16,4% had a stroke, and 8.16% had both. All laboratory results are displayed in table 1. Conclusions: Although most of the variables studied, probably because it was a small group of patients with adequate baseline control, did not reach statistical significance, some results are worth noting. eGFR is 3 points higher at one year, with a reduction in UACR, which does not reach statistical significance but translates into a lower hyperfiltration without worsening renal function or an increase in serum potassium. In addition, there was a 5-point decrease in systolic blood pressure and a 3-point in diastolic (n.s.), and a better lipid profile is achieved, with a 10-point reduction in LDL and a 24-point reduction in triglycerides.
Abstract
BACKGROUND AND AIMS
Dialysis catheter-associated bacteraemia in Intensive Care Units (ICUs) increases morbidity and mortality, prolongs hospital admission and increases admission costs. ...TauroLock™ is a lock solution containing (cyclo)-taurolidine (1.35%) and citrate (4%). (Cyclo)-taurolidine has broad antimicrobial activity against gram-positive and gram-negative bacteria and fungi. The objective of this study was to analyse the effect of systematic sealing of haemodialysis catheters in the ICUs of the Hospital Clínic de Barcelona on the incidence of bacteraemia associated with haemodialysis catheters (BACH).
METHOD
BACH episodes of patients who underwent intermittent haemodialysis (IHD) during ICU admission were reviewed. The period analysed as pre-Taurolock™ was from 2010 to 2014 and post-TauroLock™ from 2015 to 2018. Patients who only received renal replacement therapy with continuous techniques were excluded.
RESULTS
A total of 279 patients received IHD in the pre-TauroLock™ period and 331 in the post-TauroLock™ period. The number of BACH in the pre-TauroLock™ period was 18 (6.45%) and 9 (2.72%) in the post-TauroLock™ period. All infections were from percutaneous catheters (acute patients) except three catheters that were tunnelled. In the pre-TauroLock™ period, femoral catheters predominated (61.1%) while in the post-TauroLock they were jugular (66.7%). There was no association between the location of the catheter and the incidence of BACH. Of the 27 patients with BACH, 14 (51.8%) were men with a mean age of 63 years, with no significant differences between the two groups. The most frequent reasons for admission to the ICU in the pre-TauroLock™ period were post-cardiac surgery, cardiogenic, septic or hypovolemic shock and acute myocardial infarction (3 patients per group) and in the post-TauroLock™ period, septic shock and pancreatitis (3 and 2 patients respectively). The most frequent isolated bacteria were Gram-positive (in total 48.38%: pre-TauroLock™ 47.61% and post-TauroLock™ 50%), with a global predominance of staphylococcus epidermidis (32.25%) (Table). There were no significant differences in the median days from the start of haemodialysis to bacteraemia (23.5 pre-TauroLock™ versus 21 post-TauroLock™). There were also no significant differences between the days of ICU stay in the BACH in both groups or in mortality, being the overall mortality of 70.4%.
CONCLUSION
In our cohort, the systematic application of TauroLock™ in the sealing of dialysis catheters in critically ill patients reduces the incidence of BACH in ICUs.
Abstract
BACKGROUND AND AIMS
Seroconversion after a two-dose course of mRNA COVID-19 vaccination in kidney transplant recipients ranges between 30% and 50% in different series. We previously ...demonstrated that a substantial proportion of patients (35%) without a humoral response, develop a cellular response after the second dose assessed by the ELISpot technique. We aim to study the evolution of both humoral and cellular responses in the same cohort before and 1 month after the administration of the third dose of 100 mcg of mRNA-1273 COVID-19 vaccine.
METHOD
Final population included 129 KTRs studied at four time-points: at baseline before the first dose, after the second dose (median 42 days) and before (203 days) and after (232 days) the third dose. At all the time-points, IgG and IgM were assessed as well as N- and S-protein specific ELISpot. The main outcome was seroconversion after the third dose.
RESULTS
After the second dose, 26.7% of naïve cases experienced seroconversion. Before the third dose and in the absence of clinically evident COVID-19, this percentage increased to 61.9%. After the third dose, seroconversion was observed in 80.0% of patients. S-ELISpot positivity after the second dose was significantly associated with final seroconversion OR (95% CI) 3.14 (1.10–8.96); P = .032, while transplantation < 1 year and previous kidney transplant were negatively associated with OR (95% CI) 0.23 (0.07–0.80); P = .021 and OR (95% CI) 0.22 (0.06–0.78); P = .020, respectively). IgG after third dose were significantly higher (P < .001) in patients who maintained S-ELISpot positivity throughout the study (34.3%) and were correlated with S-spots after the second dose (r = 0.344, P < .001).
CONCLUSION
A substantial proportion of KTRs vaccinated with mRNA-1273 develops a late seroconversion after two doses and only a fifth remained seronegative after a third. Cellular immunity seems to play a major role in the development of a final strong humoral response.
Background
The number of octogenarians or older patients admitted to the intensive care unit (ICU) has been growing over the past several years. The aim of this study is to assess factors associated ...with acute renal replacement therapy (ARRT) requirement in these patients and the impact of this therapy on 90-day mortality. We also aimed to identify prognostic factors associated with mortality risk in the group of patients that required ARRT.
Methods
Retrospective study of octogenarian or older patients admitted to the ICU at Hospital Clínic de Barcelona from June 2007 to April 2019. Patients on chronic dialysis treatment or with a kidney transplant, and patients with limitation of therapeutic support or admitted for less than 48 h were excluded.
Results
217 patients were included in the study, of whom 36.4% required ARRT. Use of vasoactive drugs (VAD) and Sequential Organ Failure Assessment (SOFA) score on admission were higher in ARRT patients (
P
= 0.009 and < 0.001, respectively). Basal estimated glomerular filtration rate (eGFR) was lower in the ARRT cohort (
P
< 0.001). Hospital and ICU length of stay were longer in the ARRT cohort (
P
< 0.001). Ninety-day mortality was 58.2% in the ARRT cohort compared to 55.8% in the non-ARRT control cohort (
P
= NS). In the survival analysis, only female sex, sepsis and non-renal SOFA ≥ 6.5 were significantly associated with mortality (
P
= 0.002, 0.028 and 0.009, respectively) in the ARRT cohort.
Conclusion
Mortality was not significantly increased in the octogenarian or older population that required and received ARRT compared to control patients who did not require it. Severity scores like SOFA could help in the process of decision making about initiation of ARRT in this population.
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