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Introduction: The COVID-19 pandemic is a global public health problem. Patients with end-stage renal disease on hemodialysis are at a higher risk of infection and mortality than the general population. Worldwide, a vaccination campaign has been developed that has been shown to reduce severe infections and deaths in the general population. However, there are currently limited data on the clinical efficacy of vaccinations in the hemodialysis population. Methods: A national multicenter observational cohort was performed in Chile to evaluate the clinical efficacy of anti-SARS-CoV-2 vaccination in end-stage renal disease patients on chronic hemodialysis from February 2021 to August 2021. In addition, the BNT162b2 (Pfizer-BioNTech) and CoronaVac (Sinovac) vaccines were evaluated. The efficacy of vaccination in preventing SARS-CoV-2 infection, hospitalizations, and deaths associated with COVID-19 was determined. Results: A total of 12,301 patients were evaluated; 10,615 (86.3%) received a complete vaccination (2 doses), 490 (4.0%) received incomplete vaccination, and 1196 (9.7%) were not vaccinated. During follow-up, 1362 (11.0%) patients developed COVID-19, and 150 died (case fatality rate: 11.0%). The efficacy of the complete vaccination in preventing infection was 18.1% (95% confidence interval [CI]:11.8-23.8%), and prevention of death was 66.0% (95% CI:60.6-70.7%). When comparing both vaccines, BNT162b2 and CoronaVac were effective in reducing infection and deaths associated with COVID-19. Nevertheless, the BNT162b2 vaccine had higher efficacy in preventing infection (42.6% vs. 15.0%) and deaths (90.4% vs. 64.8%) compared to CoronaVac. Conclusion: The results of our study suggest that vaccination against SARS-CoV-2 in patients on chronic hemodialysis was effective in preventing infection and death associated with COVID-19.
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Se analiza la evolución y resultado perinatal del total de gestaciones ocurridas en 19 años de experiencia en mujeres receptoras de un transplante renal, casuística que se inicia en 1982. El embarazo fue planeado en la mayoría de los casos, objetivado por cuanto la latencia entre transplante y gestación fue mayor a dos años en un 76 por ciento de los casos. Hubo un 53 por ciento de hipertensión, 58 por ciento de prematurez y 34 por ciento de RCIU. En nuestra serie no hubo malformados. No se pesquiso rechazo del riñon transplantado. Los abortos correspondieron a un 9 por ciento y excluyendo a éstos, el porcentaje de letalidad fue de 6,45 por ciento
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Humanos , Femenino , Embarazo , Recién Nacido , Adolescente , Adulto , Embarazo de Alto Riesgo , Trasplante de Riñón , Creatinina , Rechazo de Injerto , Hipertensión , Inmunosupresores , Recien Nacido Prematuro , Edad Materna , Complicaciones del EmbarazoRESUMEN
Renal transplantation can be done in patients with neurogenic bladder and clean intermittent sel catheterization maintains renal function. To retrospective assess the results of renal transplantation in patients with neurogenic bladder. The medical records of seven patients aged 10 to 22 years old (3 female) followed during 7 to 32 months were reviewed. All patients had urinary tract infection prior to transplantation, were instructed to self catheterization and received tri-associated immunosupression. Grafts came from alive related donors in 5 patients and from cadavers in 2. Prior to transplantation, 3 patients were subjected to nephrectomy and 3 to bladder enlargement, leaving a pigtail catheter. After transplantation, one lymphocele was drained, one uretherostomy due to an impacted lithiasis and one nephrectomy plus vesical enlargement due to intravesical pressures over 40 cm H2O, were done. One uretheral stricture was treated with dilatation. Seven episodes of pyelonephritis, 19 urinary tract infections and 77 asymptomatic bacteriurias were documented. Serum creatinine at the end of follow up ranged from 0.7 to 2.1 mg/dl. There were 0.7 acute rejection episodes per patient and all grafts survived. Renal transplantation in patients with neurogenic bladder is feasible, performing a vesical enlargement. There is however a high frequency of infectious episodes
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Vejiga Urinaria Neurogénica/complicaciones , Trasplante de Riñón , Pielonefritis/complicaciones , Infecciones Urinarias/complicaciones , Cateterismo Urinario , Inmunosupresores/administración & dosificación , Insuficiencia Renal Crónica/etiologíaRESUMEN
El riñón senil se caracteriza morfológicamente por presentar una disminución progresiva de su masa con importante aumento de la esclerosis glomerular. Esta esclerosis glomerular del anciano se relaciona anatómica y funcionalmente con una disminución del riesgo sanguíneo renal por arterioesclerosis. Funcionalmente, hay una filtración glomerular disminuida y se destaca también una menor capacidad homeostática para la rgulación del sodio, agua e hidrogeniones. Hay además una menor capacidad para activar la vitamina D, lo cual influye en la menor absorción de calcio intestinal que hay en el anciano
