Serological Response to SARS-CoV-2 Vaccine in Hemodialyzed Patients and the Association with Later COVID-19 Positivity.

BACKGROUND: The effectiveness of the COVID-19 vaccine may differ in hemodialysis patients. The aim of this prospective multicenter study was to determine the degree of serological response to the SARS-CoV-2 vaccine in the population of dialysis patients and its association with later SARS-CoV-2 infections. METHODS: A blood sample was taken for the determination of COVID-19 serological status (IgG antibodies) in 706 dialysis patients 16 weeks after vaccination with the second dose (Pfizer-BioNTech). RESULTS: Only 314 (44.5%) hemodialyzed patients had a satisfactory response to the COVID-19 vaccine. Eighty-two patients (11.6%) had a borderline response, while 310 patients (43.9%) had an unsatisfactory (negative) post-vaccinal antibody titer. A longer dialysis vintage had an increased odds ratio (OR) of 1.01 for the occurrence of COVID-19 positivity after vaccination. In the group of subsequently positive patients, 28 patients (13.6%) died from complications of COVID-19. We have found differences in mean survival time between patients with and without appropriate responses to vaccination in favor of patients with a satisfactory serological response. CONCLUSIONS: The results showed that the dialysis population will not have the same serological response to the vaccine as the general population. The majority of dialysis patients did not develop a severe clinical picture or die at the time of positivity for COVID-19.

[Subjective general assessment of nutritional status in patients with chronic renal failure and regular hemodialysis]. / Subjektivna opca procjena nutritivnog statusa u bolesnika s kronicnim zatajenjem bubrega na redovnoj hemodijalizi.

PATIENTS AND METHODS: The protein energy malnutrition rating has been investigated in 75 hemodialysis (HD) patients with average treatment period of 67.3 month. A method of subjective global assessment (SGA) of nutritional status was used including body weight and food intake changes evaluated in last six months, as well as the nutritional status in relation to the subcutaneous fat loss and muscle mass wasting. SGA classifies the patients as: A well-nourished, B--mildly malnourished and C--severely malnourished. RESULTS: Malnutrition was identified in 40%, mild in 34.7% and severe in 5.3% of the patients. In the group of patients with normal nutritional status there were significantly fewer patients with lower values of objective parameters of nutritional status (body mass index (BMI), mid-arm muscle circumference (MAMC), phase angle from bioimpedance measurement, serum albumin) than in the group of patients with severe malnutrition. The differences in these parameters were of marginal significance between the groups with normal nutritional status and with mild malnutrition. The former had a significantly higher BMI value and serum albumin concentrations in comparison to the malnourished patients. There was also a considerable difference in the mean value of C-reactive protein (CRP) among all groups. The rates of malnutrition defined by the SGA method showed a high negative correlation with BMI, MAMC and serum albumin, and high positive correlation with CRP. CONCLUSIONS: We confirmed the SGA method to be simple to use, and to correlate strongly with other parameters of nutrition. We suggest that the CRP test be included in the assessment of nutritional status to determine the patient inflammatory status, considering the etiologic association between inflammation and malnutrition.