Background Individuals with end-stage kidney disease (ESKD) on dialysis are vulnerable to contracting COVID-19 infection, with mortality as high as 31 % in this group. Population demographics in the UAE are dissimilar to many other countries and data on antibody responses to COVID-19 is also limited. The objective of this study was to describe the characteristics of patients who developed COVID-19, the impact of the screening strategy, and to assess the antibody response to a subset of dialysis patients. Methods We retrospectively examined the outcomes of COVID19 infection in all our haemodialysis patients, who were tested regularly for COVID 19, whether symptomatic or asymptomatic. In addition, IgG antibody serology was also performed to assess response to COVID-19 in a subset of patients. Results 152 (13 %) of 1180 dialysis patients developed COVID-19 during the study period from 1st of March to the 1st of July 2020. Of these 81 % were male, average age of 52​ years and 95 % were on in-centre haemodialysis. Family and community contact was most likely source of infection in most patients. Fever (49 %) and cough (48 %) were the most common presenting symptoms, when present. Comorbidities in infected individuals included hypertension (93 %), diabetes (49 %), ischaemic heart disease (30 %). The majority (68 %) developed mild disease, whilst 13 % required critical care. Combinations of drugs including hydroxychloroquine, favipiravir, lopinavir, ritonavir, camostat, tocilizumab and steroids were used based on local guidelines. The median time to viral clearance defined by two negative PCR tests was 15 days [IQR 6–25]. Overall mortality in our cohort was 9.2 %, but ICU mortality was 65 %. COVID-19 IgG antibody serology was performed in a subset (n = 87) but 26 % of PCR positive patients (n = 23) did not develop a significant antibody response. Conclusions Our study reports a lower mortality in this patient group compared with many published series. Asymptomatic PCR positivity was present in 40 %. Rapid isolation of positive patients may have contributed to the relative lack of spread of COVID-19 within our dialysis units. The lack of antibody response in a few patients is concerning.

Inversely planned intensity-modulated radiotherapy (IMRT) and stereotactic small field radiotherapy should be verified before treatment execution. A second verification is carried out for planned treatments in IMRT and 3D conformal radiotherapy (3D-CRT) using a monitor verification commercial dose calculation management software (DCMS). For the same reference point the ion-chamber measured doses are compared for IMRT plans. DCMS (Diamond) computes dose based on modified Clarkson integration, accounting for multi-leaf collimators (MLC) transmission and measured collimator scatter factors. DCMS was validated with treatment planning system (TPS) (Eclipse 6.5 Version, Varian, USA) separately. Treatment plans computed from TPS are exported to DCMS using DICOM interface. Doses are re-calculated at selected points for fields delivered to IMRT phantom (IBA Scanditronix Wellhofer) in high-energy linac (Clinac 2300 CD, Varian). Doses measured at central axis, for the same points using CC13 (0.13 cc) ion chamber with Dose 1 Electrometer (Scanditronix Wellhofer) are compared with calculated data on DCMS and TPS. The data of 53 IMRT patients with fields ranging from 5 to 9 are reported. The computed dose for selected monitor units (MU) by Diamond showed good agreement with planned doses by TPS. DCMS dose prediction matched well in 3D-CRT forward plans (0.8 ± 1.3%, n = 37) and in IMRT inverse plans (–0.1 ± 2.2%, n = 37). Ion chamber measurements agreed well with Eclipse planned doses (–2.1 ± 2.0%, n = 53) and re-calculated DCMS doses (–1.5 ± 2.6%, n = 37) in phantom. DCMS dose validation is in reasonable agreement with TPS. DCMS calculations corroborate well with ionometric measured doses in most of the treatment plans.

Background: End stage kidney disease patients on maintenance dialysis are vulnerable to contract COVID-19 infection and variable degrees of disease severity have been reported. SEHA Kidney Care (SKC) is the largest provider of dialysis services in the United Arab Emirates providing dialysis services to ~1180 patients, including ~80 patients on peritoneal dialysis. Mortality of COVID-19 among patients with ESKD on dialysis is high and ranges from 14 to 31% in different published series. Not much is known about antibody response to COVID-19 in this group of patients. Patient population demographics in the UAE are dissimilar to many other countries. The objective of this study was to describe the characteristics of patients and clinical staff who developed COVID-19 RT-PCR positivity and assess antibody response to COVID-19.Methods: We conducted a retrospective analysis to characterize features of COVID-19 in our adult dialysis population. In addition, IgG antibody serology was also performed to assess response to COVID-19. Results: The incidence of COVID-19 infection in our population was 13%. 81% of the patients were males, average age was 53.2 ± 12​ years, and 95% were on in-center haemodialysis. The majority of patients (68%) developed mild disease while 13% required critical care. Combinations of drugs including Hydroxychloroquine, Favipiravir, Lopinavir, Ritonavir, Camostat, Tocilizumab and steroids were used based on local guidelines. The median time to viral clearance was 15 days [IQR 6-26]. Overall mortality in our cohort was 9.2%.We performed COVID-19 IgG antibody serology in a subset (n=87) of RT-PCR positive patients. Interestingly, 23 (26%) patients did not develop any antibody response. We successfully implemented a regular screening strategy for patients and staff to identify asymptomatic carriers with an aim to isolate them from the rest of the cohort.Conclusions: Our study has highlighted an important finding of lack of antibody response in a quarter of patients with ESKD. This may have significant implications for this group of patients while efforts are underway to develop an effective vaccine against COVID-19. With regular screening of all dialysis patients and staff, asymptomatic carriers can be identified and prevent spread of COVID-19 within the dialysis units.

Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) are oral hypoglycemic agents that have insulin-independent glucose-lowering effects mediated by increasing the renal excretion of glucose by inhibiting the SGLT2-mediated renal glucose reabsorption. An increasingly recognized complication induced by SGLT2i is euglycemic diabetic ketoacidosis (eDKA). Here, we describe the case of a 26-year-old male patient with type 2 diabetes mellitus and morbid obesity. Prior to presentation he was on multiple oral hypoglycemic agents including SGLT2i. He developed life-threatening severe prolonged eDKA associated with SGLT2i (Canagliflozin), precipitated by adenovirus infection. The acidosis was not responding to standard DKA therapy and renal replacement therapy but was managed effectively with insulin titration based on capillary ketone measurements. After reviewing the literature on severe prolonged eDKA induced by SGLT2 and treatment modalities used, we present previously reported cases similar to ours.

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