The World Health Organization has declared the SARS-CoV-2 infection (COVID-19) outbreak as a Public Health Emergency of International Concern and characterized it as a pandemic. 1,2 Since early March, 2020, the Spanish cases curve started to rise, with more than 177 000 people infected in 6 weeks. 3 The reported fatality-rate in the general population with COVID-19 admitted to a large tertiary Spanish Hospital is 20.7%, 34% in the subgroup of age 70-79 years. 4

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SummaryBackground and objectives Data are needed to assess safety and efficacy of the 2009 pandemic influenza A H1N1 vaccine in renal patients.Design, setting, participants, & measurements We prospectively evaluated seroconversion, predictors of response, and vaccine safety in renal patients. Hemagglutination inhibition tests to detect serum antibodies against a new influenza A-H1N1 virus were performed in 79 transplant patients, 48 hemodialysis patients, and 15 healthy workers before and 1 month after vaccination. Healthy controls and 88 of 127 renal patients were vaccinated. Seroconversion was defined as at least 2 dilutions increase in titer.Results We excluded 19 individuals seroprotected (Ն1/40) against the novel H1N1 in the initial sample. Efficacy rate in the 96 vaccinated individuals was 43.7% (42 of 96 seroconverted versus four of 27 nonvaccinated patients, P ϭ 0.007). For vaccinated subgroups, efficacy was 41.8% in transplant patients (P ϭ 0.039 versus nonvaccinated), 33.3% in hemodialysis patients (P ϭ 0.450), and 81.8% in controls. Healthy controls showed better response to vaccine than transplant (P ϭ 0.021) and dialysis (P ϭ 0.012) patients. For the transplant subgroup, longer time after transplantation (P ϭ 0.028) was associated with seroconversion, but no influence was found for age, gender, renal function, or immunosuppression. In the hemodialysis subgroup, younger age was associated with response (55.7 Ϯ 20.8 versus 71.6 Ϯ 10.1 years, P ϭ 0.042), but other specific variables, including Kt/V or time on dialysis, were not. No serious adverse events were reported, and kidney function was stable. ConclusionThe novel influenza A 2009 H1N1 vaccine was safe in renal patients, although administration of a single dose of adjuvanted vaccine induced a poor response in these patients.

Prevalence of stroke in our RTR population was 7.97%. Cerebral hemorrhage appears to be more prevalent in RTR than in general population. More than that, the cerebral hemorrhage rate we found is higher than that reported elsewhere in RTR. The main predictors of stroke were DN, PVD and age. No patient with interstitial nephropathy suffered stroke. Mortality is high in RTR with stroke.

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