IntroductionSome hemodialysis patients are reluctant to COVID-19 for the development of adverse events (AEs). The aim of this study was to verify the safety of mRNA-1273 vaccine in hemodialysis patients.MethodsWe conducted a retrospective analysis of in-center hemodialysis patients who underwent mRNA-1273 vaccine from March 1st to April 30th, 2021. All AEs occurring after the first and the second doses were collected and classified as local or systemic.ResultsOverall, 126 patients on chronic maintenance dialysis without a prior COVID-19 diagnosis were vaccinated with two doses of mRNA-1273 vaccine. Mean age was 68 (IQR, 54,7-76) years and 53.6% of patients were aged ≥ 65 years. During the observational period of 68 (IQR, 66-70) days, AEs occurred in 57.9% and 61.9% of patients after the first dose and second dose, respectively. The most common AEs were: injection-site pain (61.9%), erythema (4.8%), itching (4.8%), swelling (16.7%), axillary swelling/tenderness (2.4%), fever (17.5%) headache (7.9%), fatigue (23.8%), myalgia (17.5%), arthralgia (12.7%), dyspnoea (2.4%), nausea/vomiting (7.1%), diarrhoea (5.6%), shivers (4%) and vertigo (1.6%).The rates of local AEs were similar after the first and second doses (P=0.8), whereas systemic AEs occurred more frequently after the second dose (P=0.001). Fever (P=0.03), fatigue (P=0.02) and nausea/vomiting (P=0.03) were significantly more frequent after the second dose of the vaccine. There were no age-related differences in the rate of AEs. Overall, vaccine-related AEs in hemodialysis patients seem to be lower than in the general population.ConclusionRNA-1273 vaccine was associated with the development of transient AEs after the first (57.9%) and second doses (61.9%) in patients on chronic maintenance hemodialysis. Systemic AEs were more common after the second dose. Overall, all AEs lasted for a few days, without any apparent sequelae.

Introduction. Patients receiving in-center hemodialysis are extremely vulnerable to COVID-19. It is unclear if routine screening of asymptomatic hemodialysis patients is an effective strategy to prevent COVID-19 outbreaks within the dialysis unit. Methods. We conducted a retrospective analysis of in-center hemodialysis patients who underwent bimonthly COVID-19 rapid antigen test screening from February 15th to December 26th, 2021. Nasal rapid antigen testing was performed in all asymptomatic patients. All rapid antigen-positive tests were confirmed by RT-PCR nasopharyngeal swab. Besides universal rapid antigen screening, RT-PCR testing was conducted in all symptomatic patients and contacts of COVID-19 subjects. Results. Overall, 4079 rapid antigen tests were performed in 277 hemodialysis patients on chronic hemodialysis with a mean age of 68.4 ± 14.6 years. Thirty-eight (0.9%) rapid antigen tests resulted positive. Only five (13.8%) positive-rapid antigen tests were also positive by RT-PCR testing. During the same period, 219 patients regularly screened by rapid antigen tests bimonthly underwent 442 RT-PCR nasopharyngeal swabs for clinical reasons. RT-PCR testing yielded a positive result in 13 (5.9%) patients. The time elapsed between PCR and the negative-rapid antigen test was 7.7 ± 4.6 days (range 1.8–13.9 days). At the end of the follow-up, 6.4% of the population on in-center hemodialysis contracted COVID-19, and routine rapid antigen tests detected only 5 out of 18 (27.7%) COVID-19 cases. No outbreaks of COVID-19 were identified within the dialysis unit. Conclusion. Bimonthly rapid antigen screening led to the early diagnosis of COVID-19 in less than one-third of cases. The short incubation period of the new SARS-CoV-2 variants makes bimonthly test screening inadequate for an early diagnosis of COVID-19. More frequent tests are probably necessary to improve the utility of COVID-19 nasal rapid antigen test in patients on hemodialysis.

Background/Aim: COVID-19 is a concerning issue among in-center hemodialysis (HD) patients. To prevent COVID-19 diffusion in our HD facility, weekly rapid nasal antigen test screening was performed for all asymptomatic patients on chronic HD. This study aimed to assess the performance of weekly rapid antigen test in detecting SARS-CoV-2 infection among asymptomatic patients receiving HD. Patients and Methods: A retrospective analysis was conducted in HD patients who underwent rapid antigen test screening from December 2021 to March 2022. The diagnosis of COVID-19 with rapid antigen test was always confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR). Results: During the observational period, 1,748 rapid antigen tests were performed in 220 HD patients. Mean age was 68.4±14.6 years. Fifteen (8.5%) patients resulted positive for SARS-CoV-2 infection using rapid antigen tests. The diagnosis was subsequently confirmed in 14 (93.3%) patients by RT-PCR. During the same period, 12 (5.4%) symptomatic patients, regularly screened with weekly rapid antigen test, resulted positive for SARS-CoV-2 infection using RT-PCR. Overall, weekly rapid antigen test screening identified 14 out of 26 (53.8%) COVID-19 cases and showed a positive predictive value of 93%. Conclusion: Weekly antigen test screening of asymptomatic patients on chronic HD detected around half of the COVID-19 cases in our population.Patients on maintenance hemodialysis (HD) are a subset of the population extremely susceptible to the severe consequences of COVID-19. Advanced age, high prevalence of diabetes and cardiovascular disease, as well as immunosuppression due to end-stage kidney disease, are the main determinants of poor outcomes in this population (1-5). Patients on in-center HD also carry a significant risk of contracting SARS-CoV-2 infection, as they may share with potentially infected subjects enclosed spaces including the dialysis room, dressing room, and transportation (6). Based on this background, a sensitive testing screening for the early diagnosis of COVID-19 might be an ideal solution to prevent deadly outbreaks within the dialysis units (7). Unfortunately, no guidelines have been released on the utility of screening for the high-risk HD population until now. COVID-19 screening program is often facultative and modalities vary enormously among HD centers worldwide. Universal screening may be useful in settings with high community prevalence (8). Two types of diagnostic tests are currently used for assessing COVID-19: detection of viral RNA 2823

Background and Aims Peritoneal dialysis (PD) is a well-established replacement therapy for patients with end-stage kidney disease (ESKD). Despite innovations in PD fluid composition, PD patients experience a high morbidity rate. In particular, patients on PD have a high likelihood to switch from PD to HD due to catheter malfunction, peritonitis and ultrafiltration failure. A considerable number of risk factors are associated with a high risk of death, almost comparable with patients receiving hemodialysis (HD). This study aimed to analyze the outcome of patients receiving PD. Method A single center-retrospective study was conducted at the University Hospital of Modena. We collected data from patients who started PD from 1996 to 2021. Data were extracted from electronic healthcare records. Subjects aged < 18 years were excluded. Patients with pre-existing abdominal wall defects (i.e., hernia), low-back pain, obesity and active working life were treated by automated peritoneal dialysis (APD). Kt/V was performed at least 3 times per year. Low depurative efficacy, ultrafiltration failure and severe abdominal pathology were causes of permanent transition from HD to PD. Baseline characteristics were described using mean and standard deviation (SD), or frequencies. The chi-square or Fisher's test, and student's t-test were used to compare categorical and continuous variables between groups. For survival analysis were used Kaplan-Meier and Cox regression methods. A P value of <0.05 was considered statistically significant. All statistical analyses were performed using SPSS® statistical software. Results During the observational period, 497 patients on PD were enrolled in the study. Mean age was 63.5 (±15.6) years. Most of them were male (61%). Overall, 62.1% of the patients had at least 3 comorbidities beyond ESKD. Patients were affected by hypertension (70.4%), dyslipidemia (56.9%), cardiovascular disease (53.5%), hyperuricemia (41.6%) and diabetes (15.7%). Only 20.3% of the patients were on therapy with renin-angiotensin system inhibitors. PD was commenced at eGFR of 7±2.1 ml/min and CAPD (65.1%) was the modality of choice at the start of PD. The mean follow-up was 2.9 (±2.4) years. At end of the follow-up, 204 (41%) switched from PD to HD, 137 (27%) died, 92 (18.5%) underwent kidney transplantation and 64 (12.9%) were alive. On average, the switch from PD to home HD occurred after 3.3±2.7 years. The likelihood of transition from PD to HD for this group of patients was 10.7%, 30.3% 52.3%, and 70.3% at 1-,3-,5-, and 7 years, respectively (Fig. 1A). Patients who switched to HD were more frequently affected by diabetes (p = 0.02), hyperuricemia (p = <0.001) and hypercholesterolemia (p = 0.001) than those who remained in DP. Overall, males anticipated of 1.1 years the transition to HD compared to the females (p = 0.006). All-cause mortality in DP patients was 100.3 per 1000 person-years. In patients aged >75 years, mortality accounted for 242.1 per 1000 person-years. Cumulative all-cause 1-, 3-,5-, and 7-year mortality accounted for 8.8%, 26%, 40.4% and 55.1%, respectively (Fig. 1B). Multivariate Cox regression analysis showed that age was the only risk factor for mortality in our cohort of patients (HR = 1.07 [95%CI 1.05-1.08]; p = <0.001) whereas no risk factors for the transition to HD were found in our cohort of patients. Conclusion In our study PD patients had a high burden of comorbidities and were frequently subject to the transition to HD. Age was an independent predictor of mortality in this dynamic population. No risk factors for the transition from PD to HD were identified in this group of patients.

BACKGROUND AND AIMS Traditional vaccination strategies had poor effectiveness in host response in haemodialysis (HD) patients [1]. That is why a booster dose of SARS-CoV-2 vaccine is highly recommended to prevent worse outcomes. The aim of the study was to determine the humoral response in HD patients after the booster dose of mRNA-1273 vaccine (Moderna) [2]. METHOD In October 2021, HD patients received the booster dose and in November 2021 Anti-SARS-CoV-2 antibodies (Ab) were assessed during a cross-sectional retrospective study. Clinical data, laboratory tests and immunomodulatory therapies (IT) were collected from medical records. Of 194 patients enrolled, 26 were excluded for IT. SARS-CoV-2 Ab dosage was carried out in 168 patients using DiaSorin LIAISON SARS-CoV-2 trimetricSpike IgG (DiaSorin, Saluggia, Italy). Absence of humoral immunity was diagnosed when the antibodies value was < 33.8 BAU/mL. For statistical analysis we used Shapiro–Wilk, Mann–Whitney, Spearman's correlation and Kruskal–Wallis test. A P-value < 0.05 was considered statistically significant. RESULTS The median age was 76 [interquartile range (IQR) 60–83] years, 102 male and 66 female. 20 of these had previous SARS-CoV-2 infection. In 140 patients that received booster dose, Ab were detected after 30 ± 6 days. The response rate was 99.3%. Those who did not have SARS-CoV-2 infection showed an Ab median title of 10 700 BAU/mL (IQR 3482–18 625) while those who had previous infection showed an Ab median title of 18 300 BAU/mL (IQR 1200–37 500) (P >0.05). There was a negative correlation between age and Ab title (P < 0.01). Females showed a higher Ab title than males, both groups were homogeneous for age (P < 0.05). Ab were detected in all patients who assumed only 2 vaccine doses (mean time after last dose, 121 ± 88 days). In this group, Ab title was higher in previously infected patients (18 500 BAU/mL [IQR 15 800–44 700]) than in those who were not infected [172 BAU/mL (IQR 110–750)] (P < 0.01). Focusing on patients with previous SARS-CoV-2 infection, 2 vaccine's doses enhanced Ab title more than infection alone [455 BAU/mL (IQR 212–3500)] (P < 0.05). There were no statistically significant differences with two or three doses in Ab title (mean time after last dose 41 ± 24 and 30 ± 6 days, respectively (P >0.05). Lastly, SARS-CoV-2 infection significantly enhanced humoral immunity response independently to time elapsed since infection (P >0.05). The distribution of Ab among patients is detailed in Figure  1. CONCLUSION Early response to booster vaccine dose was present in the majority of our HD patients. Ab title was higher in younger and female patients [33]. According to other studies [4], a completed cycle of vaccine (at least 2 doses) was also recommended in patients with a previous SARS-CoV-2 infection because of the decrease of the Ab title in this group of patients. A crucial question remains unsolved: how long vaccine-induced protection will last in HD patients after booster dose?