Vaccination and Nutritional Outcomes of Hemodialysis Patients Infected With SARS-CoV-2

Abstract

Background Patients on hemodialysis are particularly vulnerable to COVID-19 and may have a reduced response to vaccination due to a decreased immune response. The nutritional status prior or during the infection could also impact on the clinical effectiveness of vaccination. Objectives We aim to describe the evolution of clinical and nutritional biomarkers of hemodialysis patients infected with SARS-CoV-2 and to assess their association with vaccination status. Methods An observational, analytic, longitudinal, retrospective multicenter study was carried out in 82 patients on hemodialysis with SARS-CoV-2 infection. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), anthropometry and biochemical parameters. The association of the vaccine doses with clinical and nutritional related variables were also evaluated. Results The percentage of vaccinated patients was similar to non-vaccinated patients. Prior to infection, the majority of the patients were malnourished. They presented lower albumin, creatinine and urea levels than the well-nourished patients. Significant deterioration of nutritional status after infection was evidenced considering GNRI score, dry weight and Body Mass Index. Albumin and creatinine also decreased significantly post-infection whereas C-reactive protein increased in the acute phase. Significant inverse correlation was found between the variation of post-pre GNRI scores and basal albumin and C-reactive protein at 7 days. Additionally, we observed the opposite trend between albumin at 30 days and basal cholesterol. A negative value in the GNRI variation was associated with bilateral pneumonia, need for hospitalization and nutritional support. Vaccinated patients presented substantially less bilateral pneumonia and hospitalization. No significant effects were observed between vaccine doses and the variation in nutritional status, although a positive correlation was detected with the albumin at 7 days and C-reactive protein prior to infection and the number of vaccine doses received. Discussion COVID-19 is associated with affectations in the nutritional status and biomarkers in hemodialysis patients. In this study vaccines have demonstrated a protective effect against the clinical consequences of COVID. However, they have shown limitations in preventing the deterioration of nutritional status after infection. The results highlight the importance of promoting the vaccination in these patients as well as incorporating nutritional assessment before, during and after the infection.

Predictors factors of COVID-19-associated mortality in dialysis patients: Importance of nutritional status

“…Accordingly, the impact of the vaccination on the nutritional indicators were attenuated. Unfortunatley we did not assess the imune response to SARS-Cov 2, for some authors have recently argued that the response to vaccination might depende on the nutritional status, which should be further explored [34,35].…”