COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment
The COVID-19 pandemic has profound adverse effects on the population on dialysis. Patients requiring dialysis are at an increased risk of SARS-CoV-2 infection and mortality, and many have experienced psychological distress as well as delayed or suboptimal care. COVID-19 survivors have prolonged vira...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Society of Nephrology. Published by Elsevier Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8842412/ https://www.ncbi.nlm.nih.gov/pubmed/35176326 http://dx.doi.org/10.1016/j.kint.2022.01.022 |
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author | El Karoui, Khalil De Vriese, An S. |
author_facet | El Karoui, Khalil De Vriese, An S. |
author_sort | El Karoui, Khalil |
collection | PubMed |
description | The COVID-19 pandemic has profound adverse effects on the population on dialysis. Patients requiring dialysis are at an increased risk of SARS-CoV-2 infection and mortality, and many have experienced psychological distress as well as delayed or suboptimal care. COVID-19 survivors have prolonged viral shedding, but generally develop a robust and long-lasting humoral immune response that correlates with initial disease severity. However, protection against reinfection is incomplete. A growing body of evidence reveals delayed and blunted immune responses to SARS-CoV-2 vaccination. Administration of a third dose within 1 to 2 months of prime-boost vaccination significantly increases antibody levels, in particular in patients with poor initial responses. Patients on dialysis have inferior immune responses to adenoviral vector vaccines than to mRNA vaccines. The immunogenicity of the mRNA-1273 vaccine is markedly better than that of the BNT162b2 vaccine, most likely by virtue of its higher mRNA content. Despite suboptimal immune responses in patients on dialysis, preliminary data suggest that vaccination partially protects against infection and severe disease requiring hospitalization. However, progressive waning of immunity and emergence of SARS-CoV-2 variants with a high potential of immune escape call for a booster dose in all patients on dialysis 4 to 6 months after prime-boost vaccination. Patients with persistent poor vaccine responses may be candidates for primary prophylaxis strategies. In the absence of specific data in patients on dialysis, therapeutic strategies in the event of established COVID-19 must be extrapolated from evidence obtained in the population not on dialysis. Neutralizing monoclonal antibodies may be an attractive option after a high-risk exposure or during the early course of infection. |
format | Online Article Text |
id | pubmed-8842412 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | International Society of Nephrology. Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-88424122022-02-15 COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment El Karoui, Khalil De Vriese, An S. Kidney Int Review The COVID-19 pandemic has profound adverse effects on the population on dialysis. Patients requiring dialysis are at an increased risk of SARS-CoV-2 infection and mortality, and many have experienced psychological distress as well as delayed or suboptimal care. COVID-19 survivors have prolonged viral shedding, but generally develop a robust and long-lasting humoral immune response that correlates with initial disease severity. However, protection against reinfection is incomplete. A growing body of evidence reveals delayed and blunted immune responses to SARS-CoV-2 vaccination. Administration of a third dose within 1 to 2 months of prime-boost vaccination significantly increases antibody levels, in particular in patients with poor initial responses. Patients on dialysis have inferior immune responses to adenoviral vector vaccines than to mRNA vaccines. The immunogenicity of the mRNA-1273 vaccine is markedly better than that of the BNT162b2 vaccine, most likely by virtue of its higher mRNA content. Despite suboptimal immune responses in patients on dialysis, preliminary data suggest that vaccination partially protects against infection and severe disease requiring hospitalization. However, progressive waning of immunity and emergence of SARS-CoV-2 variants with a high potential of immune escape call for a booster dose in all patients on dialysis 4 to 6 months after prime-boost vaccination. Patients with persistent poor vaccine responses may be candidates for primary prophylaxis strategies. In the absence of specific data in patients on dialysis, therapeutic strategies in the event of established COVID-19 must be extrapolated from evidence obtained in the population not on dialysis. Neutralizing monoclonal antibodies may be an attractive option after a high-risk exposure or during the early course of infection. International Society of Nephrology. Published by Elsevier Inc. 2022-05 2022-02-14 /pmc/articles/PMC8842412/ /pubmed/35176326 http://dx.doi.org/10.1016/j.kint.2022.01.022 Text en © 2022 International Society of Nephrology. Published by Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Review El Karoui, Khalil De Vriese, An S. COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment |
title | COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment |
title_full | COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment |
title_fullStr | COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment |
title_full_unstemmed | COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment |
title_short | COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment |
title_sort | covid-19 in dialysis: clinical impact, immune response, prevention, and treatment |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8842412/ https://www.ncbi.nlm.nih.gov/pubmed/35176326 http://dx.doi.org/10.1016/j.kint.2022.01.022 |
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