Shaira Martínez Vaquera

BACKGROUND: Chronic kidney disease (CKD) patients are at high-risk for severe coronavirus disease 2019 (COVID-19). The multicentric, observational and prospective SENCOVAC study aims to describe the humoral response and safety of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in CKD patients. Safety and immediate humoral response results are reported here. METHODS: Four cohorts of patients were included: kidney transplant (KT) recipients, and haemodialysis (HD), peritoneal dialysis (PD) and non-dialysis CKD patients from 50 Spanish centres. Adverse events after vaccine doses were recorded. At baseline and on Day 28 after the last vaccine dose, anti-Spike antibodies were measured and compared between cohorts. Factors associated with development of anti-Spike antibodies were analysed. RESULTS: A total of 1746 participants were recruited: 1116 HD, 171 PD, 176 non-dialysis CKD patients and 283 KT recipients. Most patients (98%) received mRNA vaccines. At least one vaccine reaction developed after the first dose in 763 (53.5%) and after the second dose in 741 (54.5%) of patients. Anti-Spike antibodies were measured in the first 301 patients. At 28 days, 95% of patients had developed antibodies: 79% of KT, 98% of HD, 99% of PD and 100% of non-dialysis CKD patients (P < 0.001). In a multivariate adjusted analysis, absence of an antibody response was independently associated with KT (odds ratio 20.56, P = 0.001) and with BNT162b2 vaccine (odds ratio 6.03, P = 0.023). CONCLUSION: The rate of anti-Spike antibody development after vaccination in KT patients was low but in other CKD patients it approached 100%, suggesting that KT patients require persistent isolation measures and booster doses of a COVID-19 vaccine. Potential differences between COVID-19 vaccines should be explored in prospective controlled studies.

ABSTRACT Background We hypothesized that the main barriers to integrating exercise in routine care of patients with chronic kidney disease (CKD) were structural within European healthcare systems rather than due to resistance among healthcare professionals or patients. Materials and methods This descriptive cross-sectional study used anonymized questionnaires to investigate nurses’ and physicians’ attitudes and practice towards exercise in patients with CKD, structural support within the healthcare system, and patients’ experience of exercise prescriptions. Kidney units were randomly selected in Germany, Greece, Italy, Spain, and Sweden. Results In total, 352 (35% male) nurses; 143 (54% male) physicians participated; 96% and 98%, respectively, believed exercise was beneficial. Of them, 59% (CI 50%–67%) prescribed exercise ‘always or often’ (I2 91%), ranging from 15% in Germany to 86% in Sweden. Of the facilities, 48% (CI 39%–56%) did not have a physiotherapy unit (I2 98%); six% (CI 3%–12%) did: in Italy one% (CI 0.03%–7%); in Sweden 86% (CI 42%–99%), (I2 97%). Seven% (CI 3%–12%) had physiotherapists and exercise programmes; eight% (CI 4%–13%) for all treatment modalities: in Italy four% (CI 1%–10%) and five% (CI 1%–12%), respectively; in Sweden 71% (CI 29%–96%) and 86% (CI 42%–99%), (I2 87% and 97%, respectively). Only Sweden reimbursed physiotherapy costs for all patients. In total, 1235 patients participated: those with CKD 4–5 (n = 137, male 62%); peritoneal dialysis (n = 40, male 60%); home haemodialysis (n = 30, male 63%); institutional haemodialysis (n = 928, male 59%); and kidney transplant (n = 100, male 62%). Between 9% and 37% of all patients reported having received an exercise programme, among those one- to two-thirds had continued to exercise. Conclusions Physicians and nurses regarded exercise as important for patients with CKD. Physical performance was not assessed. Most patients had not received exercise prescriptions. All countries, except Sweden, lacked physiotherapy resources and reimbursement strategies. Healthcare systems need to recognize the beneficial effects of exercise and provide adequate resources.

Background: The estimated prevalence of protein energy wasting (PEW) in haemodialysis (HD) is between 28-54%, and may be even higher1. Different nutritional strategies are available: dietary advice by a Dietitian-Nutritionist (DN), oral nutrition (ONS) or Intradialytic parenteral nutrition (IDPN), among others2. The economic cost or the lack of DN in dialysis units are barriers that limit its use. Objective: To determine the prevalence of HD patients who are potential candidates for IDPN. Methods: Descriptive, retrospective and multicentre study of 3544 patients who responded to the KDQOL-SFTMV1.3 surveys during 2022. We analysed the generic part (SF-36), the Summative Physical (ISF) and Mental Index (ISM)3. We collected demographic and clinical data, used the DPE scale4 and the expert consensus5 as screening for PIND. We assessed normality and performed non-parametric statistics. Results: 62.4% male, 73 years, BMI 25.8kg/m2 , albumin 3.93g/dl, creatinine 6.5mg/dl , CRPn 0.98 g/kg/d, FSI 49.14 [39.58-55.69], MSI 34.88 [27.75-42.55]. 45.4% had DM, 60.9% were on dialysis with AVF and 35 months on HD [15-67]. According to DPE screening components: 33% albumin <3.8g/dl; 4.1% creatinine <3.8mg/dl; 26.3% BMI <23kg/m2; 20.8% nCRP <0.8g/kg/d. 59.2% had some degree of malnutrition. 21.3% could be candidates for NPID due to moderate-severe malnutrition. According to expert consensus: 27.4% albumin <3.8g/dl plus creatinine <8mg/dl; 3% BMI <18.5kg/m2; 14.4% CRPn <0.75g/kg/d; 0.6% weight loss> 10% in the last 6 months. Only 0.23% met at least 3 of these criteria and would be candidates for NPID. We observed association between nutritional status and quality of life (QoL) (table 1). Conclusion: We found huge discrepancy in the prevalence of patients who were candidates for NPID according to the criteria used. The decision to provide NPID not only impacts on the clinical prognosis and QoL of the patient, but also entails relevant costs that could be avoided. Funding: Private Foundation Support

Background: Patients with type 2 diabetes (T2D) on hemodialysis (HD) are at increased cardiovascular risk, where body composition and inflammation could be key modulating factors. The waist-to-height ratio (WtHR) has been proposed as a simple and effective marker of central adiposity, but its role in this population remains underexplored. AIM: To evaluate differences in body composition (BC), inflammatory and nutritional parameters between T2D and non-T2D patients on HD, and to analyze the impact of the central obesity phenotype defined by WtHR ≥0.5. Methods: Prospective, multicenter study with 455 prevalent HD patients. Demographic, clinical, nutritional, BC, and inflammatory variables were collected: neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and systemic inflammatory index (SII). Post-dialysis multifrequency bioimpedance (MF-BIA) was used to assess phase angle (PhA), extracellular water/total body water ratio (ECW/TBW-r), total body fat (PBF), and visceral fat (VFA). Abdominal obesity was defined as WtHR ≥0.5. Non-parametric tests and Chi-square tests were applied; statistical significance: p<0.05. Results: T2D patients were older [73 vs. 69 years, p=0.007], had a higher BMI [26.1 vs. 23.8 kg/m2, p<0.001], PBF [30.7% vs. 25.2%, p<0.001], VFA 96.5 vs. 71.3 cm3, p<0.001, higher SII and INL (p=0.001 and p=0.008), higher proportion with INL≥3.5 (p=0.004), lower PhA [4.7° vs. 5.1°, p<0.001, and higher ECW/TBW-r (p<0.001). Fifty-six percent of T2D patients had WtHR ≥0.5. Among T2D patients, those with WtHR ≥0.5 had higher levels of VFA, IBS, INL (p<0.05), lower PhA, and higher ECW/TBW-r. In addition, they required catheters as vascular access more frequently (CYT: 64.2% vs. 35.8%, p=0.02). In the subgroup with WtHR <0.5, T2D patients continued to have older age, higher VFA, lower PhA, and higher ECW/TBW-r than non-T2D patients, with no differences in inflammation or PBF. Conclusion: The T2D phenotype with WtHR ≥0.5 in HD is associated with greater visceral adiposity, systemic inflammation, and cellular nutritional impairment, which could reflect an increased cardiovascular risk profile. The use of WtHR as a simple tool in clinical practice may contribute to more accurate risk stratification in this vulnerable population.