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Introduction: COVID-19, caused by SARS-CoV-2, has resulted in significant mortality and morbidity worldwide. Patients of chronic kidney disease who are on maintenance hemodialysis represent a vulnerable population cohort that is susceptible to severe disease. Hence, it is of utmost importance to prioritize vaccination in this population and to assess their response to said vaccination. Methods: This prospective analytical study was conducted at the Institute of Nephrology, Madras Medical College, between August 2021 and February 2022. Patients of chronic kidney disease stage 5 dialysis (CKD5D) who were on maintenance hemodialysis and who consented to receive COVID-19 vaccine were studied. Serum samples were obtained before vaccination, ≥28 days after receiving the first dose of the vaccine, and ≥28 days after receiving the second dose. Antibody titers against the spike protein were estimated using the Roche chemiluminescent immunosorbent assay. Patients were grouped into non-responders/seronegative (<0.8 U/ml) and responders/seropositive (≥0.8 U/ml), with a value ≥250 U/ml considered as robust response. Results: A total of 96 patients were included. The mean age was 36.70 (±11.53) years and 77.1% of them were male. The median dialysis vintage was 2 (IQR: 0.95-5) years. Twelve patients (9.9%) had a prior COVID-19 infection. Sixty-seven (69.8%) patients had received Covaxin and 29 (30.2%) had received Covishield vaccines. Among the 17 patients who were seronegative at baseline, 4 (23.52%) became seropositive after the first dose of the vaccine, and 11 (64.7%) were seropositive after the second dose, with high titers ("robust response") achieved in two patients (11.76%). No antibody response, despite two doses of the vaccine, was noted in six patients (35.29%). Conclusion: Our study showed a high baseline seropositivity rate, even prior to vaccination, which indicated a high rate of subclinical COVID infection. Among those who were seronegative at baseline, the seroconversion rate after two doses of Covaxin or Covishield was 64.70%. [ABSTRACT FROM AUTHOR]

Introduction: CKD5D is a high risk subgroup with high comorbidity burden, need for frequent visits to dialysis centre and a compromised immune system. The effect of SARS COV2 virus on this population is not well known. Methods: This prospective study enrolled, all CKD5D with COVID 19 infection, admitted to our hospital, from 23rd April to 30th June 2020 & whose outcome as discharge/mortality was known. Their clinical profile, investigations, treatment and outcome in terms of mortality or discharge after clearing infection was noted and analysed. Results: Total 203 dialysis patients with COVID 19 were referred to our institute. Of these total, 131 were analysed. Median age was 50 years (19-80 years) with 57% were males. Hypertension (76%) was the commonest comorbidity followed by diabetes (29%) and coronary artery disease (22%). Dyspnoea, fever and cough were present in 50%, 40%, and 33% patients respectively. 26% were asymptomatic. None had dialyser clotting. Mortality was 20.6%. Time to turn RT PCR negative was 14 days (3-40 days). Comparing deceased vs survivors: Age [56 vs 49 yrs], diabetes [56% vs 22%], duration of symptoms at admission [5 vs 4 days], dyspnea [85% vs 40%] and encephalopathy [30% vs 1%] at admission, bilateral opacities on Chest X ray [93% vs 20%] and high leucocyte count [11,059 ± 5,929 vs 7,022 ± 2,935/cmm] were statistically significant variables associated with mortality. Conclusion: Asymptomatic group was 26% of the total CKD5D with COVID 19 infection population analysed. Mortality was 20.61%. Higher age, later presentation to hospital, diabetes, dyspnoea, & encephalopathy at presentation, bilateral opacities on Chest X- Ray & higher leukocyte counts were significantly associated with mortality. [ABSTRACT FROM AUTHOR]

Hyperphosphatemia is a risk factor for ectopic calcification and coronary artery diseases in end stage renal diseases (ESRD). The aim of this study was to assess the effect of low-dose nicotinic acid on hyperphosphatemia in patients with ESRD. This randomized, double-blind clinical trial was done on 70 ESRD patients with serum phosphoure ≥5.5 mg/dl. Patients were randomly divided into two equal groups (n = 35) and the intervention group received niacin 25 mg/day as the initial dose. After 4 weeks, in patients who did not respond to treatment, niacin dose was increased up to 50 mg/dl. At the end of week 8, in case there was no treatment effect, the dose was raised to 100 mg/day. The appropriate response to treatment was defined as serum phosphorous level reductions <5.5 mg/dl. The age was 50.5 ± 14.3 years and duration of dialysis 5.1 ± 5.3 months. In the niacin group, mean phosphorus level decreased from 6.7 ± 0.84 mg/dl at the end of the 1st month to 5.8 ± 1.0 mg/dl at the end of the 2nd month and to 4.4 ± 1.4 mg/dl at the end of the 3rd month (P = 0.004). In the placebo group, mean phosphorus level increased from 6.5 ± 1.2 mg/dl to 7.2 ± 0.91 mg/dl at the end of the 3rd month (P = 0.006). In the niacin group, high density lipoprotein (HDL) increased significantly from 45.00 ± 14.9 to 47.2 ± 11.6 (P = 0.009). We conclude that niacin (100 mg/day) decreased phosphorus serum level and increased HDL serum level in patients on dialysis. [ABSTRACT FROM AUTHOR]