Thread by @kidney_boy

Hey @DanTheKidneyMan won the Lazarus award for research in dialysis and he gets to give the Lazarus Award. #NKFClinicals

Dan starts out thanking the @NKF and exploring how happy he is to see everyone.

He is going to talk about Covid and dialysis, vaccinations and treatment. #NKFClinicals

He shows a picture of two turkeys walking around Boston from 2 years ago, when the cities were empty after the March 13 shut down. #NKFClinicals

The first two people to die of COVID-19 in the US were both dialysis patients. He shares some of the experience of Suzanne Watnick and Elizabeth McNamara from CJASN cjasn.asnjournals.org/content/15/5/7… #NKFClinicals

Dialysis patients could not stay home because they had to get dialysis. #NKFClinicals

Discuss all the decisions that had to be made on the fly to help deal with the pandemic. #NKFClinicals

They gave Certificates of Triumph to patients that were able to clear their COVID and move from the COVID HD unit back to a normal HD unit. #NKFClinicals

Talks about this publication: pubmed.ncbi.nlm.nih.gov/33465417/

5.5% of dialysis patients developed COVID-19
OR 17 for living in nursing home.
Other high OR for urban as well as black people
#NKFClinicals

One of the big problems was lack of testing. And unfortunately dialysis patients were not prioritized for testing. #NKFClinicals

Dialysis patients were more likely to be diagnosed with COVID, this may represent increased symptom screening and testing.
#NKFClinicals

Showing the prevalence of SARS-CoV2 in dialysis patients from this study pubmed.ncbi.nlm.nih.gov/32987007/ #NKFClinicals

2020 was the first year ever decline in prevalent dialysis patients. 20,000 excess deaths compared to prior year. #NKFClinicals

Now looking at home treatments and though we thought it would decrease infections, did it? jasn.asnjournals.org/content/32/7/1… #NKFClinicals

116 clinics in 27 states. They matched home patients with in-center patients in the same county. Looked like 80-90% protection early in the pandemic, but the rate of infection evened out later in the pandemic. We got good at protecting in-center patients. #NKFClinicals

Showing this article: kidneynews.org/view/post/poli…

Advisory committee ion immunization practices recommend prioritizing healthcare workers on Dec 1 2020, Vaccine did not make it to dialysis units until March 28 2021. #NKFClinicals

Dialysis patients were not prioritized despite the turmoil and excess deaths.

They learned that bringing vaccine to patients was much more effective than telling patients to find a vaccine. #NKFClinicals

30% of dialysis patients are vaccine hesitant. Younger, Black, Native Americans and women were all more hesitant than average. jasn.asnjournals.org/content/32/7/1… #NKFClinicals

Seroresponse to SARS-CoV2 Vaccine in dialysis. We know that Hep B vaccine and influenza vaccines are less effective in dialysis. We were pleasantly surprised at how well the vaccines worked in dialysis. But not everyone. ncbi.nlm.nih.gov/pmc/articles/P… #NKFClinicals

Talking about the difference between third dose (part of primary series for immunocompromised) and booster which is given after completing primary series. #NKFClinicals

The vaccine is highly effective at preventing severe outcomes among dialysis patients. jasn.asnjournals.org/content/33/4/8…

#NKFClinicals

Antibody levels do predict vaccine protection. #NKFClinicals acpjournals.org/doi/full/10.73…

He is concerned about the CV signal with Evusheld especially among dialysis patients that all have underlying CV disease. #NKFClinicals

Monoclonal antibodies no longer work with current strains. New anti-viral drugs Paxlovid and mulnupiravir really have no data in dialysis.

And he is done! Great talk @DanTheKidneyMan!

And the passing of the award! #NKFClinicals with @PaulPalevsky