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Les patients atteints d'insuffisance renale au stade terminal qui sont hemodialyses sont exposes a un risque accru de contracter la forme grave de la COVID-19, les taux de mortalite variant [...], Contexte: Les differences d&apos;immunogenicite entre les vaccins anti-SRASCoV-2 a ARNm n&apos;ont pas ete bien caracterisees chez les patients hemodialyses. Nous avons compare la reponse serologique chez les patients sous hemodialyse apres la vaccination contre le SRAS-CoV-2 au moyen des vaccins BNT162b2 (Pfizer-BioNTech) et mRNA-273 (Moderna). Methodes: Nous avons procede a une etude de cohorte observationnelle et prospective dans 2 centres universitaires de Toronto, au Canada, du 2 fevrier au 20 juillet 2021, et avons inclus 129 et 95 patients qui ont recu respectivement les vaccins anti-SRAS-CoV-2 BNT162b2 et mRNA-1273. Nous avons mesure les taux d&apos;anticorps IgG diriges contre la proteine S (anti-S), contre le domaine de liaison au recepteur (ou RBD, pour receptor-binding domain [anti-RBD]) et contre la proteine de la nucleocapside (anti-N) du SRAS-CoV-2 6-7) puis 12 semaines apres la deuxieme dose de vaccin et nous avons compare ces taux aux taux medians d&apos;anticorps presents dans le serum de 211 temoins convalescents qui avaient deja contracte le SRAS-CoV-2. Resultats: Six a 7 semaines apres la deuxieme dose de vaccin, nous avons constate que 51 patients sur 70 (73 %) ayant recu le BNT162b2 et 83 patients sur 87 (95 %) ayant recu le mRNA-1273, ont obtenu des taux equivalents a ceux du serum de convalescents pour ce qui est de l&apos;anticorps anti-S (p < 0,001). Chez ceux qui ont recu le BNT162b2, 35 sur 70 (50 %) ont atteint le taux du serum de convalescents pour l&apos;anti-RBD, contre 69 sur 87 (79 %) de ceux qui ont recu le mRNA-1273 (p < 0,001). Douze semaines apres la deuxieme dose, les taux d&apos;anti-S et d&apos;anti-RBD etaient significativement moindres chez les patients ayant recu le BNT162b2 que chez ceux qui avaient recu le mRNA-1273. Pour l&apos;anti-S, 70 patients sur 122 (57,4 %) ayant recu le BNT162b2 ont maintenu un taux equivalent a celui du serum de convalescents, contre 68 sur 71 (96 %) de ceux qui avaient recu le mRNA-1273 (p < 0,001). Pour l&apos;anti-RBD, 47 patients sur 122 (38,5 %) ayant recu le BNT162b2 ont maintenu des taux anti-RBD equivalant a celui du serum de convalescents, contre 45 sur 71 (63 %) de ceux qui avaient recu le mRNA-1273 (p = 0,002). Interpretation: Chez les patients hemodialyses, le mRNA-1273 a genere une reponse humorale plus forte que le BNT162b2. Etant donne le declin rapide de l&apos;immunogenicite a 12 semaines chez les patients ayant recu le BNT162b2, une troisieme dose est recommandee chez les patients hemodialyses dans le cadre d&apos;une premiere serie, ce qui concorde avec les recommandations concernant d&apos;autres populations vulnerables.

Patients with end-stage kidney disease who are receiving maintenance hemodialysis (HD) are at increased risk for severe COVID-19, with mortality rates ranging from 9% to 28%. (1,2) Highly effective vaccines [...], Background: Differences in immunogenicity between mRNA SARS-CoV-2 vaccines have not been well characterized in patients undergoing dialysis. We compared the serologic response in patients undergoing maintenance hemodialysis after vaccination against SARS-CoV-2 with BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna). Methods: We conducted a prospective observational cohort study at 2 academic centres in Toronto, Canada, from Feb. 2, 2021, to July 20, 2021, which included 129 and 95 patients who received the BNT162b2 and mRNA-1273 SARS-CoV-2 vaccines, respectively. We measured SARS-CoV-2 immunoglobulin G antibodies to the spike protein (anti-spike), receptor binding domain (anti-RBD) and nucleocapsid protein (anti-NP) at 6-7 and 12 weeks after the second dose of vaccine and compared those levels with the median convalescent serum antibody levels from 211 controls who were previously infected with SARS-CoV-2. Results: At 6-7 weeks after 2-dose vaccination, we found that 51 of 70 patients (73%) who received BNT162b2 and 83 of 87 (95%) who received mRNA-1273 attained convalescent levels of anti-spike antibody (p < 0.001). In those who received BNT162b2, 35 of 70 (50%) reached the convalescent level for anti-RBD compared with 69 of 87 (79%) who received mRNA-1273 (p < 0.001). At 12 weeks after the second dose, anti-spike and anti-RBD levels were significantly lower in patients who received BNT162b2 than in those who received mRNA-1273. For anti-spike, 70 of 122 patients (57.4%) who received BNT162b2 maintained the convalescent level versus 68 of 71 (96%) of those who received mRNA-1273 (p < 0.001). For anti-RBD, 47 of 122 patients (38.5%) who received BNT162b2 maintained the anti-RBD convalescent level versus 45 of 71 (63%) of those who received mRNA-1273 (p = 0.002). Interpretation: In patients undergoing hemodialysis, mRNA-1273 elicited a stronger humoral response than BNT162b2. Given the rapid decline in immunogenicity at 12 weeks in patients who received BNT162b2, a third dose is recommended in patients undergoing dialysis as a primary series, similar to recommendations for other vulnerable populations.

En date du 20 aout 2020, en Ontario, la province la plus populeuse du Canada, pres de 41 000 personnes avaient requ un resultat positif au test de depistage du [...], CONTEXTE : Les patients sous dialyse a long terme pourraient avoir un risque accru d&apos;infection par le coronavirus du syndrome respiratoire aigu severe 2 (SRAS-CoV-2), et de maladie et de mortalite associees. Nous avons voulu decrire l&apos;incidence, les facteurs de risque et les issues de l&apos;infection chez ces patients en Ontario (Canada). METHODES : Nous avons utilise des ensembles de donnees reliees pour comparer les caracteristiques de la maladie et la mortalite chez les patients sous dialyse a long terme en Ontario qui ont teste positif pour le SRAS-CoV-2 et ceux qui n&apos;ont pas developpe d&apos;infection, entre le 12 mars et le 20 aout 2020. Nous avons recueilli des donnees sur l&apos;infection par le SRAS-CoV-2 de maniere prospective. Nous avons evalue les facteurs de risque d&apos;infection et de mortalite par des analyses de regression logistique multivariees. RESULTATS : Pendant la periode a l&apos;etude, 187 patients dialyses sur 12 501 (1,5 %) ont requ un diagnostic d&apos;infection par le SRAS-CoV-2. Parmi eux, 117 (62,6 %) ont ete hospitalises, et le taux de mortalite etait de 28,3 %. Les facteurs predictifs significatifs associes a l&apos;infection incluaient l&apos;hemodialyse dans un centre plutot que la dialyse a domicile (rapport de cotes [RC] 2,54; intervalle de confiance [IC] a 95 % 1,59-4,05), le fait de vivre dans un etablissement de soins de longue duree (RC 7,67; IC a 95 % 5,30-11,11), le fait d&apos;habiter la region du Grand Toronto (RC 3,27; IC a 95 % 2,21-4,80), les ethnicites Noire (RC 3,05; IC a 95 % 1,95-4,77), du sous-continent indien (RC 1,70; IC a 95 % 1,02-2,81) et autres non blanches (RC 2,03; IC a 95 % 1,38-2,97) et les quintiles de revenu inferieurs (RC 1,82; IC a 95 % 1,15-2,89). INTERPRETATION : Les patients sous dialyse a long terme sont exposes a un risque accru d&apos;infection par le SRASCoV-2 et de mortalite due a la maladie a coronavirus 2019. Il faudra travailler a eliminer les facteurs de risque d&apos;infection et vacciner ces patients en priorite.

As of Aug. 20, 2020, in Ontario, Canada's most populous province, almost 41000 people had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus [...], BACKGROUND: Patients undergoing long-term dialysis may be at higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and of associated disease and mortality. We aimed to describe the incidence, risk factors and outcomes for infection in these patients in Ontario, Canada. METHODS: We used linked data sets to compare disease characteristics and mortality between patients receiving long-term dialysis in Ontario who were diagnosed SARS-CoV-2 positive and those who did not acquire SARS-CoV-2 infection, between Mar. 12 and Aug. 20, 2020. We collected data on SARS-CoV-2 infection prospectively. We evaluated risk factors for infection and death using multivariable logistic regression analyses. RESULTS: During the study period, 187 (1.5%) of 12 501 patients undergoing dialysis were diagnosed with SARS-CoV-2 infection. Of those with SARS-CoV-2 infection, 117 (62.6%) were admitted to hospital and the case fatality rate was 28.3%. Significant predictors of infection included in-centre hemodialysis versus home dialysis (odds ratio [OR] 2.54, 95% confidence interval [CI] 1.59-4.05), living in a long-term care residence (OR 7.67, 95% CI 5.30-11.11), living in the Greater Toronto Area (OR 3.27, 95% CI 2.21-4.80), Black ethnicity (OR 3.05, 95% CI 1.95-4.77), Indian subcontinent ethnicity (OR 1.70, 95% CI 1.02-2.81), other non-White ethnicities (OR 2.03, 95% CI 1.38-2.97) and lower income quintiles (OR 1.82, 95% CI 1.15-2.89). INTERPRETATION: Patients undergoing long-term dialysis are at increased risk of SARS-CoV-2 infection and death from coronavirus disease 2019. Special attention should be paid to addressing risk factors for infection, and these patients should be prioritized for vaccination.

IMPORTANCE: Patients with advanced chronic kidney disease (CKD) have the best chance for a longer and healthier life if they receive a kidney transplant. However, many barriers prevent patients from receiving a transplant. OBJECTIVES: To evaluate the effect of a multicomponent intervention designed to target several barriers that prevent eligible patients from completing key steps toward receiving a kidney transplant. DESIGN, SETTING, AND PARTICIPANTS: This pragmatic, 2-arm, parallel-group, open-label, registry-based, superiority, cluster randomized clinical trial included all 26 CKD programs in Ontario, Canada, from November 1, 2017, to December 31, 2021. These programs provide care for patients with advanced CKD (patients approaching the need for dialysis or receiving maintenance dialysis). INTERVENTIONS: Using stratified, covariate-constrained randomization, allocation of the CKD programs at a 1:1 ratio was used to compare the multicomponent intervention vs usual care for 4.2 years. The intervention had 4 main components, (1) administrative support to establish local quality improvement teams; (2) transplant educational resources; (3) an initiative for transplant recipients and living donors to share stories and experiences; and (4) program-level performance reports and oversight by administrative leaders. MAIN OUTCOMES AND MEASURES: The primary outcome was the rate of steps completed toward receiving a kidney transplant. Each patient could complete up to 4 steps: step 1, referred to a transplant center for evaluation; step 2, had a potential living donor contact a transplant center for evaluation; step 3, added to the deceased donor waitlist; and step 4, received a transplant from a living or deceased donor. RESULTS: The 26 CKD programs (13 intervention, 13 usual care) during the trial period included 20 375 potentially transplant-eligible patients with advanced CKD (intervention group [n = 9780 patients], usual-care group [n = 10 595 patients]). Despite evidence of intervention uptake, the step completion rate did not significantly differ between the intervention vs usual-care groups: 5334 vs 5638 steps; 24.8 vs 24.1 steps per 100 patient-years; adjusted hazard ratio, 1.00 (95% CI, 0.87-1.15). CONCLUSIONS AND RELEVANCE: This novel multicomponent intervention did not significantly increase the rate of completed steps toward receiving a kidney transplant. Improving access to transplantation remains a global priority that requires substantial effort. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03329521