Ante the imminent evacuation front to the Covid-19 of the population with enfermedad renal chronica (ERC), la Sociedad Valenciana de Nefrología (SVN) would like to go ahead and solve some of the dudes and incidents that can plant this hecho.
In a webinar, which was published for its dissemination with the support of Fresenius Medical Care, not only has it been possible to alleviate the urgent need to know exhaustively the effect of vacancies in this population, we have also acknowledged some urgent issues.
And that is how he distracted the moderators of this encounter (Nayara Panizo, of the Department of Neurology of the Clinical Hospital of the University of Valencia, y Daniel Gallego, President of the National Federation of Associations -Alcer-), “The vacancies in front of the Covid-19 plant are important incognitives in this special risk patient group, considered as a priority to receive this immunization”.
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Vacation in front of Covid renal disease: Do we know everything? |
If there is a population that specifically needs these vacancies due to its high risk. And it is in these patients “there is a alteración del system immunitario, and its habitual response immunological front to other vacancies, as the of the hepatitis B, suele ser minor in comparison with the general population ”, as he explained José Luis Górriz, President of the SVN in charge of the Department of Neurology of the Clinical Hospital of the University of Valencia.
The patients with advanced ERC express a reduced response to the evacuation debited to the general suppression of the immunological system associated with uremia. In comparison with the evacuation of hepatitis B in patients with advanced ERC, the patients on dialysis, for example, has a Titles of antiquity more and a lack of ability to maintain titles of antiquities adequately a lo largo del tiempo. Además, “the relatively low response rate to a vacancy also correlates with the degree of renal failure”, Górriz points out.
Dudas with answer
Of the ceremonies that exist up to the moment when the vacancy front of the Covid-19 in public with the ERC, Natividad Tolosa, specialist in preventive medicine at Malvarrosa Hospital in Valencia, has sent three: “its necessities and needs to be prioritized in this collective, results sure and its efficacies; for that matter, although not obligatory, if the result is extremely comfortable”.
Tal y as subraya esta expertta, “all patients with ERC should be evacuated: frente la gripe, el neumoco, hepatitis B… y frente a la Covid-19 ”. I’m more, propose “create a safety belt around your patients“, Reducing in all likelihood the risk of transmission of the infection on the part of the convicts, by which” also deberían will be a priority candidate for the vacancy”.
Sondeverbod, onderhou incetidumbres, sober todo por la ascasez de evidencias en persona con enfermedad renal chronicle Only the studio that has approved the approval of the Pfizer vacuum inclusion of patients with kidney pathology (a subanalysis with 256 patients, out of a maximum of 37,000 evaluated).
Según David Navarro, of the Microbiology Service of the Clinical Hospital of the University of Valencia, “Without lack of information and experience, per the forecast is that in these patients a immunological response of minor magnitude and lower duration in comparison with the general population ”. It is assumed that this population does not have significant differences in efficiencies between commercial vehicles.
The duration of the immunization that occurs in this population, as well as in the rest of the patients (as in the rest of the evacuated patients) Possibility of being required to take additional dose or refill in these cases. There is currently no evidence of necrosis of the kidneys with pathology, and prudence is given to the time to value its indication during embarrassment and lactation. No allergies or contraindications to anti-Covid-19 vaccines have been reported that are commonly used to treat patients with ERC. The experts reunited in this forum also reviewed none of the vacancies currently available can provoke the Covid-19.
How practical aspects to take into account in the renal patient, Natividad Tolosa, aconseja “administer the vaccine during dialysis (at least 30 minutes before leaving the center), do not administer another vacancy in 14 days or make an exchange of commercial marks (for example, no dose of Pfizer y Modern) ”. The one Absolute contraindication is when a severe allergic reaction occurs ‘n a dose previa o some of its components.
In the case of kidney transplant, it is considered that the best time to administer any vaccine is during the period before the transplant or when the patient receives less immunosuppressant therapy.
In patients with ERC who co-opted the Covid-19 also recommended the evacuation, although it was necessary to hope for less than 90 days. In this sense, David Navarro has recently seen evidence that demonstrates how “with a single dose of vaccine is being used to increase the amount of immunization in patients he has performed on Covid-19 that with the doses in person that he did not hold the enfermedad ”.
A moment of webinar organized by SVN. |
Needs to cover
In this webinar he identified one of the main deficits pending patients to resolve in respect of the anti-Covid-19 evacuation in patients with ERC. And it is possible to announce the ERC’s association with increased mortality in cases of affectation by SARS-Cov2, the influence of renal insufficiency and substitutive renal treatment has not been evaluated at this time in the immunogenic response front to the vaccine.
Given the initiation of mass evacuation programs in general population, “it is necessary to study in detail the response of this subpopulation of patients, and detect only its own effect on the ultimate need for new dose recovery to maintain adequate protection in this subgroup of public elevated risk and elevated exposure to the infection due to the need for habitual and frequent prehistoric sanitation ”, it has advanced the Nayara Panizo, investigating officer of a study that will take place at the Hospital Clínico Universitario de Valencia; as we have drawn this expert, “we will study the different immunological response, clinic and the effects adverse to the vacancy in more patient patients, through various laboratory techniques that will help a better knowledge of the immunological response 19” .
A team of special preoccupation
People with chronic renal disease, and especially those with substitutive renal therapy, are particularly vulnerable patients. The rhinoceros is one of the most common organs of infection by SARS-Cov-2, as a consequence of microvascular affection.
Patients with chronic renal disease, in their distinct stages, are a risky patient who has presented mortality to the extent of the present pandemic; de hecho, la Presence of renal infarction is one of the main factors associated with a mayor mortality in patients with Covid-19.
The register of the Spanish Society of Nephrology, is updated weekly, in its last bulletin of 2/01/2021 accounts for 3,588 patients with ERC in renal replacement therapy (TSR), Hemodialysis (HD) Peritoneal dialysis (DP) and Renal Transplant (TR), with a Global mortality deaths pandemic of 21.2 per cent.
For TRS modalities, the highest elevated mortality occurred in Hemodialysis (26.7 per cent), followed by patients in peritoneal dialysis (23.4 per cent), and renal transplants (19.6 per cent).
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