SPRECIFIČNOST COVID-19 INFEKCIJE KOD BOLESNIKA NA HRONIČNOM PROGRAMU LEČENjA HEMODIJALIZAMA
Ključne reči:
kovid-19 infekcija, kovid-19 vakcina, imunološki odgovor, pacijenti na hemodijalizi
Sažetak
Tokom pandemije kovid-19 više od 585 miliona ljudi širom sveta je zaraženo ovim virusom, a preko 6,4 miliona je preminulo usled infekcije. Poput drugih zaraznih bolesti, za sprečavanje širenja infekcije od velikog je značaja primena lične higijene, smanjenje socijalnog kontakta, držanje fizičke distance i izolacije zaraženih bolesnika. Međutim, razvoj vakcina i aktivna imunizacija su od suštinskog značaja u sprečavanju širenja ove visoko zarazne bolesti.Imajući u vidu zdravstveni, sociološki i ekonomki značaj pandemije kovid-19, razvijeno je više vrsta vakcina protiv SARS-CoV-2 virusa.
Pacijenti na hroničnom programu lečenja hemodijalizom (HD) su pod povišenim rizikom od infekcije SARS-CoV-2 virusom pre svega zbog čestih pridruženih oboljenja, poremećene funkcije imunog sistema i nemogućnosti smanjenja socijalnih kontakata zbog neophodnosti odlaska u dijalizni centar najmanje tri puta nedeljno. Efikasnost i bezbednost vakcina protiv SARS-CoV-2 virusa je ispitivana i evaluirana u brojnim studijama koje su obuhvatale opštu populaciju, dok je relativno malo studija sprovedeno među dijaliznim bolesnicima. Po dosadašnjim saznanjima, kod dijaliznih bolesnika je utvrđen slabiji i sporiji imunološki odgovor na primenjene vakcine u porođenju sa osobama sa očuvanom globalnom bubrežnom funkcijom. S druge strane, u kohorti bolesnika na hroničnom programu hemodijalize, godine starost, dijabetesa i primena imunosupresivne terapije su bila faktori koji su doprineli stvaranju nižeg titra antitela na SARS-CoV-2 virus nakon aktivne imunizacije. Imajući u vidu vulnerabilnost, izloženost i smanjenu otpornost na infekcije dijaliznih bolesnika, veoma je važno primeniti vakcinaciju protiv SARS-CoV-2 virusa kod ovih bolesnika.
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5. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for
the Treatment of Covid-19 — Final Report. N Engl J Med. 2020 Nov 5;383(19):1813–26.
6. The RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-
19. N Engl J Med. 2021 Feb 25;384(8):693–704.
7. Hayek S, Ben-shlomo Y, Dagan N, Reis BY, Barda N, Kepten E, et al. Effectiveness of
REGEN-COV antibody combination in preventing severe COVID-19 outcomes. Nat
Commun. 2022 Aug 2;13(1):4480.
8. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses,
Gorbalenya AE, Baker SC, Baric RS, De Groot RJ, Drosten C, et al. The species Severe acute
respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-
2. Nat Microbiol. 2020 Mar 2;5(4):536–44.
9. Brian DA, Baric RS. Coronavirus Genome Structure and Replication. In: Enjuanes L, editor.
Coronavirus Replication and Reverse Genetics [Internet]. Berlin, Heidelberg: Springer Berlin
Heidelberg; 2005 [cited 2023 Nov 25]. p. 1–30. (Current Topics in Microbiology and
Immunology; vol. 287). Available from: https://link.springer.com/10.1007/3-540-26765-4_1
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definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies
Conference report. Kidney Int. 2011 Jul;80(1):17–28.
11. Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. Global
Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PloS One.
2016;11(7): e0158765.
12. Annual Reports [Internet]. ERA. [cited 2023 Nov 20]. Available from: https://www.era-
online.org/research-education/era-registry/annual-reports/
13. Wanner C, Amann K, Shoji T. The heart and vascular system in dialysis. The Lancet.
2016 Jul;388(10041):276–84.
14. De Jager DJ. Cardiovascular and Noncardiovascular Mortality Among Patients Starting
Dialysis. JAMA. 2009 Oct 28;302(16):1782.
15. Agrawal S, Gollapudi P, Elahimehr R, Pahl MV, Vaziri ND. Effects of end-stage renal
disease and haemodialysis on dendritic cell subsets and basal and LPS-stimulated cytokine
production. Nephrol Dial Transplant. 2010 Mar 1;25(3):737–46.
16. Sharif MR, Chitsazian Z, Moosavian M, Raygan F, Nikoueinejad H, Sharif AR, et al.
Immune disorders in hemodialysis patients. Iran J Kidney Dis. 2015 Mar;9(2):84–96.
17. Johansen KL, Chertow GM, Foley RN, Gilbertson DT, Herzog CA, Ishani A, et al. US
Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United
States. Am J Kidney Dis. 2021 Apr;77(4): A7–8.
18. Hsu CM, Weiner DE, Aweh G, Miskulin DC, Manley HJ, Stewart C, et al. COVID-19
Among US Dialysis Patients: Risk Factors and Outcomes From a National Dialysis Provider.
Am J Kidney Dis. 2021 May;77(5):748-756.e1.
19. De Meester J, De Bacquer D, Naesens M, Meijers B, Couttenye MM, De Vriese AS, et
al. Incidence, Characteristics, and Outcome of COVID-19 in Adults on Kidney Replacement
Therapy: A Regionwide Registry Study. J Am Soc Nephrol. 2021 Feb;32(2):385–96.
20. Clarke C, Prendecki M, Dhutia A, Ali MA, Sajjad H, Shivakumar O, et al. High
Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients Detected Using
Serologic Screening. J Am Soc Nephrol. 2020 Sep;31(9):1969–75.
21. Francis A, Baigent C, Ikizler TA, Cockwell P, Jha V. The urgent need to vaccinate
dialysis patients against severe acute respiratory syndrome coronavirus 2: a call to action.
Kidney Int. 2021 Apr;99(4):791–3.
22. American Society of Nephrology. Prioritizing COVID-19 Vaccination in Dialysis.
Available online: https://www.kidneynews.org/view/news/policy-advocacy/leading-
edge/prioritizing-covid-19-vaccination-in-dialysis.xml [accessed on 1 June 2021].
23. Combe C, Kirsch AH, Alfano G, Luyckx VA, Shroff R, Kanbay M, et al. At least 156
reasons to prioritize COVID-19 vaccination in patients receiving in-centre haemodialysis.
Nephrol Dial Transplant. 2021 Mar 29;36(4):571–4.
24. Garcia P, Montez-Rath ME, Moore H, Flotte J, Fults C, Block MS, et al. SARS-CoV-2
Vaccine Acceptability in Patients on Hemodialysis: A Nationwide Survey. J Am Soc Nephrol.
2021 Jul;32(7):1575–81.
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landscape. Hum Vaccin Immunother. 2023 Dec 31;19(1):2191577.
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https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines
[accessed on 4 July 2021].
27. World Health Organization. COVID-19 vaccine tracker and landscape. 2022. [accessed
2022 Dec 30] https://www.who.int/publications/m/item/draft-landscape-of-covid-19-
candidate-vaccines.
28. Basta NE, Moodie EMM. on behalf of the VIPER (Vaccines, infectious disease
prevention, and epidemiology research) Group COVID-19 vaccine development and
approvals tracker team. COVID-19 vaccine development and approvals tracker. 2020.
[accessed 2022 Dec 30].
29. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-
covid-19/covid-19-vaccines-2023-2024
30. Hannah R; Mathieu E, Rodés-Guirao L, Cameron A, Giattino C, Ortiz-Ospina E, Hasell
J, Macdonald B, Beltekian D, Dattani S, Roser Max. Coronavirus Pandemic (COVID-19). Our
World in Data. [retrieved 2024 January 27] https://ourworldindata.org/coronavirus
31. Jahn M, Korth J, Dorsch O, Anastasiou OE, Sorge-Hädicke B, Tyczynski B, et al.
Humoral Response to SARS-CoV-2-Vaccination with BNT162b2 (Pfizer-BioNTech) in
Patients on Hemodialysis. Vaccines. 2021 Apr 8;9(4):360.
32. Miyazaki, R., Miyagi, K., Yoshida, M. et al. Robust antibody response after the third
mRNA coronavirus vaccination in Japanese hemodialysis patients. Ren Replace Ther. 2023,
9, 38 (2023).
33. El-Hameed AA, Ahmed MF, Ehmemeed AOA, Mokhtar A, Abdelhamid WAR.
Assessment of humoral immune response to different COVID-19 vaccines in patients
undergoing maintenance hemodialysis. J Bras Nefrol. 2023 Oct-Dec;45(4):417-423.
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