The CKD Insider Newsletter- June Recap

Welcome to the Chronic Kidney Disease Insider Newsletter. If you are living with chronic kidney disease (CKD) on dialysis, have had a kidney transplant or are helping care for someone who is, this newsletter was created for you! The content is meant to keep you and/or a family member up to date on the latest information to help you manage your health now and in the near future in consultation with your physician.

In this month’s CKD Insider: Third dose of SARS-CoV-2 vaccine data, Advocacy alerts, New FDA EUA COVID-19 treatment, Psoriasis treatment and dialysis, NKF Research Connect launches, Urine based transplant rejection test, and the Fun Tip of the Day!

COVID-19 and kidney transplant recipients

Retrospective study shows the highest number of COVID-19 positive cases of all solid organ transplant recipients was found in kidney transplant recipients.

The National COVID Cohort Collaborative (N3C) allows researchers to use COVID-19 clinical data to answer critical research questions to address the pandemic. The N3C electronic health record depository was used in this study. The largest study to date, the authors evaluated 19,031 solid organ transplant (SOT) recipients, 2,183 were COVID positive (11.5%). The highest number of COVID positive SOT recipients was found in the kidney transplant group and was more likely to be non-white or Hispanic.

Reference: Covid-19 in Solid Organ Transplantation (SOT): Results of the National Covid Cohort Collaborative (N3C). Data presented at 2021 American Transplant Congress

Immune response of kidney transplant recipients after SARS-CoV-2 vaccination

Third dose of SARS-CoV-2 vaccine offers hope of protection against COVID-19.

Highlights from two recent studies are below:

1) The French National Authority for Health is currently recommending a 3rd dose of SARS-CoV-2 vaccine for immunosuppressed patients, a summary of their recently reported results is below.

101 solid organ transplant recipients were given 3 doses of Pfizer-BioNTech vaccine, 78 were kidney transplant recipients. The third vaccine dose was given ~61 days after the second dose.

The study showed a significant improvement in the antibody response of the vaccine for the participants, no serious adverse effects and no cases of COVID-19 reported as of this writing.

Immunosuppression in recipients was due to the use of glucocorticoids (in 87% of patients), calcineurin inhibitors (in 79% of patients), mycophenolic acid (in 63% of patients), mammalian target of rapamycin inhibitors (in 30% of patients), and belatacept (in 12% of patients).

Reference: Three Doses of an mRNA Covid-19 Vaccine in Solid-Organ Transplant Recipients. New England Journal of Medicine. June 2021

2) In the U.S. Johns Hopkins conducted a small study of people who had a solid organ transplants and received a 3rd dose of a SARS-CoV-2 vaccine, a summary of their reported data is below.

30 solid organ transplant recipients were included, 23 were kidney transplant recipients.
57% of the people received Pfizer/BioNTech and 43% received Moderna for both the first & second vaccine doses.
For the third vaccine dose 50% of the people received J&J, 20% Pfizer/BioNTech and 30% Moderna. The third dose was given 67 days on average after the second dose.
A variable increase in antibody response was seen with minimal side effects.

1/3 of patients with negative antibody titers and all patients who had low-positive antibody titers after the first 2 doses had an increase in their antibody titers.

In 25 patients, maintenance immunosuppression included tacrolimus or cyclosporine plus mycophenolate. In addition, corticosteroids were used for 24 patients, sirolimus for 1, and belatacept for 1.

Reference: Safety and Immunogenicity of a Third Dose of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: A Case Series. Annals of Internal Medicine June 2021

What this means for you:

Progress is being made. These studies can be used to support the development of larger clinical studies to determine whether SARS-CoV-2 vaccine booster doses can be officially used to prevent COVID-19 in transplant recipients in the US.
For now: Continue practicing strict COVID-19 safety precautions after vaccination and follow the CDC COVID-19 safety guidelines.

New monoclonal antibody treatment receives FDA Emergency Use Authorization

The U.S. Food and Drug Administration provided Emergency Use Authorization (EUA) to GlaxoSmithKline (GSK) for Sotrovimab, an investigational monoclonal antibody therapy, for the treatment of mild to moderate COVID-19 in patients 12 years of age and older with positive results of direct SARS-CoV-2 viral testing and who are at high risk for progression to severe COVID-19. This therapy is administered by health care providers with the hope that it will prevent the need for hospitalization due to severe COVID-19.

What this means for you: This treatment is another option to defend against hospitalization due to COVID-19. If you or a loved one tests positive for COVID-19, contact your healthcare provider to see if this antibody therapy is appropriate for you.

FDA notice: Sotrovimab is not authorized for use in patients who are hospitalized due to COVID-19, require oxygen therapy due to COVID-19, or require an increase in baseline oxygen flow rate due to COVID-19 (in patients on chronic oxygen therapy due to underlying non-COVID-19 related comorbidity).

Reference: Emergency Use Authorization Letter to GSK, FDA announcement, Fact Sheets

Chronic Kidney Disease Improvement in Research and Treatment Act

US Senators have introduced an updated version of the Chronic Kidney Disease Improvement in Research and Treatment Act bill to incentivize innovative new treatments, enhance improvements in treatment and care options for people living with kidney disease at all stages, including post kidney transplantation care. If after reading the details you are supportive of this act let your government representatives know.

Reference: Kidney Care summary of Act, Full bill

Access to Medical Nutrition Therapy

Medical nutrition therapy is a critical part of the care plan for people with chronic kidney disease and can help slow progress to dialysis as well. Although many insurance providers cover this service, some don't. The NKF is gathering support for the H.R. 6971 Medical Nutrition Therapy Act of 2020. If you would like to support this bill add your name to the link below.

NKF Kidney Voices Advocacy for Nutrition Therapy

Become a Photographer
or just take better pictures!

Smartphones have made taking pictures easier than ever, with increasing improvements in the quality of the images and tools to modify images at your fingertips, many people are using their phone over a camera. Whether you have a proper camera or are using a smart phone, picture taking can provide a creative outlet that allows you to focus on something other than your daily responsibilities. Every picture has a point of view and that point of view can be enhanced or changed and turned into beautiful art with a few great tips! Check out some of the tips below or look up your own!

National Geographic gives some tips - Think like a landscape painter
For iPhone users Apple has instructional videos to help you get great action shots, take interesting black and white photos and snap pictures at the off light hours to give your subjects a distinctive glow.
General Smartphone camera picture taking tips

What it is: A retrospective study of 8,911 individuals with CKD on dialysis who also have psoriasis was conducted using the United States Renal Data System to investigate the association of psoriasis and infections common to individuals with CKD on dialysis. The results showed a significantly higher risk of all infections evaluated compared to those without psoriasis, and that psoriasis treatment (systemic, local and light) was associated with a significantly decreased risk of some infections and death.

What this means for you: If you have psoriasis and are on kidney dialysis check with your physician to see if the information in this publication would be useful in your treatment plan.

Reference: Treatment of psoriasis in end-stage renal disease patients is associated with decreased mortality: A retrospective cohort study. The American Journal of Medical Sciences

What it is: A platform that allows you to sign up and be notified of kidney related research studies. You can join as a patient or researcher to become a partner in patient-centered outcomes research (PCOR) and comparative effectiveness research (CER).

What this means for you: If you have ever wondered how researchers find their participants and wanted to become aware of research studies on kidney disease and potentially join in, this platform connects you to a community of researchers.

Learn more about NKF Research Connect

What it is: The first and only urine-based test for the detection of kidney transplant rejection available today. The NephroSant developed QSant™ test measures 6 urinary markers (cfDNA, m-cfDNA, CXVL-10, clusterin, total protein and creatinine), and uses additional post transplant information to create a quantitative QScore™ that indicates the risk of rejection. The QSant™ test rules in and rules out active rejection with >95% sensitivity and specificity. Tests are ordered by the physician and sent to the person taking it and returned to the lab via Fedex.

What this means for you: The earlier kidney rejection can be detected the more options your nephrologist will have to help preserve your kidneys function for as long as possible. This test offers you the convenience of at home testing, saving you a visit to the doctors office and provides important information on your risk for transplant rejection.