Home » Covid, because it is important to get vaccinated in those suffering from kidney failure

Covid, because it is important to get vaccinated in those suffering from kidney failure

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Covid, because it is important to get vaccinated in those suffering from kidney failure

We often speak of “fragile” patients when referring to Sars-CoV-2 virus infection. And sometimes we forget the importance of including who in this population suffer from kidney failure, or rather chronic kidney disease, especially if at an advanced stage. As the experts of the Italian Society of Nephrology (SIN) recall, on the occasion of the congress, a lot of attention is needed precisely to this population. Especially if he is on dialysis. As reported by a survey conducted by the SIN itself, it is registered among dialysis patients ten times higher mortality to that estimated to date in the general population during the second phase of the pandemic (26% vs 2.4%).

Patients undergoing dialysis treatment and kidney transplant recipients have not only been shown to be more susceptible to becoming infected with Covid-19, but, more importantly, when infected have a much higher risk of dying than the general population.

So the vaccine defends us

In short: those undergoing dialysis treatment must be considered at risk. And not only because potentially more at risk of developing different problems in the case of Covid-19, but also for the specific fragility due to the numerous diseases of other organs associated with their renal pathology, with consequent increased risk of mortality in case they get sick of Covid-19. Furthermore, it should not be forgotten that patients on chronic dialysis must also go to the dialysis center three times a week, in environments where there are numerous other patients, with an exposure to the infection clearly higher than the average.

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The inclusion of dialysis patients in vaccination priority programs has allowed SIN to start a cohort study to monitor the health status of nephrological patients who will receive anti-Covid vaccines. Preliminary analyzes of the data collected indicate that vaccination in dialysis patients resulted in a clear reduction in the most serious consequences of the infection (hospitalization and / or death).

Although the Omicron variant resulted in global growth in infections and a relative surge in the number of cases in patients with chronic kidney disease on dialysis, the clinical impact – as well as in the general population – was more modest in terms of hospitalizations and mortality. In the dialysis population, a mortality of 40% in the first phase of Covid-19 has gone from a mortality of less than 5%; an important discrepancy which, although it may partly depend on a reduced pathogenicity of the latest variants of the virus, is largely explained by the unquestionable effectiveness of vaccination.

The technology for “ad personam” dialysis

Another aspect emerges from the experts of the Italian Society of Nephrology. Technology is revolutionizing the lives of patients with chronic kidney disease: already today in some regions – including Lombardy, Piedmont and Puglia – it is possible to perform dialysis treatment “remotely”.

These are pioneering experiences that respond to the concrete needs of these extremely fragile patients, forced to move from their home even three times a week, with an important impact on healthcare costs and quality of life. “About 20% of dialysis treatments – explains Piergiorgio Messa, President of the Italian Society of Nephrology (SIN), former Director of the Complex Operational Unit of Nephrology, Dialysis and Kidney Transplant – Polyclinic of Milan and Full Professor of Nephrology at the University of Studies of Milan – could be managed remotely (home dialysis), while 70/80% of extracorporeal dialysis remains, which requires the presence of a nurse or a caregiver who has undergone adequate training (ranging from 3 to 6 months).

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Peritoneal dialysis constitutes the real challenge of the next few years in terms of replacement therapy, being the technique that has more roots in the area and greater possibilities of conducting with telemedicine and video-dialysis techniques ”.

We pay attention to the kidney

The kidney is a very sensitive organ, and therefore it can easily get sick by suffering from pathologies that affect the whole organism such as diabetes or becoming the site of infections. However, when a chronic disease such as hypertension, the same diabetes or serious pictures of atherosclerosis occurs in the arteries that carry blood to the kidneys and through these organs or an infection creates such damage that it cannot be reabsorbed, it can be going towards renal failure.

This pathological condition involves a progressive decrease in the activity of the kidney, which is no longer able to “purify” the blood and ensure the normal control mechanisms of the body’s fluids, thus producing urine that does not respond to the real needs of the organism , because too much or too little concentrated. Over the years, renal failure that initially does not give any trouble begins to show signs of its presence.

One of the first symptoms it may be the increase in the amount of urine, linked to its poor concentration, which induces the need to get up several times during the night. Or the amount of urine produced in 24 hours drops a lot, reaching as much as half a liter per day. Or the color of the urine becomes darker, an indication of possible blood loss. Or severe fatigue, accompanied by itching and loss of appetite. Finally, if the kidney significantly loses its ability to respond to the demands of the body, swelling (the so-called edema) may occur, localized mainly in the legs, and linked to the inability of the kidneys to eliminate excess fluids.

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For the same reason, dehydration can occur. In fact, if the kidney is sick it is not able to reduce the production of urine when you sweat a lot or you are the victim of a strong diarrhea, with the result that the body is lacking fundamental mineral salts. When the situation tends to worsen further, then, the kidney itself changes its structure becoming smaller, almost shrunken. This is the stage where we speak of “grinzo kidney”and in which the various components of the kidney are no longer able to properly filter the blood.

The most dramatic phase of renal failure therefore begins with the accumulation of toxic or only harmful substances in the body, capable of heavily damaging the body. Thus begins the phase of uremia, which can be defined as a sort of generalized intoxication of the organism.

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