CKD Insider March 2021 Recap- Kidney transplant & SARS-CoV-2 Vaccine

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 : COVID-19 Updates, kidney transplant research, Cigna in home kidney care program expansion, aerobic exercise benefits for hemodialysis, FDA cleared new dialysis machine and the Fun Tip of the Day!

SARS-CoV-2 Vaccine

For people on Dialysis: Vaccines are now being made available at dialysis centers through a nationwide initiative. If you haven’t gotten your SARS-CoV-2 vaccine yet, ask your dialysis center if they will be administering it soon

For Kidney Transplant Recipients: Both Moderna and Pfizer-BioNTech SARS-CoV-2 mRNA vaccines require two doses for full protection against the virus for people who are not immunocompromised. If you are not aware, immunocompromised individuals were excluded from original studies of the SARS-CoV-2 mRNA vaccines. Johns Hopkins published a recent study on the immune response of solid organ transplant recipients following the first dose of SARS-CoV-2 mRNA vaccines.

If you have received your first dose of either the Moderna or Pfizer –BioNTech mRNA SARS-CoV-2 vaccine and are receiving anti–metabolite maintenance immunosuppression therapy, please be aware that this recent study from Johns Hopkins looking at 436 transplant recipients (including kidney recipients) found that after 20 days the majority of the study participants did not mount an antibody response. Younger participants that were not receiving anti-metabolite maintenance immunosuppression therapy however did develop an antibody response. There are limitations to this study as the authors only included results from the first SARS-CoV-2 vaccine dose received. Reference

What this means for you: If you are receiving anti-metabolite maintenance immunosuppression therapy, you should keep the COVID-19 protective measures you have in place now after you get the first dose of the Moderna or Pfizer-BioNTech mRNA SARS-CoV-2 vaccine. Additionally you should speak with your healthcare provider to get a semi-quantitative antibody test to confirm your immune response after the first and second doses before relaxing the COVID-19 protective measures you have in place now. If you would like to participate in a followup study by Johns Hopkins please see below.

SARS-CoV-2 Variants

There are currently 8 SARS-CoV-2 variants that are being monitored by the CDC.

3 are categorized as variants of interest (NY_B.1.526, NY_B.1.525, Brazil_ P.2)
5 are categorized as variants of concern (UK_ B.1.1.7, Japan/Brazil_P.1, S. Africa_ B.1.351, California_ B.1.427, California_ B.1.429).

A SARS-CoV-2 variant is considered a variant of concern by the CDC if "there is evidence of increased transmissibility, more severe disease, a reduction in neutralization by antibodies generated during previous infection or vaccination, reduced effectiveness of treatments or vaccines, or diagnostic detection failures."

Studies are ongoing to determine the effectiveness of current vaccines against these SARS-CoV-2 variants. As this is an evolving situation, you will hear about this on the news, it is important to recognize not all studies are created equal and to look at the study details yourself. Only studies that have been peer reviewed and/or with appropriate supporting documentation will be included in this newsletter.

All of the 3 main manufacturers of the SARS-CoV-2 vaccines currently available in the US are evaluating booster vaccines to protect against SARS-CoV-2 variants that could evade current SARS-CoV-2 vaccines. Moderna recently sent a variant-specific vaccine candidate against the S. African B.1.351 to the NIH for clinical study. References: Pfizer, Moderna, J & J.

Post vaccination mask wearing guidance

Research is still ongoing to understand if people who have been vaccinated can still carry the SARS-CoV-2 virus and pass it on to someone else, even if they don’t develop COVID-19 from the protection that the SARS-CoV-2 vaccine provides.

To understand why it is important to continue to wear a mask after vaccination until we get more data view the moving graphic in this article, which provides a quick visual to explain the need for caution until we have more data.

For kidney transplant recipients.

What it is: Johns Hopkins is conducting an Organ Transplant study designed is to examine levels of antibodies in organ transplant recipients who have gotten the SARS-CoV-2 vaccine. This is a follow up to the above mentioned report and is ongoing and has an open enrollment, sign up here.

Why it's important: The data from this study can provide valuable information on how effectively the vaccine can help transplant patients get immunity.

Note: "The study does not provide the vaccine, and study team members will not be offering guidance as to whether or not one should receive a SARS-CoV-2 vaccine.

Spring has arrived!

If you live in a region where daylight savings time will occur your clocks will have sprung forward by one hour, meaning you lost one hour of sleep. This adjustment affects most people in a not so pleasant way. If your looking for ways to get your sleep back on track read below the 6 tips to get better sleep.

If you want to understand the science behind these tips and the importance of sleep read the book "Why we sleep?" by Matt Walker who goes into detail on how important sleep is to many body functions including your immune system, which we want to keep strong during these COVID-19 pandemic times!

6 tips to get better sleep:

1. Regularity: Keep consistent sleep and wake times to improve the quantity & quality of your sleep. 7-9 hours of sleep is recommended.
2. Temperature: Keep it cool. Your body needs to drop it's temperature by 2-3 degrees fahrenheit to initiate and stay asleep. Aim for 65F/18C.
3. Darkness: In the last hour before bed, dim down the lights in your home, don't look at TV or phone and wear an eye mask or use black out shades.
4. Alcohol/Caffeine: Stay away from it in the afternoon and the evening, it disrupts your sleep.
5. Have a wind down routine: Find what works for you to relax before bed and then stick to this routine.
6. Having trouble sleeping? If you can't sleep within 20-25 min, don't stay in bed, get up and move around, don't connect the bed with being awake, only go to bed when sleepy.

If you have sleep apnea or insomnia these tips won't necessarily help. You should speak to your doctor.

Want to learn more?
See the 20 min TED Talk: Sleep is your superpower by Matt Walker and learn about the importance of sleep. There is some interesting information that you might not know!

What it is: Researchers analyzed data from 15 previously completed randomized controlled clinical trials. They found that in adults with kidney failure undergoing maintenance hemodialysis aerobic exercise lessens several hemodialysis-related symptoms, including restless leg syndrome (RLS), symptoms of depression, muscle cramping, and fatigue. The authors noted more research was needed to see the extent of the benefits.

What this means for you: Get moving! You will be better for it! :) The lead author Dr. Bohm found that as little as 20 to 30 minutes of aerobic exercise 2 to 3 times per week seemed to improve several common symptoms in people undergoing hemodialysis and made them feel better. References: 1, 2

What it is: Cigna recently announced the expansion to their in-home kidney care program to include Medicare Advantage members in additional states. The program consists of regular home visits from care managers to help people living with chronic kidney disease (CKD) and end stage renal disease (ESRD) manage their health and stay out of the hospital.

What this means for you: If you are a Cigna MA member in one of the following states you can now access the kidney care program in most parts of Florida, Colorado, Texas, Pennsylvania, Illinois, North Carolina, South Carolina, New Jersey, Delaware, Maryland, Missouri, Kansas, and the District of Columbia.

What it is: A newly approved portable in center dialysis machine that connects directly with electronic medical records for patients prescriptions and treatment data. The system was previously available internationally and is now available in the US.

What this means for you: If this system is adopted by your dialysis center it will help your healthcare team keep up to date with your treatments and potentially help minimize the beeping alarms that are sometimes set off by movement!

Reference