Rationale & Objective Optimal anti-hypertensive therapy with reno-protective effects is essential to slow diabetic kidney disease progression. We evaluated the impact of dihydropyridine calcium-channel-blockers on kidney outcomes in patients with type-2 diabetes receiving guideline-directed renin–angiotensin inhibitors and sodium–glucose cotransporter-2 inhibitors Study Design, Participants &; Settings A retrospective cohort study using Clalit Health Services (2016-2021). Exposure Adults with type-2 diabetes treated with both renin–angiotensin inhibitors and sodium–glucose cotransporter-2 inhibitors were categorized into dihydropyridine calcium-channel-blockers group (renin–angiotensin inhibitors + dihydropyridine calcium-channel-blockers, with or without other agents) or a dihydropyridine calcium-channel-blockers-free group, (renin–angiotensin inhibitors ± other antihypertensives excluding dihydropyridine calcium-channel-blockers). Outcomes: The primary outcome was a major adverse kidney event (MAKE; ≥40% eGFR decline or progression to kidney failure). Secondary outcomes included initiation of renal replacement therapy and all-cause mortality; Safety outcomes included hospitalizations and acute kidney injury. Analytical Approach Inverse probability of treatment weighting was applied to balance baseline characteristics. Results We included 31,031 patients with type 2 diabetes treated with both sodium–glucose cotransporter-2 inhibitors and renin–angiotensin inhibitors 12,172 (60.8%) received dihydropyridine calcium-channel-blockers, and 18,859 (39.2 %) received dihydropyridine calcium-channel-blockers -free therapy. Median follow-up was 1,260 days. Overall, 482 patients experienced major adverse kidney event, and 2064 patients died. dihydropyridine calcium-channel-blockers use was associated with a higher risk of major adverse kidney event compared with dihydropyridine calcium-channel-blocker-free therapy (weighted HR 1.33 95%CI 1.03-1.73, P=0.03), which remained significant after accounting for competing risk of death (HR 1.39, 95%CI 1.13-1.7, P=0.002). dihydropyridine calcium-channel-blocker use was not significantly associated with all-cause mortality or safety outcomes. Limitations The observational design is subject to residual confounding and did not allow for full characterization of medication exposure. Conclusions In patients with type 2 diabetes treated with renin–angiotensin system inhibitors and sodium–glucose cotransporter-2 inhibitors, concomitant therapy with dihydropyridine calcium channel blockers was associated with a higher risk of adverse kidney outcomes. These findings may help inform clinicians when weighing the potential risks and benefits of second-line antihypertensive therapy in this population. Plain-Language Summary We studied 31,031 adults with type 2 diabetes taking both renin–angiotensin inhibitors and sodium–glucose cotransporter-2 inhibitors. We compared those also using dihydropyridine calcium-channel blockers with those using other blood-pressure medicines. Over a median follow-up of 3.5 years, major kidney events (kidney failure or a sustained ≥40% eGFR drop) were uncommon but occurred more often in the dihydropyridine calcium-channel blockers group. After adjusting for baseline differences, dihydropyridine calcium-channel blockers use was associated with a 33% higher risk of major kidney events but not with a higher risk of overall mortality. In conclusion, adding a dihydropyridine calcium channel blocker to renin–angiotensin system inhibitor and sodium–glucose cotransporter-2 inhibitor therapy may be associated with worse kidney outcomes, and these findings may help clinicians weigh the risks and benefits of second-line blood pressure treatment in this population.

Background:Kidney transplant recipients (KTRs) face a heightened risk of cardiovascular disease but the impact of post-transplant mineral and bone disorders on this risk remains unclear. This study investigated the association between serum calcium, phosphate and calcium-phosphate (Ca × P) product levels and cardiovascular outcomes. Methods:In this retrospective cohort study, adult KTRs transplanted between 2005 and 2014 at a large centre were analysed. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality and a composite of MACE and mortality. Cumulative exposure to abnormal mineral levels was assessed using time-weighted average calculations. Cox proportional hazards models were used to evaluate associations adjusting for confounders, including estimated glomerular filtration rate (eGFR). Mineral abnormalities were analysed both as continuous variables and by quartiles. Results:The study included 649 KTRs (median follow-up 2943 days), with 109 patients (16.8%) experiencing MACE. Over time, calcium exposure decreased, while phosphate and Ca × P product exposure increased. Hypercalcaemia was not significantly associated with MACE, all-cause mortality or the composite outcome. In contrast, hyperphosphataemia remained significantly associated with an increased risk of MACE {hazard ratio [HR] 1.414 [95% confidence interval (CI) 1.044-1.916]) and the composite outcome [HR 1.353 (95% CI 1.064-.721)] even after adjustment for eGFR. Elevated, Ca × P product levels were similarly associated with increased cardiovascular risk [HR 1.055/mg2/dl2 (95% CI 1.015-1.096) and HR 1.043/mg2/dl2 (95% CI 1.013-1.075), respectively]. Conclusions:While hypercalcaemia does not independently predict cardiovascular outcomes post-transplant, sustained hyperphosphataemia and elevated Ca × P product are significant risk factors for adverse cardiovascular events in KTRs.

Rationale & Objective:Optimal antihypertensive therapy with renoprotective effects is essential to slow diabetic kidney disease progression. We evaluated the impact of dihydropyridine calcium channel blockers on kidney outcomes in patients with type 2 diabetes receiving guideline-directed renin angiotensin system inhibitors and sodium/glucose cotransporter 2 inhibitors. Study Design Participants & Settings:A retrospective cohort study using Clalit Health Services (2016-2021). Exposure:Adults with type 2 diabetes treated with both renin angiotensin system inhibitors and sodium/glucose cotransporter 2 inhibitors were categorized into dihydropyridine calcium channel blockers group (renin angiotensin system inhibitors + dihydropyridine calcium channel blockers, with or without other agents) or a dihydropyridine calcium channel blocker-free group (renin angiotensin system inhibitors ± other antihypertensives excluding dihydropyridine calcium channel blockers). Outcomes:The primary outcome was a major adverse kidney event (MAKE; defined as ≥40% estimated glomerular filtration rate decline or progression to kidney failure). Secondary outcomes included initiation of renal replacement therapy and all-cause mortality. Safety outcomes included hospitalizations and acute kidney injury. Analytical Approach:Inverse probability of treatment weighting was applied to balance baseline characteristics. Results:We included 31,031 patients with type 2 diabetes treated with both sodium/glucose cotransporter 2 inhibitors and renin angiotensin system inhibitors. A total of 12,172 (60.8%) received dihydropyridine calcium channel blockers, and 18,859 (39.2%) received dihydropyridine calcium channel blocker-free therapy. Median follow-up was 1,260 days. Overall, 482 patients experienced MAKE, and 2,064 patients died. Dihydropyridine calcium channel blocker use was associated with a higher risk of MAKE compared with dihydropyridine calcium channel blocker-free therapy (weighted HR, 1.33; 95% CI, 1.03-1.73; P = 0.03), which remained significant after accounting for competing risk of death (HR, 1.39; 95% CI, 1.13-1.7; P = 0.002). Dihydropyridine calcium channel blocker use was not significantly associated with all-cause mortality or safety outcomes. Limitations:The observational design is subject to residual confounding and did not allow for full characterization of medication exposure. Conclusions:In patients with type 2 diabetes treated with renin angiotensin system inhibitors and sodium/glucose cotransporter 2 inhibitors, concomitant therapy with dihydropyridine calcium channel blockers was associated with a higher risk of adverse kidney outcomes. These findings may help inform clinicians when weighing the potential risks and benefits of second-line antihypertensive therapy in this population.

BACKGROUND:Kidney transplant recipients are at increased risk for infections such as BK virus, with few treatment options. This study assessed how nonidentical but compatible ABO blood types influence BKPyV-DNAemia risk. METHODS:We conducted a retrospective single-center study from 1/1/2011 to 1/12/2021, focusing on BK viremia (>10 000 copies/mL in two consecutive measurements one week apart) within the first posttransplant year. We used stepwise forward regression for multivariate analysis. RESULTS:Of the 1244 transplants, 1084 involved identical blood types. The percentage of living donor grafts was 63.3% (787 cases), with 98.8% (158 cases) in the mismatched blood type group. There were 78 significant BK viremia episodes in the first year, occurring in 5.5% of matched and 11.3% of mismatched blood type recipients (OR 2.16, p = 0.006). For living donors, the viremia rate was 6% overall, with 4.6% in the matched blood type group and 11.4% in the mismatched blood type group (OR 2.22, p = 0.001). Multivariate analysis revealed an increased risk of mismatched blood types in living donor grafts (OR = 2.75, p = 0.002). CONCLUSIONS:This study revealed an association between blood type mismatch and increased BK viremia in kidney transplant recipients, highlighting a modifiable risk factor for clinicians in organ procurement.

Background To investigate the impact of sodium-glucose cotransporter 2 (SGLT2) inhibitors on the prevalence, severity, and complications of hyponatremia and hypernatremia in diabetic patients using real-world data, compared with dipeptidyl peptidase 4 (DPP4) inhibitors. Methods This was a retrospective cohort study, and the dataset was sourced from the data repositories of Clalit Health Services. From January 1, 2016, through December 31, 2021, we identified diabetic patients who received SGLT2 inhibitors, comparing them with a propensity matched control group treated with DPP4 inhibitors. The coprimary end points were a composite outcome of the prevalence of severe hyponatremia and hospitalizations because of hyponatremia and the prevalence of moderate hypernatremia and hospitalizations because of hypernatremia. Results The study included 22,686 patients, with 11,343 receiving SGLT2 inhibitors and an equal number treated with DPP4 inhibitors. A significant reduction in the risk of the hyponatremia primary composite outcome was observed in patients treated with SGLT2 inhibitors (hazard ratio [HR], 0.60; 95% confidence intervals [CI], 0.53 to 0.69), as well as in the risk of the hypernatremia composite primary with a HR of 0.54 (95% CI, 0.44 to 0.63), compared with DPP4 inhibitors. In addition, the risk of hospitalizations because of hyponatremia and hypernatremia was significantly lower in the SGLT2 inhibitor group (HR, 0.64; 95% CI, 0.54 to 0.74; P < 0.001; and HR, 0.55; 95% CI, 0.36 to 0.74; P = 0.002; respectively). Conclusions SGLT2 inhibitors were associated with a reduced prevalence of hyponatremia and a lower risk of hyponatremia-related hospitalizations compared with DPP4 inhibitors in patients with diabetes.

Selecting the optimal first-line therapy for type 2 diabetes is crucial for glycemic control and providing cardiovascular and renal protection, though the combined benefits of metformin with SGLT2 inhibitors (SGLT2i), remain uncertain. This study aimed to compare outcomes in adults with type 2 diabetes treated with SGLT2i alone versus in combination with metformin. This retrospective cohort study analysed data from Clalit Health Services (2016–2021). Propensity score matching was applied to balance baseline characteristics between groups. Primary outcomes were a composite kidney outcome (40% decline in eGFR, or progression to ESRD), and all-cause mortality. Safety outcomes included hospitalizations and metabolic acidosis. The study included 45,545 patients, with 6774 patients in each group following propensity score matching. The median follow-up time was 1166 days. Combination therapy with metformin and SGLT2i was associated with significantly reduced risk of all-cause mortality (aHR 0.74, 95% CI 0.64–0.84), and composite kidney outcomes (aHR 0.65; 95% CI 0.48–0.87) even after accounting for mortality as a competing risk (aHR 0.67; 95% CI 0.5–0.9). Furthermore, combination therapy reduced the risks of hospitalization (aHR 0.93; 95% CI 0.87–0.99) and metabolic acidosis (aHR 0.58; 95% CI 0.4–0.83), compared with SGLT2i alone. Patients receiving combination therapy with metformin and SGLT2i showed significantly reduced risks of CKD progression and mortality compared to those treated with SGLT2i alone. These findings support the use of metformin with SGLT2i as a first-line treatment for type 2 diabetes irrespective of glycemic control or cardio-renal risk factors.

BACKGROUND:Selecting the optimal first-line therapy for type 2 diabetes is essential for achieving glycemic control and providing cardio-renal protection, though the combined benefits of metformin with SGLT2 inhibitors, remain uncertain. METHODS:This retrospective cohort study analyzed data from Clalit Health Services (2016-2021), to compare outcome in adults with type 2 diabetes treated with SGLT2 inhibitors alone versus in combination with metformin. Propensity score matching was applied to balance baseline characteristics between groups. Primary outcomes were a composite kidney outcome (40% decline in eGFR, or progression to ESRD), and all-cause mortality. Safety outcomes included hospitalizations, acute kidney injury and metabolic acidosis. RESULTS:The study included 45,545 patients, with 6774 patients in each group following propensity score matching. The median follow-up time was 1166 days. Combination therapy with metformin and SGLT2 inhibitors was associated with significantly reduced risk of all-cause mortality (aHR 0.74, 95% CI 0.64-0.84), and composite kidney outcomes (aHR 0.65 95% CI 0.48-0.87) even after accounting for mortality as a competing risk (aHR 0.67; 95% CI 0.5-0.9). Furthermore, combination therapy was associated with reduced risks of hospitalization (aHR 0.93 95% CI 0.87-0.99), severe acute kidney injury events (aHR 0.72 95% CI 0.54-0.96) and metabolic acidosis events (aHR 0.58 95% CI 0.4-0.83), compared with SGLT2 inhibitors alone. CONCLUSIONS:Patients receiving combination therapy with metformin and SGLT2 inhibitors showed significantly reduced risks of kidney disease progression and mortality compared to those treated with SGLT2 inhibitors alone. These findings support the use of metformin with SGLT2 inhibitors as a first-line treatment strategy for type 2 diabetes irrespective of glycemic control or cardio-renal risk factors.

Introduction: The correlation between hypercholesterolemia and cardiovascular disease in kidney transplant recipients (KTRs) remains uncertain. We sought to characterize the association between abnormal cholesterol profiles and cardiovascular morbidity and mortality in this unique population. Methods: This retrospective cohort study was conducted at a single center and included all adult KTR, transplanted between January 2005 and April 2014. The primary outcome was major adverse cardiovascular events (MACE) while the secondary outcome was the composite outcome of MACE and all-cause mortality. Exposure to abnormal cholesterol levels was calculated using a time-weighted average calculation. MACE and mortality risk were analyzed using a multivariate time- varying Cox model. Results: The final cohort comprised 737 KTR, with a median follow-up of 2,920 days. A total of 126 patients (17.1%) experienced MACE. High LDL-C levels and MACE risk were correlated by multivariate analysis (HR 1.008 per mg/dL, 95% CI: 1.001-1.016), while low HDL-C levels were not significantly associated with MACE (HR 0.992 per mg/dL, 95% CI: 0.976-1.009). A higher LDL-C/HDLC ratio was significantly associated with an increased risk of MACE in multivariate analyses (HR 1.502 per unit, 95% CI: 1.147-1.968), and also correlated with the composite outcome (HR 1.35 per unit, 95% CI: 1.06-1.71). Conclusions: A high LDL-C/HDL-C ratio is predictive of an increased risk of cardiovascular morbidity and mortality in KTRs. These fi nd- ings emphasize the significance of the LDL-C/HDL-C ratio as a valuable marker of cardiovascular risk and support current recommendations to improve hypercholesterolemia in this high-risk group. (c) 2024 The Author(s). Published by S. Karger AG, Basel

This article describes a study examining the association between treatment with ACE inhibitors or angiotensin receptor blockers (ARBs) and incident hypoglycemia in patients with or without diabetes who were admitted to the internal medicine departments of a tertiary hospital in the Tel Aviv district of Israel. The authors found that treatment with ARBs, but not ACE inhibitors, compared with treatment with neither, was associated with a reduced risk of hypoglycemia regardless of diabetes status.

Hemodialysis patients are highly susceptible to poor nutritional status. Our objective was to investigate whether poor nutritional status during mRNA-SARS-CoV-2 vaccination is correlated with impaired vaccine responses. This retrospective study was conducted in two hospital-based dialysis units. The nutritional status of hemodialysis patients was assessed, using a malnutrition inflammation score (MIS) at the time of their first BNT162b2 vaccine dose. One month after the second vaccine dose, we performed a quantitative assessment of antibodies against the spike protein (anti-S1 IgG). A total of 115 hemodialysis patients, with an average age of 72 were enrolled in the study. Among them, 39 (33.9%) were female, and 67 (58.2%) had diabetes mellitus. In 43/115 (37.4%) patients, moderate to severe malnutrition (MIS > 5) was detected. Comparatively, malnourished patients showed a lower log-transformed mean level of anti-S1 IgG compared to those with normal nutrition (2.91 ± 0.83 vs. 3.25 ± 0.72, respectively, p = 0.024). In a multivariable analysis that adjusted for age, sex, and KT/V, the nutritional status assessed by an MIS remained inversely associated with an anti-S1 IgG response [B; −0.066 (−0.117 to −0.015)]. In conclusion, moderate to severe malnutrition in hemodialysis patients is associated with reduced humoral responses to BNT162b2 vaccination.

The prevailing assumption is that following kidney transplantation the pattern of kidney function decline is consistent. Nevertheless, numerous factors leading to graft loss may emerge, altering the trajectory of kidney function. In this study, we aim to assess alterations in estimated glomerular filtration rate (eGFR) trajectory over an extended period of follow‐up and examine its correlation with graft survival.

We clarified the diagnostic and therapeutic challenges as-sociated with pseudohypertension in very elderly patients. Pseudohypertension is diagnosed when cuff blood pressure measurements for both systolic and diastolic blood pressure are significantly higher than direct intra-arterial blood pres-sure recordings. Pseudohypertension is considered a manifes-tation of combined intimal and medial arterial calcifications. Non-invasive diagnosis is extremely difficult, but pseudohy-pertension should be considered in certain groups of very elderly hypertensive patients. Importantly, most of the very elderly patients diagnosed with pseudohypertension present with hypertension, especially isolated systolic hypertension, and this condition should be treated. Treatment must be un-dertaken cautiously (start low, go slow), with a recommended target blood pressure < 150/80 mmHg. Orthostatism should be measured routinely, both by the patient and the attending physician.

BACKGROUND:Hemodialysis patients are at high risk for severe COVID-19 disease. Despite a high early seropositivity rate, dialysis patients mount a dampened immune response following two doses of an mRNA vaccine. This study aimed to evaluate the serologic response to a booster dose of BNT162b2 vaccine, 6 months after the second dose, among hemodialysis patients.METHODS:This prospective study included 80 hemodialysis patients and 56 healthcare workers serving as controls. Serologic samples were evaluated before and ∼3 weeks after the third vaccine dose. The primary outcomes were the seropositivity rate and the log-transformed anti-SARS-COV-2 S1 (RBD) IgG as a continuous variable after the third dose. Secondary outcomes were the proportion of participants with "high response," defined as antibody levels >1,000 AU/mL, and "robust response," defined as antibody levels >4,160 AU/mL, according to prespecified cutoff values associated with neutralizing antibodies. Univariate and multivariate analyses were conducted to identify predictors of antibody response.RESULTS:Among 80 hemodialysis patients, seropositivity rates improved from 78% (62/80) before the third dose, up to 96% (77/80) after the booster dose. The S1-RBD log-transformed antibody level increased significantly following the third dose from 2.15 ± 0.75 to 3.99 ± 0.83 compared with 2.65 ± 0.4 to 4.31 ± 0.42 in the control group. Among the hemodialysis patients, 88% (70/80) became "high responders" (>1,000 AU/mL), and of these, 79% (63/80) mounted a "robust response" (>4,160 AU/mL). Baseline antibody level, dialysis therapy, and hypoalbuminemia were independent predictors of impaired antibody response.CONCLUSIONS:A third dose of BNT162b2 COVID-19 vaccine, 6 months after the standard two-dose vaccination regimen, substantially improved humoral response in hemodialysis patients.

Data regarding immunogenicity of mRNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines among kidney transplant recipients in the months following vaccination are lacking. We aimed to investigate humoral immune response at 3-4 months post-vaccination among a cohort of kidney transplant recipients, compared with a control group of dialysis patients. Anti-spike antibodies were tested at 1 and 3-4 months after vaccination. Of 259 kidney transplant recipients tested at a median time of 110 days from second vaccine dose, 99 (38%) were seropositive, compared with 83% (101/122) of control patients. Younger age, better renal function and lower immunosuppression levels were associated with seropositivity. A total of 14% (13/94) of participants seropositive at 1 month became seronegative at follow-up and 11% (18/165) became seropositive. The latter were mainly individuals with higher antibody levels at 1 month. Antibody levels at 3-4 months were significantly reduced in both study groups, although the decline was more pronounced in the control group. Kidney transplant recipients present poor antibody response to mRNA SARS-CoV-2 vaccination, with only 38% seropositive at 3-4 months. Nevertheless, the decay in antibody response over time is modest, and some patients may present delayed response, reaching adequate antibody levels at 3-4 months. Low seropositivity rates in this group call for investigating other immunization strategies.

Immune response to two SARS-CoV-2 mRNA vaccine doses among kidney transplant recipients (KTRs) is limited. We aimed to evaluate humoral and cellular response to a third BNT162b2 dose. In this prospective study, 190 KTRs were evaluated before and ∼3 weeks after the third vaccine dose. The primary outcomes were anti-spike antibody level >4160 AU/ml (neutralization-associated cutoff) and any seropositivity. Univariate and multivariate analyses were conducted to identify variables associated with antibody response. T-cell response was evaluated in a subset of participants. Results were compared to a control group of 56 healthcare workers. Among KTRs, we found a seropositivity rate of 70% (133/190) after the third dose (37%, 70/190, after the second vaccine dose); and 27% (52/190) achieved levels above 4160 AU/ml after the third dose, compared to 93% of controls. Variables associated with antibody response included higher antibody levels after the second dose (odds ratio [OR] 30.8 per log AU/ml, 95% confidence interval [CI]11–86.4, p < 0.001); and discontinuation of antimetabolite prior to vaccination (OR 9.1,95% CI 1.8–46.5, p = 0.008). T-cell response was demonstrated in 13% (7/53). In conclusion, third dose BNT162b2 improved immune response among KTRs, however 30% still remained seronegative. Pre-vaccination temporary immunosuppression reduction improved antibody response. Graphical Abstract

BACKGROUND:Accumulating data indicate that sub-therapeutic levels of tacrolimus are associated with long-term kidney graft loss. However, elevated doses increase the risk of infection and drug toxicity, which also threaten graft and patient longevity. We sought to determine the minimal tacrolimus level required to maintain graft survival. METHODS:We conducted a single-center historical cohort study. The first-year post-transplant exposure time was calculated for each of the five tacrolimus trough level intervals. This measure was adjusted to the exposure time below a given interval level, allowing us to define the threshold for the optimal tacrolimus level as the upper limit of the interval. We then determined the association between the adjusted exposure time at each tacrolimus level interval and our primary outcome, death-censored graft loss. RESULTS:One thousand four hundred and seventeen patients with a median follow-up of 5.3 years were included in the final cohort. The tacrolimus level interval of 5-6 ng/ml was the highest interval, which demonstrated a statistically significant association between adjusted exposure time and increased risk of graft loss (HR 1.58, per log days, p = .002). Cumulative exposure time above 14 days with a tacrolimus level below 6 ng/ml was associated with an increased rate of graft loss in most studied subgroups, except for recipients with pre transplant diabetes. CONCLUSIONS:Maintaining tacrolimus levels above 6 ng/ml during the first-year post-transplant might improve kidney graft survival.

BackgroundEnd-stage kidney disease substantially increases the risk of severe COVID-19. However, despite early robust immunogenicity of the mRNA-SARS-CoV-2 vaccination in patients with hemodialysis, the longevity of humoral response in this high-risk population is still unknown.MethodsA prospective cohort study aimed to evaluate the longevity of serologic response in patients with hemodialysis, compared with a control group, 6 months following the second dose of the BNT162b2 vaccine. We assessed antibody response by quantitative measurement of IgG antibodies against the receptor-binding domain of the Spike protein (anti-S1-RBD IgG). Study outcomes were defined as a seropositivity rate and log-transformed anti-S1-RBD IgG levels at 6 months, and the change in antibody levels between 3 and 6 months.FindingsThe cohort included 104 patients with hemodialysis and 84 controls. At a median time of 184 days (IQR, 183–188) following the second dose of the vaccine, 83/104 (79.8%) patients with hemodialysis maintained seropositivity for the anti-S1-RBD IgG level compared to 83/84 (98.8%) in the control group (p < 0.001). The log-transformed antibody level was significantly lower in the hemodialysis group (2.23 ± 0.39 log AU/ml vs. 2.69 ± 0.65 log AU/ml, respectively, p < 0.001). Older age and hypoalbuminemia were the only variables that were found to be associated with reduced log-transformed antibody levels in univariate and multivariate analysis. There was no interaction between dialysis status and an antibody-level decline rate (p = 0.972).ConclusionAmong patients with hemodialysis, a seropositivity rate and anti-S1-RBD antibody titers were substantially reduced compared with a control group, at 6 months following the second dose of the BNT162b2 vaccine. These findings support the prioritization of patients with hemodialysis for a third “booster” dose.

Background Kidney function is a significant factor associated with increased incidence of hypoglycaemia, especially among patients with diabetes mellitus (DM). We here quantified the association between elevated creatinine and incident hypoglycaemia among patients admitted to internal medicine departments, with and without DM. Methods This is a retrospective cohort analysis study. Included were all patients discharged from internal medicine units between 2010 and 2013. Patients were excluded if creatinine levels rose or dropped more than 0.3 mg/dL during hospitalization. The CKD-EPI equation was used to calculate glomerular filtration rate (eGFR). Logistic regression analysis (backward LR method) was used to study the association between eGFR and hypoglycaemia incidence. Results Included were 39 316 patients (mean age 68.0 +/- 18.0 years, 49.3% males, 25.9% with DM, eGFR 69.5 +/- 24.9 mL/min/1.73 m(2)). Among study participants, 6.5% had at least one hypoglycaemic event. Logistic regression modelling showed that eGFR was inversely associated with incident hypoglycaemia (OR 0.988, 95% CI 0.986-0.990, p < .001). Results were similar for patients with and without DM. Estimated GFR was negatively correlated with admission CRP levels for patients with (r = -.143, p < .001) and without DM (r = -.166, p < .001). Estimated GFR was also positively correlated with admission serum albumin levels for both patients with (r = .304, p < .001) and without DM (r = .354, p < .001). Conclusion Among non-critically-ill patients hospitalized in internal medicine departments, reduced eGFR is associated with increased risk of hypoglycaemia. Glucose monitoring for all inpatients with CKD is suggested, regardless of DM status.