Anti-epidemic Ability Improvement Project For People With Kidney Disease And Immunocompromised Population (Shanghai Station)

At present, with the strong support of the state and related policies, China's epidemic prevention and control work has achieved initial success, but we must also be alert to the long-term impact of the new crown on human beings, optimize and adjust prevention and control policies and measures according to the time and situation, and strengthen the protection of key groups. On February 22, 2023, the Project for Improving the Anti-epidemic Ability of Immunocompromised People with Kidney Diseases (Shanghai Station) was held. Several experts gathered online to give a wonderful speech on the improvement of the anti-epidemic ability of people with kidney disease, elderly patients, and other immunocompromised people under the new crown epidemic. Academic exchange.

Click to cistanche benefits and side effects for kidney disease

The meeting invited Professor Jiang Gengru from Xinhua Hospital Affiliated with Shanghai Jiaotong University School of Medicine, Professor Wang Niansong from Shanghai Sixth People's Hospital as the chairman of the meeting, Professor Chen Xiaonong from Ruijin Hospital Affiliated with Shanghai Jiaotong University School of Medicine, Professor Li Shanqun from Zhongshan Hospital Affiliated to Fudan University, Professor Gu Leyi from Renji Hospital served as the speaker, and Professor Lu Wei from Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Professor Sheng Xiaohua from Shanghai Sixth People's Hospital served as the panelists.

At the beginning of the meeting, Professor Jiang Gengru delivered a speech as the chairman of the meeting. Professor Jiang introduced that under the COVID-19 epidemic, patients with chronic kidney disease, especially dialysis patients, have severe disease and mortality rates far higher than the general population. How to improve the epidemic prevention capabilities of these immune-compromised populations, and Reduce the risk of severe illness and death is the focus of the current prevention and control of the new crown epidemic.

"Kidney" is the most important choice, careful protection under the new crown epidemic

Prof. Chen Xiaonong introduced a lot of ideas, focused on patients with kidney disease, and summarized and shared the protective measures and suggestions for patients with kidney disease under the new crown epidemic.

Professor Chen Xiaonong said that the prevalence of adult chronic kidney disease (CKD) in China is high, and the number of patients is huge. Kidney disease patients generally have low immunity. The new crown pandemic poses a great threat to the life and health of kidney disease patients. Studies have shown that people with CKD, acute kidney injury (AKI), and lupus nephritis (LN) combined with COVID-19 have an increased risk of severe disease, and the mortality rate is much higher than that of non-COVID-19 people. In addition, end-stage renal disease is one of the high-risk factors for COVID-19-related death. Dialysis patients need to travel frequently to and from the hospital, and the risk of exposure to SARS-CoV-2 is generally higher than that of the general population, resulting in a high risk of new crown infection in hospital dialysis patients. Home dialysis patients face a higher risk of dialysis death. It can be seen that patients with kidney disease are not only highly susceptible to the disease, but also have an increased risk of developing severe disease, critical disease, or death once they are infected with the new crown.

Considering the particularity of patients with kidney disease, government agencies and academic groups at home and abroad suggest that if the patient’s condition is stable and there are no vaccination contraindications, priority should be given to vaccination against COVID-19; for family members and nursing staff of CKD patients, especially dialysis centers Medical staff should actively vaccinate to form an immune barrier and reduce the risk of infection for patients.

However, the current vaccine has a very limited protective effect on Chinese kidney disease patients, and cannot meet the new crown protection needs of all kidney disease patients. On the one hand, dialysis patients are less willing to be vaccinated, and the vaccination rate is lower; on the other hand, patients with kidney disease receive immunosuppressive therapy, which will affect the efficacy of the vaccine, making the vaccine response rate of this group of people poor, and the effectiveness of the vaccine against mutants. will fall.

Professor Chen Xiaonong emphasized that long-acting neutralizing antibody preventive therapy is one of the additional preventive measures for patients with kidney disease. Tesagvirumab/Sigavirumab (TIXA/CILGA) is currently the only long-acting neutralizing antibody in the world that can be used for pre-exposure prophylaxis. Attachment of host cells. The PROVENT study confirmed that compared with placebo, tesagevirumab/sigavirumab (TIXA/CILGA) reduced the risk of symptomatic COVID-19 by 83% within 6 months, safety and tolerability good. In terms of pharmacokinetics, tesagravirumab/sigavirumab (TIXA/CILGA) is not metabolized by the kidneys, and renal impairment and dialysis will not affect its PK, which can provide vaccine-based safety for people with kidney disease, Strong protection.

Ending the new crown epidemic needs to focus on the protection of vulnerable groups

Subsequently, Professor Li Shanqun delivered a wonderful speech entitled "Ending the COVID-19 Epidemic Needs to Pay Attention to the Protection of Vulnerable Groups". At present, the global epidemic is at a high level, but as many as 2% of the immunocompromised population are still susceptible to the new coronavirus, and the need for strengthening the protection of the new crown is even more urgent for this group of people. In China, the overall prevalence of chronic diseases exceeds 30%, and the population over 60 years old exceeds 200 million. Therefore, protecting the vulnerable population and accelerating the construction of a herd immunity barrier are the keys to China's prevention and control of the new crown.

Vulnerable populations may not be able to produce sufficient immune responses due to advanced age, comorbid underlying diseases, and low immune function, and the dysregulation of immune responses in this population will lead to severe COVID-19. Data have shown that compared with people with normal immune function, people with low immune function, such as the elderly and patients with chronic diseases, have a higher risk of hospitalization, severe illness, and death after infection with COVID-19.

Not only that, but COVID-19 vaccines are significantly less protective for vulnerable populations. In China, the vaccination rate of the elderly, especially those over 80 years old, is low, and even if vaccinated, the mortality rate of the elderly is still higher than that of the young. In addition, after being vaccinated, people with chronic diseases still have a high risk of severe illness and death after infection with the new crown. It can be seen that for people with impaired immune function, even if they receive multiple doses of vaccines, they still cannot produce a good response, and protection other than vaccines is urgently needed.

Professor Li Shanqun pointed out that under the current high epidemic situation in the world, wearing a mask, maintaining social distancing, and full vaccination are still important protective measures to deal with the new crown. For vulnerable groups such as the elderly, comorbid chronic diseases, and low immune function, the new long-acting SARS-CoV-2 monoclonal antibody is a powerful supplement to the vaccine and can be used for the prevention of new crowns. In addition, tesagravirumab/sigavirumab (TIXA/CILGA) maintains the neutralizing activity of the currently prevailing omecriron variant strain, and foreign authoritative guidelines and institutions recommend that it can be used for the exposure of vulnerable populations. pre-prevention.

The threat and protection of the elderly with chronic diseases in the face of COVID-19

Professor Gu Leyi, proceeding from China's national conditions, delivered a wonderful speech titled "The Threat and Protection of the Elderly with Combining Chronic Diseases Facing COVID-19". The long-term impact of the new crown.

The elderly are a high-risk group for new coronary pneumonia. China has a large population of elderly people, and they often have chronic diseases such as cardiovascular disease, diabetes, chronic respiratory disease, chronic liver disease, chronic kidney disease, and Alzheimer's disease. On the one hand, the existence of underlying diseases greatly increases the risk of severe illness and death of the elderly after infection with the new crown and the disease burden of patients after infection increases. On the other hand, once the elderly are infected with the new crown, COVID-19 will worsen the patient's original underlying diseases, such as aggravating cardiovascular damage, accelerating the progression of diabetes and liver disease, inducing acute exacerbations in patients with chronic obstructive pulmonary disease, accelerating the progression of kidney disease and causing Increased risk of kidney failure.

In the long run, advanced age is one of the high-risk factors for the long-term impact of the new crown on symptoms. After infection, the elderly are prone to more serious long-term effects of the new crown. Specific symptoms include fatigue, dyspnea, sleep disturbance, loss of smell, loss of taste, and cognitive impairment. Data have shown that the risk of cognitive decline in the elderly increases 6 months after infection with the new crown, and even 12 months after recovery from COVID-19, the elderly still have significant cognitive impairment. The long-term impact of these new crowns will eventually threaten the quality of life of the elderly, and even cause the elderly to be unable to take care of themselves or social alienation. Therefore, new crown protection measures for the elderly need to be strengthened urgently.

Professor Gu Leyi emphasized that long-acting neutralizing antibodies are a new strategy for the prevention of new crowns in the immunocompromised elderly population. In the case of the elderly and other vulnerable populations with a low ability to produce antibodies, exogenous antibody supplements can be provided efficiently and quickly. Complementary to build immune barriers. The subgroup analysis data of the PROVENT study showed that the relative risk of telaprevir/cigavirumab (TIXA/CILGA) was reduced by 87.8% (95% CI, 56.9-96.6) in the elderly population ≥60 years old, confirming that teenager Virimumab/sigavirumab (TIXA/CILGA) is effective in pre-exposure prophylaxis in the elderly population.

Talking about the management of dialysis patients during the epidemic situation

In the final discussion session of the meeting, Professor Lu Wei and Professor Sheng Xiaohua had a wonderful discussion on dialysis patients during the epidemic.

Professor Lu Wei first gave detailed suggestions on the management of dialysis patients in special periods: during the COVID-19 epidemic, implement Class B and B tubes, improve relevant systems, strengthen the management of hemodialysis rooms, and prevent infection while ensuring the quality of dialysis. After recovering from COVID-19, nutritional assessment and monitoring of patients, combined with multidisciplinary diagnosis and treatment if necessary, are important management measures. In the daily management of dialysis patients, focus on individualized management and special management to prevent complications. Strengthen patient education and psychological counseling, ensure balanced nutrition, maintain good living habits, and adequate rest.

Professor Sheng Xiaohua added that nutrition management, vascular access management, and complication management are all key tasks in the management of hemodialysis patients, which require the joint efforts of all dialysis center medical staff. Especially for elderly dialysis patients with underlying diseases, relevant indicators should be monitored and evaluated to ensure the quality of dialysis. The vaccination rate of dialysis patients is low, and the vaccine response rate is limited. Long-acting neutralizing antibodies are a new strategy and a new choice for this group of people to protect against new crowns. In addition, the daily management of patients is equally important, which is helpful for health education and monitoring of related indicators, timely detection of problems and helping patients to solve them, and timely adjustment and optimization of dialysis programs.

Summarize  

At the end of the meeting, Professor Wang Niansong and Professor Jiang Gengru summarized the main points of the meeting. The two experts emphasized that strengthening the ability of vulnerable groups to cope with the new crown epidemic is the focus of China's current epidemic prevention and control work. All medical staff should sum up experience and lessons, and cooperate with all sectors of society to make adequate preparations to better deal with the next new crown epidemic.

One yuan starts again, and Vand Vientiane is renewed. I believe that with the joint efforts of all medical staff, patients, and family members of patients, patients with kidney disease will be able to survive the epidemic smoothly.

for more information: Ali.ma@wecistanche.com