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Alhasan KA, Raina R, Boyer O, Koh J, Bonilla-Felix M, Sethi SK, Amer YS, Coccia P, Temsah MH, Exantus J, Khan SA, Zhong X, Koch V, Duzova A, Vasudevan A, McCulloch M, Allen U, Filler G, Montini G. IPNA clinical practice recommendations on care of pediatric patients with pre-existing kidney disease during seasonal outbreak of COVID-19. Pediatr Nephrol 2025; 40:1795-1815. [PMID: 39733391 PMCID: PMC11946955 DOI: 10.1007/s00467-024-06565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 09/13/2024] [Accepted: 09/13/2024] [Indexed: 12/31/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, instigated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has profoundly impacted healthcare infrastructures around the globe. While children are usually asymptomatic or have mild symptoms, children with pre-existing kidney conditions require specialized attention. This pivotal report, championed by the International Pediatric Nephrology Association (IPNA), delivers precise and actionable recommendations tailored for pediatric patients with kidney ailments in this pandemic landscape. Central to our findings are rigorous infection control protocols. These are particularly stringent in high-risk zones, emphasizing telehealth's indispensable role, the significance of curtailing in-person consultations, and the imperative of following rigorous guidelines in regions with heightened COVID-19 prevalence. Additionally, the report delves into vaccination approaches for children with kidney issues, highlighting that the choice of vaccine is often governed by regional accessibility and policy frameworks, rather than a universal preference. A notable observation is the potential correlation between COVID-19 vaccines and specific kidney disorders. However, establishing a direct causal link remains elusive. In summary, our research accentuates the critical need for specialized pediatric kidney care during global health crises and reaffirms the continuous research imperative, especially regarding vaccination ramifications.
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Affiliation(s)
- Khalid A Alhasan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Kidney & Pancreas Health Center, Riyadh, Saudi Arabia.
| | - Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General and Akron Children Hospital, Akron, OH, USA
| | - Olivia Boyer
- Paris Cité University, Pediatric Nephrology, Reference Center for Idiopathic Nephrotic Syndrome in Children and Adults, Imagine Institute, Necker Children's Hospital, APHP, Paris, France
| | - Jean Koh
- Department of Paediatric Nephrology, Starship Children's Hospital, Auckland, New Zealand
| | - Melvin Bonilla-Felix
- Department of Pediatrics, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
| | - Sidharth K Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, 122001, Haryana, India
| | - Yasser S Amer
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Paula Coccia
- Division of Pediatric Nephrology, Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mohamad-Hani Temsah
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Judith Exantus
- Department of Pediatrics, Faculty of Medicine and Pharmacy, State University of Haïti, State University Hospital of Haïti, Port-Au-Prince, Haiti
| | - Samina A Khan
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Xuhui Zhong
- Department of Pediatric Nephrology, Peking University First Hospital, Beijing, China
| | - Vera Koch
- Children's Institute Hospital das Clinicas Univ Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ali Duzova
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Anil Vasudevan
- Department of Pediatric Nephrology, St. John's Medical College Hospital, St. John's Academy of Health Sciences, Bengaluru, India
| | - Mignon McCulloch
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Upton Allen
- Division of Infectious Diseases and the Transplant and Regenerative Medicine Center, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Guido Filler
- Department of Paediatrics, Children's Hospital, London Health Science Centre, Western University, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
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Kute VB, Rela M, Abraham G, Gulati S, Bhalla AK, Chauhan S, Mishra VV, Meshram HS. A Narrative Review COVID-19 in Solid-Organ Transplantation: Real-World Evidence From India. EXP CLIN TRANSPLANT 2022; 20:32-42. [PMID: 36018018 DOI: 10.6002/ect.donorsymp.2022.l21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Worldwide, India ranks number 2 and 3 for COVID-19 burden and absolute transplant numbers, respectively. Here, we summarized our single and multicenter Indian studies on solid-organ transplant during the COVID-19 pandemic. During the pandemic, solid-organ transplants declined 40% to 50%. The mortality rate in COVID-19-positive kidney transplant recipients (11.6%) was lower in India compared with the developed world during the first wave and lower compared with maintenance hemodialysis patients (13% to 38%) but significantly higher compared with the nonimmunosuppressed general population (1% to 3%) in India. We contributed to National Organ and Tissue Transplant Organization transplant-related guidelines to increase safety and access to solid-organ transplant. We reported the safety and feasibility of remdesivir (n = 57) and convalescent plasma therapy (n = 10) in kidney transplant recipients. We reported 100% patient and graft survival without any complications related to COVID-19 in a large cohort of kidney transplant recipients who recovered from COVID-19 (n = 372) and a large cohort of kidney transplant recipients of living donors (n = 31) who recovered from COVID-19 without any change in induction and maintenance immunosuppression. COVID-19 disease severity and mortality in the second episode (reoccurring infection) was higher (46%) compared with the first episode (11.6%). There was 4.4% incidence of COVID-19-associated mucormycosis in kidney transplant recipients with mortality of 46% in the second wave. We reported COVID-19 vaccine safety with suboptimal efficacy in kidney transplant recipients and dialysis patients compared with the general population. Our report suggested that transplant with carefully selected COVID-19-recovered donors and patients may be feasible and safe, at least over the short term. Continued research is needed on vaccine efficacy, booster doses, and long-term follow up sequelae.
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Affiliation(s)
- Vivek B Kute
- From the Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRCITS), Ahmedabad, India
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Nogueira GM, Oliveira MS, Moura AF, Cruz CMS, Moura-Neto JA. COVID-19 in dialysis units: A comprehensive review. World J Virol 2021; 10:264-274. [PMID: 34631476 PMCID: PMC8474976 DOI: 10.5501/wjv.v10.i5.264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/21/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been challenging for healthcare professionals worldwide. One of the populations affected by the pandemic are patients on renal replacement therapy, as kidney disease is an independent risk factor for severe COVID-19 and maintenance dialysis (a life-sustaining therapy) cannot be interrupted in the vast majority of cases. Over the past months, several authors and medical societies have published recommendations and guidelines on the management of this population. This article is a comprehensive review regarding the measures to prevent, contain and deal with a COVID-19 pandemic in the dialysis setting. We recapitulate the epidemiology and pathophysiology of COVID-19 in kidney dysfunction and present the main recommendations concerning the screening of healthcare personnel, dialysis patients and visitors as well as measures to improve the safety of the dialysis facilities’ environments. In addition to preventive measures, this article briefly describes actions directed towards management of an outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within a dialysis facility, the management of complications in dialysis patients with COVID-19 and overall data regarding the management of children with kidney disease.
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Affiliation(s)
- Gabriel Martins Nogueira
- Department of Medicine, Bahiana School of Medicine and Public Health, Salvador 40290-000, Brazil
| | - Moisés Santana Oliveira
- Department of Medicine, Bahiana School of Medicine and Public Health, Salvador 40290-000, Brazil
| | - Ana Flávia Moura
- Department of Internal Medicine, Bahiana School of Medicine and Public Health, Salvador 40290-000, Brazil
| | - Constança Margarida Sampaio Cruz
- Department of Internal Medicine, Bahiana School of Medicine and Public Health, Salvador 40290-000, Brazil
- Department of Internal Medicine, Hospital Santo Antônio, Salvador 40415-006, Brazil
| | - José A Moura-Neto
- Department of Internal Medicine, Bahiana School of Medicine and Public Health, Salvador 40290-000, Brazil
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Prasad N, Behera MR, Bhatt M, Agarwal SK, Gopalakrishnan N, Fernando E, Chaudhary AR, Sahay M, Singh S, Jain A, Tapiawala S, Kamble A, Khanna U, Bohra R, Gupta A, Anandh U, Jha V. Outcomes of symptomatic coronavirus disease 19 in maintenance hemodialysis patient in India. Semin Dial 2021; 34:360-367. [PMID: 34259363 PMCID: PMC8447077 DOI: 10.1111/sdi.13000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/23/2021] [Accepted: 06/15/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Maintenance hemodialysis (MHD) patients face disadvantages with higher risk of acquiring SARS-CoV-2 infection, atypical manifestations, and associated multiple comorbidities. We describe patients' outcomes with symptomatic COVID-19 on MHD in a large cohort of patients from India. METHODS Data were collected prospectively from hemodialysis units in 11 public and private hospitals between March 15, 2020, and July 31, 2020. The survival determinants were analyzed using stepwise backward elimination cox-regression analysis. RESULTS Of the 263 total patients (mean age 51.76 ± 13.63 years and males 173) on MHD with symptomatic COVID-19, 35 (13.3%) died. Those who died were older (p = 0.01), had higher frequency of diabetic kidney disease (p = 0.001), comorbidities (p = 0.04), and severe COVID-19 (p = 0.001). Mortality was higher among patients on twice-weekly MHD than thrice-weekly (p = 0.001) and dialysis through central venous catheter (CVC) as compared to arteriovenous fistula (p = 0.001). On multivariate analysis, CVC use (HR 2.53, 95% CI 1.26-5.07, p = 0.009), disease severity (HR = 3.54, 95% CI 1.52-8.26, p = 0.003), and noninvasive ventilatory support (HR 0.59, 95% CI 0.25-0.99, p = 0.049) had significant effect on mortality. CONCLUSION The adjusted mortality risk of COVID-19 in MHD patients is high in patients associated with severe COVID-19 and patients having CVC as vascular access.
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Affiliation(s)
- Narayan Prasad
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Mansi Bhatt
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | | | | | | | | | | | | | | | | | - Rubina Bohra
- Shri Aurobindo Medical College and Postgraduate Institute, Indore, India
| | | | | | - Vivekanand Jha
- George Institute India, University of New South Wales, Sydney, New South Wales, Australia
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Patel MR, Kushwaha RS, Behera M, Bhadauria DS, Yachha M, Kaul A, Prasad N. Aftermath of fortnightly universal testing for severe acute respiratory corona virus-2 infection in maintenance hemodialysis patients. Semin Dial 2021; 34:338-346. [PMID: 34169574 PMCID: PMC8447208 DOI: 10.1111/sdi.12997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Asymptomatic maintenance hemodialysis patients with acute respiratory corona virus-2 (SARS-COV-2) are missed with pre-dialysis screening without testing. The possible ideal strategy of testing each patient before each shift with reverse transcription polymerase chain reaction (RT-PCR) is not feasible. We aimed to study the effectiveness of fortnightly screening with RT-PCR for SARS-CoV-2 in curbing transmission. METHODS Between July 1, 2020 and September 30, 2020, all 273 patients receiving hemodialysis were subjected to fortnightly testing for SARS-Cov-2 in the unit to detect asymptomatic patients. The cost and effectiveness of universal testing in preventing transmission were analyzed using susceptible-infectious-removed (SIR) modeling assuming R0 of 2.2. RESULTS Of 273 MHD patients, 55 (20.1%) found infected with SARS-CoV-2 over 3 months. Six (10.9%) were symptomatic, and 49 (89.1%) asymptomatic at the time of testing. Six (10.9%) asymptomatic patients develop symptoms later, and 43 (78.2%) remained asymptomatic. A total of seven (6.1%) HCWs also tested positive for the virus. Fortnightly universal testing is cost-effective, and SIR modeling proved effective in preventing person-to-person transmission. CONCLUSIONS Repeated universal testing in maintenance hemodialysis patients detected 89% of asymptomatic SARS-CoV-2 patients over 3 months and appeared to be an effective strategy to prevent person-to-person transmission in the dialysis unit.
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Affiliation(s)
- Manas R Patel
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ravi S Kushwaha
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Manas Behera
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Dharmendra S Bhadauria
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Monika Yachha
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anupma Kaul
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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