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Bota SE, McArthur E, Naylor KL, Blake PG, Yau K, Hladunewich MA, Levin A, Oliver MJ. Long-Term Morbidity and Mortality of Coronavirus Disease 2019 in Patients Receiving Maintenance Dialysis: A Multicenter Population-Based Cohort Study. KIDNEY360 2024; 5:1116-1125. [PMID: 39151048 PMCID: PMC11371337 DOI: 10.34067/kid.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 06/04/2024] [Indexed: 08/18/2024]
Abstract
Key Points The rates of long-term mortality, reinfection, cardiovascular outcomes, and hospitalization were high among coronavirus disease 2019 (COVID-19) survivors on maintenance dialysis. Several risk factors, including intensive care unit admission related to COVID-19 and reinfection, were found to have a prolonged effect on survival. This study shows that the burden of COVID-19 remains high after the period of acute infection in the population receiving maintenance dialysis. Background Many questions remain about the population receiving maintenance dialysis who survived coronavirus disease 2019 (COVID-19). Previous literature has focused on outcomes associated with the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it may underestimate the effect of disease. This study describes the long-term morbidity and mortality among patients receiving maintenance dialysis in Ontario, Canada, who survived SARS-CoV-2 infection and the risk factors associated with long-term mortality. Methods We conducted a population-based cohort study of patients receiving maintenance dialysis in Ontario, Canada, who tested positive for SARS-CoV-2 and survived 30 days between March 14, 2020, and December 1, 2021 (pre-Omicron), with follow-up until September 30, 2022. Our primary outcome was all-cause mortality while our secondary outcomes included reinfection, composite of cardiovascular (CV)–related death or hospitalization, all-cause hospitalization, and admission to long-term care or complex continuing care. We also examined risk factors associated with long-term mortality using multivariable Cox proportional hazards regression. Results We included 798 COVID-19 survivors receiving maintenance dialysis. After the first 30 days of infection, death occurred at a rate of 15.0 per 100 person-years (95% confidence interval [CI], 12.9 to 17.5) over a median follow-up of 1.4 years (interquartile range, 1.1–1.7) with a nadir of death at approximately 0.5 years. Reinfection, composite CV death or hospitalization, and all-cause hospitalization occurred at a rate (95% CI) of 15.9 (13.6 to 18.5), 17.4 (14.9 to 20.4), and 73.1 (66.6 to 80.2) per 100 person-years, respectively. In addition to traditional predictors of mortality, intensive care unit admission for COVID-19 had a prolonged effect on survival (adjusted hazard ratio, 2.6; 95% CI, 1.6 to 4.3). Reinfection with SARS-CoV-2 among 30-day survivors increased all-cause mortality (adjusted hazard ratio, 2.2; 95% CI, 1.4 to 3.3). Conclusions The burden of COVID-19 persists beyond the period of acute infection in the population receiving maintenance dialysis in Ontario with high rates of death, reinfection, all-cause hospitalization, and CV disease among COVID-19 survivors.
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Affiliation(s)
- Sarah E. Bota
- ICES, Toronto, Ontario, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Eric McArthur
- ICES, Toronto, Ontario, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Kyla L. Naylor
- ICES, Toronto, Ontario, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Peter G. Blake
- Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
- Ontario Health, Toronto, Ontario, Canada
- Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada
| | - Kevin Yau
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michelle A. Hladunewich
- Ontario Health, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Provincial Renal Agency, Vancouver, British Columbia, Canada
| | - Matthew J. Oliver
- Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Marques Vidas M, Muñez Rubio E, Quiroga B, Montejano R, Morales E, Candel FJ. Strategies for prevention and treatment of SARS-COV-2 infection in patients with chronic kidney disease: Literature review. Nefrologia 2024; 44:150-158. [PMID: 38575481 DOI: 10.1016/j.nefroe.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/06/2023] [Indexed: 04/06/2024] Open
Abstract
COVID-19 has proven to be particularly aggressive in patients with chronic kidney disease (CKD). The lower immune response rate and the greater susceptibility to progress to severe forms of the disease have contributed to this phenomenon, which has persisted in the post-vaccination era of the pandemic. Paradoxically, CKD has been excluded from most clinical trials of the main therapeutic tools developed against SARS-CoV-2. However, experience in the use of these drugs has been accumulating in different stages of CKD, supporting their use with guarantees of efficacy and safety. The objective of this review is to gather all treatment indications for COVID-19 in the different phases of the disease, tailored to CKD in its various stages, including renal replacement therapy.
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Affiliation(s)
- María Marques Vidas
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Elena Muñez Rubio
- Unidad de Enfermedades Infecciosas, Servicio Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Borja Quiroga
- ISS-La Princesa, Servicio de Nefrología, Hospital Universitario de la Princesa, Madrid, Spain
| | - Rocío Montejano
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, CIBER-INFEC, Madrid, Spain
| | - Enrique Morales
- Servicio de Nefrología, Hospital Universitario 12 de Octubre; Instituto de Investigación i+12 del Hospital Universitario 12 de Octubre; Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Javier Candel
- Enfermedades Infecciosas y Microbiología Clínica, Coordinación de Trasplantes, Banco de Tejidos, IdISSC, Hospital Universitario Clínico San Carlos, Departamento de Medicina, Universidad Complutense, Madrid, Spain
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Ghazanfar A, Abbas M, Hussain MW, Kayal M. Risk stratification of renal transplant recipients using routine parameters: Implication of learning from SARS-CoV-2 into transplant follow-up program. World J Transplant 2023; 13:344-356. [PMID: 38174144 PMCID: PMC10758680 DOI: 10.5500/wjt.v13.i6.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/21/2023] [Accepted: 11/13/2023] [Indexed: 12/15/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is a global pandemic that is associated with a high risk of morbidity and mortality among recipients of solid organ transplantation. In the course of acute SARS-CoV-2 infection, various laboratory markers have been identified as predictors for high risk of mortality. AIM To risk stratify renal transplant recipients (RTxR) using general demographic parameters, comorbidities and routine laboratory markers for the severity of the disease and its outcomes. We believe that learning about these routinely moni tored parameters can help us plan better strategies for the RTxR follow-up program. METHODS This present study includes RTxR who acquired SARS-CoV-2 infection from March 2020 to February 2021. We recorded the basic demographics, comorbidities and routine laboratory markers. We investigated the impact of SARS-CoV-2 infection on RTxRs and risk-stratified the progression of disease severity and outcomes in terms of recovery or mortality. RESULTS From 505 RTxRs in our renal transplant follow-up program, 29 (7.75%) RTxRs had PCR-positive SARS-CoV-2 infection. We recorded 8 deaths from SARS-CoV-2 infection giving an overall mortality rate of 1.6% but a significant 27.6% mortality in SARS-CoV-2 positive recipients. Age more than 68 years, non-Caucasian ethnicity and male gender were associated with a significant drop in survival probability; P ≤ 0.001. < 0.001 and < 0.0001 respectively. 87.5% of the deceased were diabetic; P ≤ 0.0.0001. Estimated glomerular filtration rate of less than 26 mL/min/1.73 m2, serum albumin less than 20 g/L, Hemoglobin less than 9.6 g/L and serum calcium less than 1.70 mmol/L were all associated with significantly increased risk of mortality; P = 0.0128, < 0.001, < 0.0001 and 0.0061 respectively. CONCLUSION This study has identified some routinely used modifiable parameters in predicting a higher risk of mortality and morbidity. This knowledge can be used in RTxR follow-up programs by addressing these parameters early to help reduce the morbidity and mortality in RTxRs.
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Affiliation(s)
- Abbas Ghazanfar
- Renal and Transplant Unit, St Georges University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Madiha Abbas
- Department of Anesthesia and Intensive Care Medicine, Epsom and St Helier University Hospitals NHS Trust, London KT8 7EG, United Kingdom
| | - Md Walid Hussain
- Department of Renal and Transplant Surgery, St Georges University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Malik Kayal
- Department of Renal and Transplant Surgery, St Georges University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
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Ezzat H, Teama NM, Bichari WA. Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients and the Risk of Hypercoagulability: Should we Consider Routine Screening? Indian J Nephrol 2023; 33:101-107. [PMID: 37234431 PMCID: PMC10208532 DOI: 10.4103/ijn.ijn_142_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/14/2021] [Indexed: 05/28/2023] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) has become a pandemic in late 2019. Its clinical presentation varies from asymptomatic infection to severe respiratory failure. Infection control strategies to minimize the risk of transmission of COVID-19 in end-stage renal disease (ESRD) patients receiving in-center hemodialysis (HD) have been implemented. Development of humoral response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adult patients with ESRD receiving HD has not been sufficiently reported. Methods A total of 179 asymptomatic HD patients undergoing regular HD were screened for COVID-19 infection. Infection with SARS-CoV-2 was confirmed through a real-time reverse transcription polymerase chain reaction assay of nasopharyngeal swab specimens. They were classified into positive and negative groups according to the results of PCR. Results Of the 179 asymptomatic patients, we found that 23 patients (12.8%) were positive for COVID-19. Their mean age was 45.61 ± 13.38 years. There was a significant difference between both groups regarding C-reactive protein, lymphocytes, and platelet counts (P < 0.001). Also, TAT (thrombin-antithrombin complex) and D-dimer levels were significantly increased among the positive group (11.47 ± 1.51 vs. 7.53 ± 1.64 mcq/L, P < 0.001; 1171.52 ± 267.6 vs. 542.76 ± 107.06 ng/mL, P < 0.001, respectively). Conclusion Asymptomatic SARS-CoV-2 infection is detected in HD patients. They carry the risk of hypercoagulability complications. We need more strict infection control measures and proactive diagnosis to limit the spread of the infection and lethal thromboembolic complications.
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Affiliation(s)
- Haitham Ezzat
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nahla Mohamed Teama
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Walid Ahmed Bichari
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Martin de Francisco Á, Fernández Fresnedo G. Long COVID-19 renal disease: A present medical need for nephrology. Nefrologia 2023; 43:1-5. [PMID: 37031074 PMCID: PMC10060193 DOI: 10.1016/j.nefroe.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 03/31/2023] Open
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Tamura H. Pediatric kidney transplantation during the COVID-19 pandemic. World J Clin Cases 2022; 10:12494-12499. [PMID: 36579110 PMCID: PMC9791532 DOI: 10.12998/wjcc.v10.i34.12494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/31/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
A waiting list for non-emergency transplant medical care was recommended in the first half of 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Hence, the number of kidney transplants temporarily declined. However, the waiting list for transplant medical care was lifted in the latter half of 2020 with the establishment of a polymerase chain reaction test system and the spread of infection prevention. The basic stance is to recommend vaccination to post-transplant recipients, recipients, and donors who are scheduled to undergo transplantation, and their families, with the start of vaccine therapy in 2021. The mortality rate of patients undergoing kidney transplants who had COVID-19 is slightly higher than healthy persons, and acute kidney injury was reported to lead to graft loss. However, pediatric cases of severe disease are rare and without deaths. Kidney transplantation medical care will be continuously provided by implementing infection prevention and treatments based on the latest evidence, promoting donated kidney transplantation, and hoping that pediatric patients with renal failure will grow up healthy, both physically and mentally, and become independent members of society, just like healthy children.
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Affiliation(s)
- Hiroshi Tamura
- Department of Pediatrics, Kumamoto University, Kumamoto 860-8556, Japan
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Carriazo S, Aparicio-Madre MI, Tornero-Molina F, Fernández-Lucas M, Paraiso-Cuevas V, González-Parra E, del Río-Gallegos F, Marques-Vidas M, Alcázar-Arroyo R, Martins-Muñoz J, Sánchez-Villanueva R, Gil-Casares B, Gutiérrez-Martínez E, Martínez-Rubio MP, Ortiz A. Impact of different COVID-19 waves on kidney replacement therapy epidemiology and mortality: REMER 2020. Nephrol Dial Transplant 2022; 37:2253-2263. [PMID: 35927791 PMCID: PMC9384646 DOI: 10.1093/ndt/gfac234] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Kidney replacement therapy (KRT) confers the highest risk of death from coronavirus disease 2019 (COVID-19). However, most data refer to the early pandemic waves. Whole-year analysis compared with prior secular trends are scarce. METHODS We present the 2020 REMER Madrid KRT registry, corresponding to the Spanish Region hardest hit by COVID-19. RESULTS In 2020, KRT incidence decreased 12% versus 2019, while KRT prevalence decreased by 1.75% for the first time since records began and the number of kidney transplants (KTs) decreased by 16%. Mortality on KRT was 10.2% (34% higher than the mean for 2008-2019). The 2019-2020 increase in mortality was larger for KTs (+68%) than for haemodialysis (+24%) or peritoneal dialysis (+38%). The most common cause of death was infection [n = 419 (48% of deaths)], followed by cardiovascular [n = 200 (23%)]. Deaths from infection increased by 167% year over year and accounted for 95% of excess deaths in 2020 over 2019. COVID-19 was the most common cause of death (68% of infection deaths, 33% of total deaths). The bulk of COVID-19 deaths [209/285 (73%)] occurred during the first COVID-19 wave, which roughly accounted for the increased mortality in 2020. Being a KT recipient was an independent risk factor for COVID-19 death. CONCLUSIONS COVID-19 negatively impacted the incidence and prevalence of KRT, but the increase in KRT deaths was localized to the first wave of the pandemic. The increased annual mortality argues against COVID-19 accelerating the death of patients with short life expectancy and the temporal pattern of COVID-19 mortality suggests that appropriate healthcare may improve outcomes.
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Affiliation(s)
- Sol Carriazo
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040; Madrid, Spain
| | - Manuel I Aparicio-Madre
- RЄMЭЯ. Oficina Regional de Coordinación de Trasplantes de la Comunidad de Madrid, Madrid, Spain
| | | | | | | | - Emilio González-Parra
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040; Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | | | - María Marques-Vidas
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Hospital Puerta de Hierro; Madrid, Spain
| | | | | | | | | | | | | | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040; Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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Cuevas‐Budhart MÁ, Celaya Pineda IX, Perez Moran D, Trejo Villeda MA, Gomez del Pulgar M, Rodríguez Zamora MC, Ramos‐Sanchez A, Paniagua Sierra J. Patient experience in automated peritoneal dialysis with telemedicine monitoring during the COVID-19 pandemic in Mexico: Qualitative study. Nurs Open 2022; 10:1092-1101. [PMID: 36229915 PMCID: PMC9834531 DOI: 10.1002/nop2.1377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/09/2022] [Accepted: 09/04/2022] [Indexed: 01/13/2023] Open
Abstract
AIM The aim of the study was to understand the experiences of patients on automated peritoneal dialysis (APD) during the period of confinement due to the COVID-19 pandemic. DESIGN Qualitative exploratory study, phenomenological through semi-structured telephone interview. METHOD A priori sampling was carried out with patients on APD with remote monitoring and telephone follow-up, in 13 hospitals in Mexico. RESULTS Twenty-nine informants, mean age 45.41 ± 16.93; 15 women and 14 men. The analysis revealed four categories of analysis: home isolation, clinical follow-up, socioeconomic challenges and infodemic. The experiences of these patients led them to somatize emotions, presenting symptoms such as anxiety, sadness, loneliness, sleep, eating and digestive disorders, situation that sets the tone for future research on telemedicine care models, coping styles, emotional support strategies and socioeconomic impact on patients with chronic home treatments during the pandemic.
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Affiliation(s)
- Miguel Ángel Cuevas‐Budhart
- Unidad de investigación Médica en Enfermedades Nefrológicas, CMN Siglo XXIInstituto Mexicano del Seguro SocialMexico CityMexico
| | | | - Diana Perez Moran
- Unidad de Investigación de Epidemiologia en Servicios de SaludCMN Siglo XXI. Instituto Mexicano del Seguro SocialMexico CityMexico
| | | | | | | | - Alfonso Ramos‐Sanchez
- CEO. Innovación y tecnología al servicio de la saludMacrotechSanto DomingoDominican Republic
| | - Jose Ramón Paniagua Sierra
- Unidad de investigación Médica en Enfermedades Nefrológicas, CMN Siglo XXIInstituto Mexicano del Seguro SocialMexico CityMexico
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Vaccination and COVID-19 in Polish Dialysis Patients: Results from the European Clinical Dialysis Database. Vaccines (Basel) 2022; 10:vaccines10091565. [PMID: 36146642 PMCID: PMC9505069 DOI: 10.3390/vaccines10091565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Patients with end-stage kidney disease undergoing hemodialysis are particularly vulnerable to severe COVID-19 as a result of older age and multimorbidities. Objectives: Data are still limited and there are no published data on mortality in hemodialyzed patients in Poland, in particular when vaccines became available. We assessed the epidemiologic and clinical data of patients with laboratory-confirmed COVID-19 and assessed the mortality in 2019, 2020, and 2021, as well as the vaccination rate in 2021. Patients and Methods: Retrospectively collected data from 73 Fresenius Nephrocare Poland hemodialysis centers and one public unit were analyzed. Results: In 2021, the vaccination rate was 96%. The unadjusted mortality (number of deaths divided by number of patients) in 2019 was 18.8%, while the unadjusted (after exclusion of COVID-related deaths) mortality in 2020 was 20.8%, and mortality in 2021 was 16.22%. The prevalence of cardiovascular deaths in 2019 and 2020 was almost identical (41.4% vs. 41.2%, respectively), and in 2021, the figures increased slightly to 44.1%. The prevalence of sudden cardiac deaths in 2019 was higher than in 2020 (19.6% vs. 17.3%, respectively) and consequently decreased in 2021 (10.0%), as well as strokes (6.2% vs. 5.4%, and 3.31% in 2021), whereas deaths due to gastrointestinal tract diseases were lower (2.5% vs. 3.2%, and 2.25% in 2021), diabetes complications (0.5% vs. 1.3%, and 0.5% in 2021), sepsis (5.1% vs. 6.3%, and 8.79% in 2021), respiratory failure (1.2 vs. 1.6%, and 2.83% in 2021), and pneumonia (1.4% vs. 2.0%, and 0.82%). There were 1493 hemodialyzed COVID-19 positive patients, and among them, 191 died in 2020 (12.79%). In 2021, there were 1224 COVID-19 positive patients and 260 died (21.24%). The mortality of COVID-19 positive dialyzed patients contributed 13.39% in 2020 and 16.21% in 2021 of all recorded deaths. Conclusions: The mortality among HD patients was higher in 2021 than in 2020 and 2019, despite the very high vaccination rate of up to 96%. The higher non-COVID-19 mortality may be due to the limited possibility of hospitalization and dedicated care during the pandemic. This information is extremely important in order to develop methods to protect this highly vulnerable patient group. Prevention plays a key role; other measures are essential in the mitigation and spread of COVID-19 in HD centers.
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Firket L, Bouquegneau A, Seidel L, Bonvoisin C, Grosch S, Hayette MP, Jouret F, Weekers L. The prospective screening for SARS-CoV-2 S1/S2 antibodies delineates the factual incidence of COVID-19 and shows a sustained serological response post COVID-19 in kidney transplant recipients. Acta Clin Belg 2022; 78:200-205. [PMID: 35938938 DOI: 10.1080/17843286.2022.2108978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND The impact of immunosuppression on the occurrence of Coronavirus Disease 2019 (COVID-19) remains unclear. METHODS We conducted a prospective screening of anti-S1/S2 IgGs against SARS-CoV-2 Spike protein from March, 1 2020 to May, 15 2021 (prior to the vaccination campaign) in a cohort of 713 kidney transplant recipients (KTRs). In a first phase, the factual incidence and seroprevalence of COVID-19 was established in this cohort: cases diagnosed by serology were added to RT-PCR-based diagnoses to obtain the overall incidence of COVID-19 in both symptomatic and asymptomatic KTRs. In the second phase, the kinetics of the post-COVID-19 humoral response were studied, taking into account the severity of the disease defined by the need for oxygen therapy (group S, "severe") or not (group nS, "not severe"). RESULTS The combined diagnostic approaches identified 138 COVID-19 cases (19.2%), with 37 diagnoses by serology (26.8%). The rate of asymptomatic KTRs reached 20.3% (28/138). Thirteen patients (9.4%) died from COVID-19. The seroconversion rate was 91.7% (99/108). The peak anti-S1/S2 IgG level was 85 [30-150] AU/ml and was similar between the S and nS groups (117 [38; 186] AU/ml versus 73 [23; 140] AU/ml). A high probability of persistence of anti-S1/S2 IgG post-COVID-19 was observed, with only 10.1% (7/69) of the patients having negated their serology during the 9-month follow-up. CONCLUSION Our pragmatic serological screening combined with RT-PCR tests provides a better estimation of the real incidence of COVID-19 in KTRs. A significant proportion of KTRs develop humoral immunity post COVID-19, which most often persists beyond 9 months.
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Affiliation(s)
- Louis Firket
- Division of Nephrology, University of Liege Hospital (ULiege CHU), Liege, Belgium
| | - Antoine Bouquegneau
- Division of Nephrology, University of Liege Hospital (ULiege CHU), Liege, Belgium
| | - Laurence Seidel
- Division of Biostatistics, University of Liege Hospital (ULiege CHU), Liege, Belgium
| | - Catherine Bonvoisin
- Division of Nephrology, University of Liege Hospital (ULiege CHU), Liege, Belgium
| | - Stéphanie Grosch
- Division of Nephrology, University of Liege Hospital (ULiege CHU), Liege, Belgium
| | - Marie-Pierre Hayette
- Division of Microbiology, University of Liege Hospital (ULiege CHU), Liege, Belgium
| | - François Jouret
- Division of Nephrology, University of Liege Hospital (ULiege CHU), Liege, Belgium.,Laboratory of Translational Research in Nephrology, University of Liege GIGA Research Center, ULiege, Belgium
| | - Laurent Weekers
- Division of Nephrology, University of Liege Hospital (ULiege CHU), Liege, Belgium
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Lim YJ, Khan U, Karpha I, Ross A, Saif M, Remberger M, Kalakonda N, Pettitt AR, Floisand Y. COVID‐19 outcomes in haematopoietic cell transplant recipients: A systematic review and meta‐analysis. EJHAEM 2022; 3:862-872. [PMID: 35941880 PMCID: PMC9350043 DOI: 10.1002/jha2.465] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
Up‐to‐date information on coronavirus disease 2019 (COVID‐19) outcomes and risk factors in haematopoietic cell transplantation (HCT) recipients is required to inform on decisions about cancer treatment and COVID‐19 mitigation strategies. We performed a meta‐analysis to address this knowledge gap. All studies with at least five patients who reported COVID‐19‐related deaths in HCT recipients were included. The primary outcome was COVID‐19‐related death. Secondary outcomes were COVID‐19‐related mechanical ventilation (MV) and intensive care unit (ITU) admission. The cumulative COVID‐19‐related death rate among HCT recipients was 21% (95% confidence interval [CI] 18%–24%), while MV and ITU admission rates were 14% (95% CI 11%–17%) and 18% (95% CI 14%–22%), respectively. Subgroup analysis showed higher death rates in patients who developed COVID‐19 within 12 months of HCT (risk ratio [RR] 1.82, 95% CI 1.09–3.03), within 6 months of receiving immunosuppressant drugs (RR 2.11, 95% CI 1.38–3.20) or in the context of active graft‐versus‐host disease (RR 2.38, 95% CI 1.10–5.16). Our findings support the idea that HCT should remain an integral part of cancer treatment during the COVID‐19 pandemic but also highlight the need to prioritise preventative measures in those patients who are at increased risk of adverse COVID‐19 outcomes.
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Affiliation(s)
- Yeong Jer Lim
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Umair Khan
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Indrani Karpha
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Andrew Ross
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
| | - Muhammad Saif
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
| | - Mats Remberger
- Department of Medical Sciences Uppsala University and KFUE Uppsala University Hospital Uppsala Sweden
| | - Nagesh Kalakonda
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Andrew R. Pettitt
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Yngvar Floisand
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Centre for Cancer Cell Reprogramming, Institute of Clinical Medicine University of Oslo Oslo Norway
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12
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Kuramitsu K, Yamanaga S, Osawa R, Hibi T, Yoshikawa M, Toyoda M, Shimata K, Yosuke E, Ono M, Kenmochi T, Sogawa H, Natori Y, Yano H, Chen-Yoshikawa T, Yoshida K, Fukumoto T, Yuzawa K, Egawa H. Impact of COVID-19 on the Living Donor Liver and Kidney Transplantation Programs in Japan in 2020. Transpl Infect Dis 2022; 24:e13845. [PMID: 35505462 PMCID: PMC9348111 DOI: 10.1111/tid.13845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/13/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
Background Although many transplant programs have been forced to suspend living donor transplants due to the emergence of coronavirus disease (COVID‐19), there are relatively few real‐time databases to assess center‐level transplant activities. We aimed to delineate the actual impact of COVID‐19 on living donor transplant programs and the resumption process in Japan. Methods In a nationwide survey, questionnaires were sent to 32 liver transplant programs that had performed at least more than one case of living donor liver transplantation in 2019 and 132 kidney transplant programs that had performed more than one living donor kidney transplantation in 2018. Results Thirty‐one (96.9%) and 125 (94.7%) liver and kidney transplant programs responded, respectively. In the early pandemic period, 67.7% (21/31) of liver programs and 29.8% (37/125) of kidney programs were able to maintain transplant activities similar to those during the pre‐pandemic period. After temporal suspension, 58.1% of kidney programs resumed their transplant activity after the number of local COVID‐19 cases peaked. Establishing institutional COVID‐19 screening, triage, and therapeutic management protocols was mandatory to resume transplant activity for 64.5% and 67.7% of liver and kidney programs, respectively. In the future wave of COVID‐19, 67.7% of liver programs would be affected by institutional COVID‐19 intensive care unit‐bound patient numbers, and 55.7% of kidney programs would stop if hospital‐acquired severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection spreads. Conclusions: This nationwide survey revealed for the first time how living donor liver and kidney transplant programs changed in response to the COVID‐19 pandemic in a country where living donor transplantations are predominant.
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Affiliation(s)
- Kaori Kuramitsu
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan
| | - Shigeyoshi Yamanaga
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Ryosuke Osawa
- Department of Infectious Disease, Kameda Medical Center, Chiba, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Hospital, Kumamoto, Japan
| | - Mikiko Yoshikawa
- Department of Transplant and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mariko Toyoda
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Hospital, Kumamoto, Japan
| | - Ebisu Yosuke
- Department of Infectious Disease, Kameda Medical Center, Chiba, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Tokyo University, Tokyo, Japan
| | - Takashi Kenmochi
- Department of Transplantation, Fujita Health University, Aichi, Japan
| | - Hiroshi Sogawa
- Department of Surgery, Westchester Medical Center/New York Medical College, NY, USA
| | - Yoichiro Natori
- Division of Infectious Disease, Department of Medicine, University of Miami, FL, USA
| | - Harumi Yano
- Department of Public Health, International University of Health and Welfare, Chiba, Japan
| | | | - Kazunari Yoshida
- Department of Organ Transplant Medicine, Kitasato University, Kanagawa, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan
| | - Kenji Yuzawa
- Department of Transplant Surgery, Mito Medical Center, Ibaraki, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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13
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López-Oliva MO, Pérez-Flores I, Molina M, José Aladrén M, Trujillo H, Redondo-Pachón D, López V, Facundo C, Villanego F, Rodríguez M, Carmen Ruiz M, Antón P, Rivas-Oural A, Cabello S, Portolés J, de la Vara L, Tabernero G, Valero R, Galeano C, Moral E, Ventura A, Coca A, Muñoz MÁ, Hernández-Gallego R, Shabaka A, Ledesma G, Martínez P, Ángeles Rodríguez M, Tamajón LP, Cruzado L, Emilio Sánchez J, Jiménez C. [Management of immunosuppressive therapy in kidney transplant recipients with COVID19. A multicentre national study derived form the S.E.N. COVID registry.]. Nefrologia 2022; 43:S0211-6995(22)00076-5. [PMID: 35528867 PMCID: PMC9055748 DOI: 10.1016/j.nefro.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/27/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION SARS CoV2 infection has had a major impact on renal transplant patients with a high mortality in the first months of the pandemic. Intentional reduction of immunosuppressive therapy has been postulated as one of the cornerstone in the management of the infection in the absence of targeted antiviral treatment. This has been modified according to the patient`s clinical situation and its effect on renal function or anti-HLA antibodies in the medium term has not been evaluated. OBJECTIVES Evaluate the management of immunosuppressive therapy made during SARS-CoV2 infection, as well as renal function and anti-HLA antibodies in kidney transplant patients 6 months after COVID19 diagnosis. MATERIAL AND METHODS Retrospective, national multicentre, retrospective study (30 centres) of kidney transplant recipients with COVID19 from 01/02/20 to 31/12/20. Clinical variables were collected from medical records and included in an anonymised database. SPSS statistical software was used for data analysis. RESULTS 615 renal transplant recipients with COVID19 were included (62.6% male), with a mean age of 57.5 years.The predominant immunosuppressive treatment prior to COVID19 was triple therapy with prednisone, tacrolimus and mycophenolic acid (54.6%) followed by m-TOR inhibitor regimens (18.6%). After diagnosis of infection, mycophenolic acid was discontinued in 73.8% of patients, m-TOR inhibitor in 41.4%, tacrolimus in 10.5% and cyclosporin A in 10%. In turn, 26.9% received dexamethasone and 50.9% were started on or had their baseline prednisone dose increased.Mean creatinine before diagnosis of COVID19, at diagnosis and at 6 months was: 1.7±0.8, 2.1±1.2 and 1.8±1 mg/dl respectively (p<0.001).56.9% of the patients (N=350) were monitored for anti-HLA antibodies. 94% (N=329) had no anti-HLA changes, while 6% (N=21) had positive anti-HLA antibodies. Among the patients with donor-specific antibodies post-COVID19 (N=9), 7 patients (3.1%) had one immunosuppressant discontinued (5 patients had mycophenolic acid and 2 had tacrolimus), 1 patient had both immunosuppressants discontinued (3.4%) and 1 patient had no change in immunosuppression (1.1%), these differences were not significant. CONCLUSIONS The management of immunosuppressive therapy after diagnosis of COVID19 was primarily based on discontinuation of mycophenolic acid with very discrete reductions or discontinuations of calcineurin inhibitors. This immunosuppression management did not influence renal function or changes in anti-HLA antibodies 6 months after diagnosis.
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Affiliation(s)
| | | | - María Molina
- Servicio de Nefrología, Hospital U. Germans Trias y Pujol, Barcelona, Spain
| | - Mª José Aladrén
- Servicio de Nefrología, Hospital U. Miguel Servet, Zaragoza, Spain
| | | | | | - Verónica López
- Servicio de Nefrología, Hospital U. Carlos Haya, Málaga, Spain
| | - Carme Facundo
- Servicio de Nefrología, Hospital U. Fundación Puigvert, Barcelona, Spain
| | | | - Marisa Rodríguez
- Servicio de Nefrología, Hospital U. Gregorio Marañón, Madrid, Spain
| | - Mª Carmen Ruiz
- Servicio de Nefrología, Hospital U. Virgen de las Nieves, Granada, Spain
| | - Paula Antón
- Servicio de Nefrología, Hospital U. Bellvitge, Barcelona, Spain
| | | | - Sheila Cabello
- Servicio de Nefrología, Hospital U. Son Espases, Palma de Mallorca, Spain
| | - José Portolés
- Servicio de Nefrología, Hospital U. Puerta de Hierro, Madrid, Spain
| | | | | | - Rosalía Valero
- Servicio de Nefrología, Hospital U. Marqués de Valdecilla, Santander, Spain
| | - Cristina Galeano
- Servicio de Nefrología, Hospital U. Ramón y Cajal, Madrid, Spain
| | | | - Ana Ventura
- Servicio de Nefrología, Hospital U. La Fe, Valencia, Spain
| | - Armando Coca
- Servicio de Nefrología, Hospital Clínico U. Valladolid, Spain
| | | | | | - Amir Shabaka
- Servicio de Nefrología, Hospital Fundación Alcorcón, Madrid, Spain
| | - Gabriel Ledesma
- Servicio de Nefrología, Hospital U. Infanta Sofía, Madrid, Spain
| | - Patricia Martínez
- Servicio de Nefrología, Hospital U. Príncipe de Asturias, Madrid, Spain
| | | | | | | | - J Emilio Sánchez
- Servicio de Nefrología, Hospital de Cabueñes, Asturias, Coordinador Registro COVID S.E.N, Spain
| | - Carlos Jiménez
- Servicio de Nefrología, Hospital U. La Paz, Madrid, Spain
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14
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Gonzalez-Perez M, Montes-Casado M, Conde P, Cervera I, Baranda J, Berges-Buxeda MJ, Perez-Olmeda M, Sanchez-Tarjuelo R, Utrero-Rico A, Lozano-Ojalvo D, Torre D, Schwarz M, Guccione E, Camara C, Llópez-Carratalá MR, Gonzalez-Parra E, Portoles P, Ortiz A, Portoles J, Ochando J. Development of Potent Cellular and Humoral Immune Responses in Long-Term Hemodialysis Patients After 1273-mRNA SARS-CoV-2 Vaccination. Front Immunol 2022; 13:845882. [PMID: 35401504 PMCID: PMC8983822 DOI: 10.3389/fimmu.2022.845882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/24/2022] [Indexed: 12/02/2022] Open
Abstract
Long-term hemodialysis (HD) patients are considered vulnerable and at high-risk of developing severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection due to their immunocompromised condition. Since COVID-19 associated mortality rates are higher in HD patients, vaccination is critical to protect them. The response towards vaccination against COVID-19 in HD patients is still uncertain and, in particular the cellular immune response is not fully understood. We monitored the humoral and cellular immune responses by analysis of the serological responses and Spike-specific cellular immunity in COVID-19-recovered and naïve HD patients in a longitudinal study shortly after vaccination to determine the protective effects of 1273-mRNA vaccination against SARS-CoV-2 in these high-risk patients. In naïve HD patients, the cellular immune response measured by IL-2 and IFN-ɣ secretion needed a second vaccine dose to significantly increase, with a similar pattern for the humoral response. In contrast, COVID-19 recovered HD patients developed a potent and rapid cellular and humoral immune response after the first vaccine dose. Interestingly, when comparing COVID-19 recovered healthy volunteers (HV), previously vaccinated with BNT162b2 vaccine to HD patients vaccinated with 1273-mRNA, these exhibited a more robust immune response that is maintained longitudinally. Our results indicate that HD patients develop strong cellular and humoral immune responses to 1273-mRNA vaccination and argue in favor of personalized immune monitoring studies in HD patients, especially if COVID-19 pre-exposed, to adapt COVID-19 vaccination protocols for this immunocompromised population.
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Affiliation(s)
| | - Maria Montes-Casado
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Patricia Conde
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Cervera
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Jana Baranda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Mayte Perez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Rodrigo Sanchez-Tarjuelo
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alberto Utrero-Rico
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Daniel Lozano-Ojalvo
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Denis Torre
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Megan Schwarz
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ernesto Guccione
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Carmen Camara
- Department of Immunology, Hospital La Paz, Madrid, Spain
| | | | - Emilio Gonzalez-Parra
- Department of Nephrology, Instituto de Investigación Sanitaria (IIS)-Fundación Jimenez Díaz, Madrid, Spain
| | - Pilar Portoles
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Presidencia, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Alberto Ortiz
- Department of Nephrology, Instituto de Investigación Sanitaria (IIS)-Fundación Jimenez Díaz, Madrid, Spain
| | - Jose Portoles
- Department of Nephrology, Hospital Puerta de Hierro, Madrid, Spain
| | - Jordi Ochando
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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15
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Faraldo-Cabana A, Peix-Jiménez B, Fernández-Díaz R, Sanz-María J, Fernández-Cruz AM, Ortuño-Soriano I. Incidencia de infección por SARS-CoV-2 en pacientes con un trasplante renal funcionante de un hospital terciario de la Comunidad de Madrid. ENFERMERÍA NEFROLÓGICA 2022. [DOI: 10.37551/s2254-28842022006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
En diciembre de 2019, apareció un nuevo coronavirus que ha dado lugar a una pandemia. Dadas las características del paciente trasplantado, se hace necesario conocer cuál ha sido la repercusión respecto a la infección por SARS-CoV-2, planteándonos como objetivo describir la incidencia de SARS-CoV-2 en pacientes con un trasplante renal.Se llevó a cabo un estudio observacional de cohorte retrospectiva de pacientes con un trasplante renal y que están en seguimiento por la consulta de trasplantes de un hospital terciario, durante el periodo comprendido entre el 1 de marzo de 2020 y el 1 de marzo de 2021. Se incluyeron 604 individuos, con una edad media de 61,6±12,8 años. Un 62,3% (n=376) fueron hombres.La incidencia por SARS-CoV-2 fue 14,9% (n=90). La mortalidad por SARS-CoV-2 fue 3,8% (n=23) lo que supone una letalidad del 25,5%. Al comparar si han pasado la infección en función del sexo no se encontraron diferencias significativas. Tampoco al comparar en función de la edad media, que fue de 60,9±11,8 años en los infectados y de 61,7±12,9 años en los no infectados. Se encontraron diferencias significativas (p=0,005) al comparar la media de años transcurridos desde el trasplante; que fue de 8,7±5,6 años en los infectados y de 11±7,3 años en los no infectados.La incidencia de infección por SARS-CoV-2 encontrada en personas con TR fue muy superior a la descrita para la población general. La letalidad y la mortalidad también fueron mayores que en la población general, pero acordes con otras poblaciones de individuos con TR.
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16
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SARS-CoV-2 Infection in Patients on Dialysis: Incidence and Outcomes in the Lazio Region, Italy. J Clin Med 2021; 10:jcm10245818. [PMID: 34945114 PMCID: PMC8708577 DOI: 10.3390/jcm10245818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/25/2021] [Accepted: 12/09/2021] [Indexed: 01/08/2023] Open
Abstract
Patients with end-stage kidney disease represent a frail population and might be at higher risk of SARS-CoV-2 infection. The Lazio Regional Dialysis and Transplant Registry collected information on dialysis patients with a positive swab. The study investigated incidence of SARS-CoV-2 infection, mortality and their potential associated factors in patients undergoing maintenance hemodialysis (MHD) in the Lazio region. Method: The occurrence of infection was assessed among MHD patients included in the RRDTL from 1 March to 30 November 2020. The adjusted cumulative incidence of infection and mortality risk within 30 days of infection onset were estimated. Logistic and Cox regression models were applied to identify factors associated with infection and mortality, respectively. Results: The MHD cohort counted 4942 patients; 256 (5.2%) had COVID-19. The adjusted cumulative incidence was 5.1%. Factors associated with infection included: being born abroad, educational level, cystic renal disease/familial nephropathy, vascular disease and being treated in a dialysis center located in Local Health Authority (LHA) Rome 2. Among infected patients, 59 (23.0%) died within 30 days; the adjusted mortality risk was 21.0%. Factors associated with 30-day mortality included: age, malnutrition and fever at the time of swab. Conclusions: Factors associated with infection seem to reflect socioeconomic conditions. Factors associated with mortality, in addition to age, are related to clinical characteristics and symptoms at the time of swab.
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17
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Sagnelli C, Sica A, Gallo M, Peluso G, Varlese F, D'Alessandro V, Ciccozzi M, Crocetto F, Garofalo C, Fiorelli A, Iannuzzo G, Reginelli A, Schonauer F, Santangelo M, Sagnelli E, Creta M, Calogero A. Renal involvement in COVID-19: focus on kidney transplant sector. Infection 2021; 49:1265-1275. [PMID: 34611792 PMCID: PMC8491762 DOI: 10.1007/s15010-021-01706-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/22/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Kidney transplant recipients and patients on the waiting list for kidney transplant who acquire SARS-CoV-2 infection are at serious risk of developing severe COVID-19, with an increased risk of mortality for the their immunosuppressive state; other risk factors for mortality have been identified in some comorbidities such as obesity, diabetes, asthma and chronic lung disease. MATERIALS AND METHODS The COVID-19 pandemic has led to a sharp reduction in kidney transplants in most countries, mainly due to the concern of patients on the waiting list for their potential increased susceptibility to acquire SARS-CoV-2 infection in healthcare facilities and for the difficulties of transplant centers to ensure full activity as hospitals have had to focus most of their attention on COVID-19 patients. Indeed, while the infection curve continued its exponential rise, there was a vertical decline in kidney donation/transplant activity. CONCLUSION This review article focuses on the damage induced by SARS-CoV-2 infection on kidney and on the adverse effect of this pandemic on the entire kidney transplant sector.
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Affiliation(s)
- Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie n. 1, 80138, Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Monica Gallo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131, Naples, Italy
| | - Gaia Peluso
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini, 5, 80131, Naples, Italy
| | - Filippo Varlese
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini, 5, 80131, Naples, Italy
| | - Vincenzo D'Alessandro
- UOSD Centro Trapianti di rene e Chirurgia del Retroperitoneo, AOU-University of Naples Federico II, 80131, Naples, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 80128, Rome, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131, Naples, Italy
| | - Carlo Garofalo
- Division of Nephrology, University of Campania "Luigi Vanvitelli", 80137, Naples, Italy
| | - Alfonso Fiorelli
- Department of Thoracic Surgery, University of Campania "Luigi Vanvitelli", 80137, Naples, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University Naples, Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Fabrizo Schonauer
- Division of Plastic, Reconstructive and Aesthetic Surgery, University of Naples Federico II, 80131, Naples, Italy
| | - Michele Santangelo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini, 5, 80131, Naples, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie n. 1, 80138, Naples, Italy.
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131, Naples, Italy
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini, 5, 80131, Naples, Italy
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18
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Goffin E, Candellier A, Vart P, Noordzij M, Arnol M, Covic A, Lentini P, Malik S, Reichert LJ, Sever MS, Watschinger B, Jager KJ, Gansevoort RT. COVID-19-related mortality in kidney transplant and haemodialysis patients: a comparative, prospective registry-based study. Nephrol Dial Transplant 2021; 36:2094-2105. [PMID: 34132811 PMCID: PMC8394823 DOI: 10.1093/ndt/gfab200] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has exposed haemodialysis (HD) patients and kidney transplant (KT) recipients to an unprecedented life-threatening infectious disease, raising concerns about kidney replacement therapy (KRT) strategy during the pandemic. This study investigated the association of the type of KRT with COVID-19 severity, adjusting for differences in individual characteristics. METHODS Data on KT recipients and HD patients diagnosed with COVID-19 between 1 February 2020 and 1 December 2020 were retrieved from the European Renal Association COVID-19 Database. Cox regression models adjusted for age, sex, frailty and comorbidities were used to estimate hazard ratios (HRs) for 28-day mortality risk in all patients and in the subsets that were tested because of symptoms. RESULTS A total of 1670 patients (496 functional KT and 1174 HD) were included; 16.9% of KT and 23.9% of HD patients died within 28 days of presentation. The unadjusted 28-day mortality risk was 33% lower in KT recipients compared with HD patients {HR 0.67 [95% confidence interval (CI) 0.52-0.85]}. In a fully adjusted model, the risk was 78% higher in KT recipients [HR 1.78 (95% CI 1.22-2.61)] compared with HD patients. This association was similar in patients tested because of symptoms [fully adjusted model HR 2.00 (95% CI 1.31-3.06)]. This risk was dramatically increased during the first post-transplant year. Results were similar for other endpoints (e.g. hospitalization, intensive care unit admission and mortality >28 days) and across subgroups. CONCLUSIONS KT recipients had a greater risk of a more severe course of COVID-19 compared with HD patients, therefore they require specific infection mitigation strategies.
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Affiliation(s)
- Eric Goffin
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Alexandre Candellier
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
- Department of Nephrology, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Priya Vart
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marlies Noordzij
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, ‘C.I. PARHON’ University Hospital, ‘Grigore T. Popa’ University of Medicine, Iasi, Romania
| | - Paolo Lentini
- Nephrology and Dialysis Unit, San Bassiano Hospital, Vicenza, Italy
| | - Shafi Malik
- Department of Renal and Transplant, University Hospital of Coventry and Warwickshire and University of Leicester, Coventry, UK
| | - Louis J Reichert
- Department of Nephrology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Mehmet S Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Bruno Watschinger
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Kitty J Jager
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ron T Gansevoort
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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19
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Billa V, Kothari J, Bichu S, Kumar R, Usulumarty D, Tilve P, Hariharan S. From Infection to Immunity - Impact of COVID-19 Across Nine Hemodialysis Centres in Mumbai. Indian J Nephrol 2021; 31:544-549. [PMID: 35068761 PMCID: PMC8722561 DOI: 10.4103/ijn.ijn_361_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/29/2020] [Accepted: 10/18/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There are several studies of symptomatic hemodialysis patients with proven COVID-19 infection. However, there is paucity of data on asymptomatic COVID-19 infection in the outpatient hemodialysis population. The true prevalence and transmission of this infection in hemodialysis centres is unknown. This study was conducted across hemodialysis centers by testing all patients and staff for COVID-19 PCR and later for IgG antibody, irrespective of their symptoms. METHODS All 705 hemodialysis patients and 103 dialysis staff across nine centres, were tested for COVID-19 over a period of 54 days of the pandemic, and for COVID IgG antibody of available enrolled staff and patients, after 8 weeks of study termination. RESULTS The period prevalence of infection in patients and staff was 7.1% and 14.6% respectively. Mortality in patients was 18%, and all staff recovered. Clustering of patients and staff occurred at 3 of 9 centers. Of 26 HIV positive patients, only one contracted the COVID-19 infection and has recovered. Of those infected, seroconversion occurred in 80% of patients and 83% of staff. Seroconversion also occurred in 16% of patients and 37% of staff, who were asymptomatic and COVID PCR negative during the study period. CONCLUSIONS Testing a patient only when symptomatic, identified only 26% (13/50) of infected patients. For every single symptomatic patient who tested positive, there were 3 other asymptomatic infected ones. There was a high seroconversion rates in infected subjects. But antibodies also developed in asymptomatic subjects, indicating silent transmission and antibody generation in this population.
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Affiliation(s)
- Viswanath Billa
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- Sushrut Hospital and Research Centre, Mumbai, Maharashtra, India
- Bombay Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Jatin Kothari
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- PD Hinduja Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Shrirang Bichu
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- Bombay Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Rajesh Kumar
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- LH Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Deepa Usulumarty
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- Sushrut Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Parag Tilve
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- Bombay Hospital and Research Centre, Mumbai, Maharashtra, India
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20
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Slon Roblero MF, Gómez Larrambe N, Labat Yanguas H, Hernández Barcos A, Fierro González S, Espadas Sucunza M. "Stay at home". Home dialysis, an added benefit in times of pandemic. Nefrologia 2021; 41:699-700. [PMID: 36165159 PMCID: PMC8771255 DOI: 10.1016/j.nefroe.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/17/2021] [Indexed: 06/16/2023] Open
Affiliation(s)
- Maria Fernanda Slon Roblero
- Complejo Hospitalario de Navarra, Servicio de Nefrología, Unidad de Diálisis Domiciliaria, Pamplona, Navarra, Spain; Instituto Navarro para la Investigación de la Salud (IDISNA), Área de las Enfermedades Cardiovasculares y Renales, Pamplona, Navarra, Spain.
| | - Nerea Gómez Larrambe
- Complejo Hospitalario de Navarra, Servicio de Nefrología, Unidad de Diálisis Domiciliaria, Pamplona, Navarra, Spain; Instituto Navarro para la Investigación de la Salud (IDISNA), Área de las Enfermedades Cardiovasculares y Renales, Pamplona, Navarra, Spain
| | - Helena Labat Yanguas
- Complejo Hospitalario de Navarra, Servicio de Nefrología, Unidad de Diálisis Domiciliaria, Pamplona, Navarra, Spain
| | - Asunción Hernández Barcos
- Complejo Hospitalario de Navarra, Servicio de Nefrología, Unidad de Diálisis Domiciliaria, Pamplona, Navarra, Spain
| | - Susana Fierro González
- Complejo Hospitalario de Navarra, Servicio de Nefrología, Unidad de Diálisis Domiciliaria, Pamplona, Navarra, Spain
| | - Maria Espadas Sucunza
- Complejo Hospitalario de Navarra, Servicio de Nefrología, Unidad de Diálisis Domiciliaria, Pamplona, Navarra, Spain
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21
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Ito T, Kenmochi T, Ota A, Kuramitsu K, Soyama A, Kinoshita O, Eguchi S, Yuzawa K, Egawa H. National survey on deceased donor organ transplantation during the COVID-19 pandemic in Japan. Surg Today 2021; 52:763-773. [PMID: 34686930 PMCID: PMC8536472 DOI: 10.1007/s00595-021-02388-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/11/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE We investigated the status of deceased organ donation and transplantation through a questionnaire distributed to transplant centers in Japan during the COVID-19 pandemic. METHODS The questionnaire was distributed electronically to 206 transplant centers for heart (n = 11), lung (n = 10), liver (n = 25), kidney (n = 130), pancreas (n = 18), and small intestine (n = 12) transplantation. Organ donations and organ transplantation data were extracted from the Japan Organ Transplant Network website. RESULTS We received questionnaire responses from 177 centers (response rate, 86%). In 2020, the number of brain-dead donors (BDDs) decreased to 68 (69% of the year-on-year average) and the number of donors after cardiac death (DCDs) decreased to 9 (32% of the year-on-year average). Eighty-five (48%) transplant centers (heart, n = 0; lung, n = 0; liver, n = 4; kidney, n = 78; pancreas, n = 22; and small intestine, n = 0) suspended transplant surgeries in response to the COVID-19 pandemic. Consequently, the number of organ transplantations from deceased donors was significantly lower in 2020 than in 2019. CONCLUSION Although the COVID-19 pandemic has had less impact in Japan than in other countries, it has affected transplantation activity significantly, suspending transplantation surgeries in 48% of the transplantation centers, including 78% of the kidney transplantation centers, and reducing the number of organ donations to 61% of the year-on-year average.
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Affiliation(s)
- Taihei Ito
- Department of Transplantation and Regenerative Medicine, Fujita Health University, School of Medicine, Dengakugakubo 1-98, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan.
| | - Takashi Kenmochi
- Department of Transplantation and Regenerative Medicine, Fujita Health University, School of Medicine, Dengakugakubo 1-98, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kaori Kuramitsu
- Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Osamu Kinoshita
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Kenji Yuzawa
- Department of Transplantation Surgery, National Hospital Organization Mito Medical Center, Mito, Ibaraki, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
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22
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Shabaka A, Gruss E, Landaluce‐Triska E, Gallego‐Valcarce E, Cases‐Corona C, Ocaña J, Tato‐Ribera A, Lopez‐Revuelta K, Furaz‐Czerpak KR, Fernández‐Juárez G. Late thrombotic complications after SARS-CoV-2 infection in hemodialysis patients. Hemodial Int 2021; 25:507-514. [PMID: 34060217 PMCID: PMC8239758 DOI: 10.1111/hdi.12935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/23/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION There is an increased risk of thrombotic complications in patients with COVID-19. Hemodialysis patients are already at an increased risk for thromboembolic events such as stroke and pulmonary embolism. The aim of our study was to determine the incidence of late thrombotic complications (deep vein thrombosis, pulmonary embolism, stroke, new-onset vascular access thrombosis) in maintenance hemodialysis patients after recovery from COVID-19. METHODS We performed a retrospective cohort study of 200 prevalent hemodialysis patients in our center at the start of the pandemic. We excluded incident patients after the cohort entry date and those who required hemodialysis for acute kidney injury, and excluded patients with less than 1 month follow-up due to kidney transplantation or death from non-thrombotic causes. FINDINGS One-hundred and eighty five prevalent hemodialysis patients finally met the inclusion criteria; 37 patients (17.6%) had SARS-CoV-2 infection, out of which 10 (27%) died during the acute phase of disease without evidence of thrombotic events. There was an increased risk of thrombotic events in COVID-19 survivors compared to the non-infected cohort (18.5% vs. 1.9%, p = 0.002) after a median follow-up of 7 months. Multivariate regression analysis showed that COVID-19 infection increased risk for late thrombotic events adjusted for age, sex, hypertension, diabetes, antithrombotic treatment, and previous thrombotic events (Odds Ratio (OR) 26.4, 95% confidence interval 2.5-280.6, p = 0.01). Clinical and laboratory markers did not predict thrombotic events. CONCLUSIONS There is an increased risk of late thrombotic complications in hemodialysis patients after infection with COVID-19. Further studies should evaluate the benefit of prolonged prophylactic anticoagulation in hemodialysis patients after recovery from COVID-19.
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Affiliation(s)
- Amir Shabaka
- Nephrology DepartmentHospital Universitario Fundación AlcorcónMadridSpain
| | - Enrique Gruss
- Nephrology DepartmentHospital Universitario Fundación AlcorcónMadridSpain
| | | | | | - Clara Cases‐Corona
- Nephrology DepartmentHospital Universitario Fundación AlcorcónMadridSpain
| | - Javier Ocaña
- Nephrology DepartmentHospital Universitario Fundación AlcorcónMadridSpain
| | - Ana Tato‐Ribera
- Nephrology DepartmentHospital Universitario Fundación AlcorcónMadridSpain
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23
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Casaux-Huertas A, Ochando-García A, Limón-Cáceres E, Andreu-Périz D. “Del miedo a la resiliencia”. Estudio fenomenológico sobre el impacto de la pandemia por COVID-19 en cuidadoras de pacientes dependientes en hemodiálisis. ENFERMERÍA NEFROLÓGICA 2021. [DOI: 10.37551/s2254-28842021022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: profundizar en el conocimiento sobre las vivencias y el soporte percibido en cuidadoras primarias que atendieron a pacientes dependientes en tratamiento con hemodiálisis durante el periodo de pandemia por COVID-19 en la ciudad de Madrid. Material y Método: estudio transversal efectuado con diez cuidadoras primarias de pacientes en tratamiento de hemodiálisis que habían proporcionado cuidados durante el periodo de marzo 2020 a junio 2021. La recolección de los datos se realizó mediante entrevistas semiestructuradas a distancia hasta conseguir la saturación de las unidades de significado. Se realizó un análisis cualitativo fenomenológico mediante el método de siete pasos de Colaizzi. Resultados: del análisis de los discursos emergieron dimensiones asociadas a diferentes subcategorías: miedo inicial sobre la enfermedad, pérdida de libertad, riesgo percibido durante el transporte, soporte percibido por parte de los centros de diálisis, capacidad de resiliencia, miedo a la muerte e impacto de la vacunación. Conclusiones: en la etapa álgida del brote epidémico las vivencias de las cuidadoras estuvieron muy influidas por el desconocimiento de la enfermedad y el miedo al contagio. Adaptaron medidas de auto prevención para mantener a salvo a su familiar. Apreciaron la seguridad proporcionada por los profesionales de los centros. Les preocupaba los riesgos inherentes a los traslados y la falta de soporte de los servicios sociales. Son conscientes de su propia fragilidad y la de la persona cuidada y no perciben grandes cambios ni en su forma de vida ni en su esperanza de futuro, pese a la vacunación y otros adelantos científicos.
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Affiliation(s)
- Ana Casaux-Huertas
- Escuela de Enfermería Fundación Jiménez Díaz. Campus de Villalba. Madrid. España. Fundación Iñigo Alvarez de Toledo. Madrid. España
| | | | - Enric Limón-Cáceres
- Universitat de Barcelona. España. Programa VINCat (Control de las Infecciones nosocomiales en Cataluña)
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24
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Jayant K, Reccia I, Bachul PJ, Al-Salmay Y, Pyda JS, Podda M, Perez-Gutierrez A, Dor FJMF, Becker Y, di Sabato D, LaMattina J, Barth R, Fung J, Witkowski P. The Impact of COVID-19 on Kidney Transplant Recipients in Pre-Vaccination and Delta Strain Era: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:4533. [PMID: 34640552 PMCID: PMC8509345 DOI: 10.3390/jcm10194533] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 01/08/2023] Open
Abstract
Herein, we performed a meta-analysis of published clinical outcomes of corona virus disease 2019 (COVID-19) in hospitalized kidney transplant recipients. A systematic database search was conducted between December 1, 2019 and April 20, 2020. We analyzed 48 studies comprising 3137 kidney transplant recipients with COVID-19. Fever (77%), cough (65%), dyspnea (48%), and gastrointestinal symptoms (28%) were predominant on hospital admission. The most common comorbidities were hypertension (83%), diabetes mellitus (34%), and cardiac disease (23%). The pooled prevalence of acute respiratory distress syndrome and acute kidney injury were 58% and 48%, respectively. Invasive ventilation and dialysis were required in 24% and 22% patients, respectively. In-hospital mortality rate was as high as 21%, and increased to over 50% for patients in intensive care unit (ICU) or requiring invasive ventilation. Risk of mortality in patients with acute respiratory distress syndrome (ARDS), on mechanical ventilation, and ICU admission was increased: OR = 19.59, OR = 3.80, and OR = 13.39, respectively. Mortality risk in the elderly was OR = 3.90; however, no such association was observed in terms of time since transplantation and gender. Fever, cough, dyspnea, and gastrointestinal symptoms were common on admission for COVID-19 in kidney transplant patients. Mortality was as high as 20% and increased to over 50% in patients in ICU and required invasive ventilation.
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Affiliation(s)
- Kumar Jayant
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
| | - Isabella Reccia
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
| | - Piotr J. Bachul
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Yaser Al-Salmay
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Jordan S. Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA;
| | - Mauro Podda
- Department of Emergency Surgery, Azienda Ospedaliero-Universitaria Di Cagliari, University Hospital Policlinico Duilio Casula, 09124 Cagliari, Italy;
| | - Angelica Perez-Gutierrez
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Frank J. M. F. Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
| | - Yolanda Becker
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Diego di Sabato
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - John LaMattina
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Rolf Barth
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - John Fung
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Piotr Witkowski
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
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25
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Vardhan H, Kumar A, Shyama S, Chaudhary N, Pandey S, Rai DK, Kumar D, Kumar S. Clinical Profile and Outcome of Haemodialysis in Patients With COVID-19 - A Single Centre Experience. Cureus 2021; 13:e17170. [PMID: 34548976 PMCID: PMC8437208 DOI: 10.7759/cureus.17170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 disease is the third coronavirus to have emerged in the last 20 years. The COVID-19 infection causes more severe illness in patients with comorbid diseases, especially in patients with diabetes, hypertension and kidney failure. Methods This is a retrospective study using electronic records and laboratory data of adult patients hospitalised at All India Institute of Medical Sciences (AIIMS), Patna between May 1st, 2020 and March 31st, 2021, who were diagnosed with COVID-19 and needed haemodialysis. The demographic characteristics, co-morbidities, symptoms, clinical course, laboratory parameters, and treatments were recorded. The aim of this study is to evaluate the clinical profile and outcome of patients on hemodialysis with COVID-19 infection. Results The study included 261 COVID-19 patients who needed haemodialysis. The most common symptoms on admission were fever (72.8%), cough (64.3%) and dyspnoea (46.6%). The mean age was 58.4 +/-15 years. A total of 195 patients (74.7%) were male. The most common co-morbid condition was hypertension (85.1%) followed by diabetes (71.9%). A total of 118 (45.2) patients had acute on chronic kidney disease (CKD), 40 (15.3) were on maintenance haemodialysis (MHD) and 103 (39.5) were having acute kidney injury (AKI). Eight patients were renal transplant recipients. At presentation, 183 (70.1%) patients were having mild to moderately severe infection and 78 (29.9%) patients were having severe disease. A total of 213 patients required ICU admissions, 186 (75.3%) of whom required invasive ventilation. Overall mortality was 66% (172/261) and the rest were discharged. Conclusion The study suggests that COVID-19 disease has a significantly more severe course and poorer outcome in patients requiring haemodialysis.
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Affiliation(s)
- Harsh Vardhan
- Nephrology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Amit Kumar
- Nephrology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Shyama Shyama
- General Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Neha Chaudhary
- Community and Family Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Sanjay Pandey
- Physical Medicine & Rehabilitation, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Deependra K Rai
- Respiratory Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Deepak Kumar
- Physical Medicine & Rehabilitation, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Sanyal Kumar
- Physical Medicine & Rehabilitation, Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Patna, Patna, IND
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26
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Ajaimy M, Liriano-Ward L, Graham JA, Akalin E. Risks and Benefits of Kidney Transplantation during the COVID-19 Pandemic: Transplant or Not Transplant? KIDNEY360 2021; 2:1179-1187. [PMID: 35368354 PMCID: PMC8786107 DOI: 10.34067/kid.0002532021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/12/2021] [Indexed: 02/04/2023]
Abstract
COVID-19 has significantly affected the transplant community, by leading to decreased transplant activity and increased waiting list time. As expected, COVID-19 causes substantial mortality in both ESKD and kidney transplant populations. This is due to underlying CKD and a high prevalence of comorbid conditions, such as diabetes mellitus, hypertension, and cardiovascular disease in this group. Transplant programs have faced the difficult decision of weighing the risks and benefits of transplantation during the pandemic. On one hand, there is a risk of COVID-19 exposure leading to infection while patients are on maximum immunosuppression. Alternatively, there are risks of delaying transplantation, which will increase waitlist times and may lead to waitlist-associated morbidity and mortality. Cautious and thoughtful selection of both the recipient's and donor's post-transplant management has been required during the pandemic, to mitigate the risk of morbidity and mortality associated with COVID-19. In this review article, we aimed to discuss previous publications related to clinical outcomes of COVID-19 disease in kidney transplant recipients, patients with ESKD on dialysis, or on the transplant waiting list, and the precautions transplant centers should take in decision making for recipient and donor selection and immunosuppressive management during the pandemic. Nevertheless, transplantation in this milieu does seem to be the correct decision, with careful patient and donor selection and safeguard protocols for infection prevention. Each center should conduct risk assessment on the basis of the patient's age and medical comorbidities, waitlist time, degree of sensitization, cold ischemia time, status of vaccination, and severity of pandemic in their region.
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Affiliation(s)
- Maria Ajaimy
- Division of Nephrology, Montefiore Einstein Center for Transplantation, Bronx, New York
| | - Luz Liriano-Ward
- Division of Nephrology, Montefiore Einstein Center for Transplantation, Bronx, New York
| | - Jay A. Graham
- Division of Nephrology, Montefiore Einstein Center for Transplantation, Bronx, New York
| | - Enver Akalin
- Division of Nephrology, Montefiore Einstein Center for Transplantation, Bronx, New York
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27
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Arenas Jimenez MD, González-Parra E, Riera M, Rincón Bello A, López-Herradón A, Cao H, Hurtado S, Collado S, Ribera L, Barbosa F, Dapena F, Torregrosa V, Broseta JJ, Soto Montañez C, Navarro-González JF, Ramos R, Bover J, Nogués-Solan X, Crespo M, Dusso AS, Pascual J. Mortality in Hemodialysis Patients with COVID-19, the Effect of Paricalcitol or Calcimimetics. Nutrients 2021; 13:2559. [PMID: 34444716 PMCID: PMC8401800 DOI: 10.3390/nu13082559] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In COVID-19 patients, low serum vitamin D (VD) levels have been associated with severe acute respiratory failure and poor prognosis. In regular hemodialysis (HD) patients, there is VD deficiency and markedly reduced calcitriol levels, which may predispose them to worse outcomes of COVID-19 infection. Some hemodialysis patients receive treatment with drugs for secondary hyperparathyroidism, which have well known pleiotropic effects beyond mineral metabolism. The aim of this study was to evaluate the impact of VD status and the administration of active vitamin D medications, used to treat secondary hyperparathyroidism, on survival in a cohort of COVID-19 positive HD patients. METHODS A cross-sectional retrospective observational study was conducted from 12 March to 21 May 2020 in 288 HD patients with positive PCR for SARS-CoV2. Patients were from 52 different centers in Spain. RESULTS The percent of HD patients with COVID-19 was 6.1% (288 out of 4743). Mortality rate was 28.4% (81/285). Three patients were lost to follow-up. Serum 25(OH)D (calcidiol) level was 17.1 [10.6-27.5] ng/mL and was not significantly associated to mortality (OR 0.99 (0.97-1.01), p = 0.4). Patients receiving active vitamin D medications (16/94 (17%) vs. 65/191(34%), p = 0.003), including calcimimetics (4/49 (8.2%) vs. 77/236 (32.6%), p = 0.001), paricalcitol or calcimimetics (19/117 (16.2%) vs. 62/168 (36.9%); p < 0.001), and also those on both paricalcitol and calcimimetics, to treat secondary hyperparathyroidism (SHPTH) (1/26 (3.8%) vs. 80/259 (30.9%), p < 0.001) showed a lower mortality rate than patients receiving no treatment with either drug. Multivariate Cox regression analysis confirmed this increased survival. CONCLUSIONS Our findings suggest that the use of paricalcitol, calcimimetics or the combination of both, seem to be associated with the improvement of survival in HD patients with COVID-19. No correlation was found between serum VD levels and prognosis or outcomes in HD patients with COVID-19. Prospective studies and clinical trials are needed to support these findings.
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Affiliation(s)
- María Dolores Arenas Jimenez
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
- Fundación Renal Iñigo Alvarez de Toledo, 28003 Madrid, Spain
| | | | - Marta Riera
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
| | - Abraham Rincón Bello
- Fresenius Medical Care, Dirección Médica FMC, 28760 Madrid, Spain; (A.R.B.); (A.L.-H.); (S.H.); (L.R.); (R.R.)
| | - Ana López-Herradón
- Fresenius Medical Care, Dirección Médica FMC, 28760 Madrid, Spain; (A.R.B.); (A.L.-H.); (S.H.); (L.R.); (R.R.)
| | - Higini Cao
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
| | - Sara Hurtado
- Fresenius Medical Care, Dirección Médica FMC, 28760 Madrid, Spain; (A.R.B.); (A.L.-H.); (S.H.); (L.R.); (R.R.)
| | - Silvia Collado
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
| | - Laura Ribera
- Fresenius Medical Care, Dirección Médica FMC, 28760 Madrid, Spain; (A.R.B.); (A.L.-H.); (S.H.); (L.R.); (R.R.)
| | - Francesc Barbosa
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
| | - Fabiola Dapena
- Department of Nephrology, Consorci Sanitari Alt Penedes Garraf, 08800 Barcelona, Spain; (F.D.); (J.-J.B.)
| | - Vicent Torregrosa
- Department of Nephrology and Kidney Transplantation, Hospital Clinic, 08036 Barcelona, Spain; (V.T.); (C.S.M.)
| | - José-Jesús Broseta
- Department of Nephrology, Consorci Sanitari Alt Penedes Garraf, 08800 Barcelona, Spain; (F.D.); (J.-J.B.)
| | - Carlos Soto Montañez
- Department of Nephrology and Kidney Transplantation, Hospital Clinic, 08036 Barcelona, Spain; (V.T.); (C.S.M.)
| | - Juan F. Navarro-González
- Research Division and Department of Nephrology, Hospital Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain;
- Instituto de Tecnologías Biomédicas, Universidad de La Laguna, 38010 Tenerife, Spain
- Red de Investigación Renal (REDINREN–RD16/0009/0022), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Rosa Ramos
- Fresenius Medical Care, Dirección Médica FMC, 28760 Madrid, Spain; (A.R.B.); (A.L.-H.); (S.H.); (L.R.); (R.R.)
| | - Jordi Bover
- Department of Nephrology, Hospital Can Ruti, 08916 Barcelona, Spain;
| | - Xavier Nogués-Solan
- Department of Internal Medicine, Hospital del Mar, Institut Mar for Medical Research, CIBERFES, 08003 Barcelona, Spain;
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
| | - Adriana S. Dusso
- Bone and Mineral Research Unit, Instituto de Investigaciones Sanitarias del Principado de Asturias, 33011 Oviedo, Spain;
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
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Vergara A, Molina-Van den Bosch M, Toapanta N, Villegas A, Sánchez-Cámara L, de Sequera P, Manrique J, Shabaka A, Aragoncillo I, Ruiz MC, Benito S, Sánchez E, Soler MJ. The Impact of Age on Mortality in Chronic Haemodialysis Popu-Lation with COVID-19. J Clin Med 2021; 10:3022. [PMID: 34300188 PMCID: PMC8304096 DOI: 10.3390/jcm10143022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023] Open
Abstract
Age and chronic kidney disease have been described as mortality risk factors for coronavirus disease 2019 (COVID-19). Currently, an important percentage of patients in haemodialysis are elderly. Herein, we investigated the impact of age on mortality among haemodialysis patients with COVID-19. Data was obtained from the Spanish COVID-19 chronic kidney disease (CKD) Working Group Registry. From 18 March 2020 to 27 August 2020, 930 patients on haemodialysis affected by COVID-19 were included in the Registry. A total of 254 patients were under 65 years old and 676 were 65 years or older (elderly group). Mortality was 25.1% higher (95% CI: 22.2-28.0%) in the elderly as compared to the non-elderly group. Death from COVID-19 was increased 6.2-fold in haemodialysis patients as compared to the mortality in the general population in a similar time frame. In the multivariate Cox regression analysis, age (hazard ratio (HR) 1.59, 95% CI: 1.31-1.93), dyspnea at presentation (HR 1.51, 95% CI: 1.11-2.04), pneumonia (HR 1.74, 95% CI: 1.10-2.73) and admission to hospital (HR 4.00, 95% CI: 1.83-8.70) were identified as independent mortality risk factors in the elderly haemodialysis population. Treatment with glucocorticoids reduced the risk of death (HR 0.68, 95% CI: 0.48-0.96). In conclusion, mortality is dramatically increased in elderly haemodialysis patients with COVID-19. Our results suggest that this high risk population should be prioritized in terms of protection and vaccination.
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Affiliation(s)
- Ander Vergara
- Nephrology Department, Vall d’Hebrón University Hospital, 08035 Barcelona, Spain; (A.V.); (N.T.)
- Nephrology Research Group, Vall d’Hebrón Research Institute, REDinREN, 08035 Barcelona, Spain;
| | | | - Néstor Toapanta
- Nephrology Department, Vall d’Hebrón University Hospital, 08035 Barcelona, Spain; (A.V.); (N.T.)
- Nephrology Research Group, Vall d’Hebrón Research Institute, REDinREN, 08035 Barcelona, Spain;
| | - Andrés Villegas
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain;
| | - Luis Sánchez-Cámara
- Nephrology Department, Fundación para la Investigación Biomédica Gregorio Marañón, 28007 Madrid, Spain; (L.S.-C.); (I.A.)
| | - Patricia de Sequera
- Nephrology Department, Infanta Leonor University Hospital, 28031 Madrid, Spain;
| | - Joaquín Manrique
- Nephrology Department, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
- Nephrology Department, Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
| | - Amir Shabaka
- Nephrology Department, Fundación Alcorcón University Hospital, 28922 Madrid, Spain;
| | - Inés Aragoncillo
- Nephrology Department, Fundación para la Investigación Biomédica Gregorio Marañón, 28007 Madrid, Spain; (L.S.-C.); (I.A.)
| | - María Carmen Ruiz
- Nephrology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | - Silvia Benito
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, 08025 Barcelona, Spain;
| | - Emilio Sánchez
- Nephrology Department, Cabueñes University Hospital, 33394 Gijón, Spain;
| | - María José Soler
- Nephrology Department, Vall d’Hebrón University Hospital, 08035 Barcelona, Spain; (A.V.); (N.T.)
- Nephrology Research Group, Vall d’Hebrón Research Institute, REDinREN, 08035 Barcelona, Spain;
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Soler MJ, Noordzij M, Abramowicz D, de Arriba G, Basile C, van Buren M, Covic A, Crespo M, Duivenvoorden R, Massy ZA, Ortiz A, Sanchez JE, Petridou E, Stevens K, White C, Vart P, Gansevoort RT. Renin-Angiotensin System Blockers and the Risk of COVID-19-Related Mortality in Patients with Kidney Failure. Clin J Am Soc Nephrol 2021; 16:1061-1072. [PMID: 34088718 PMCID: PMC8425613 DOI: 10.2215/cjn.18961220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/02/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES There is concern about potential deleterious effects of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19). Patients with kidney failure, who often use ACEis/ARBs, are at higher risk of more severe COVID-19. However, there are no data available on the association of ACEi/ARB use with COVID-19 severity in this population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS From the European Renal Association COVID-19 database (ERACODA), we retrieved data on kidney transplant recipients and patients on dialysis who were affected by COVID-19, between February 1 and October 1, 2020, and had information on 28-day mortality. We used Cox proportional-hazards regression to calculate hazard ratios for the association between ACEi/ARB use and 28-day mortality risk. Additionally, we studied the association of discontinuation of these agents with 28-day mortality. RESULTS We evaluated 1511 patients: 459 kidney transplant recipients and 1052 patients on dialysis. At diagnosis of COVID-19, 189 (41%) of the transplant recipients and 288 (27%) of the patients on dialysis were on ACEis/ARBs. A total of 88 (19%) transplant recipients and 244 (23%) patients on dialysis died within 28 days of initial presentation. In both groups of patients, there was no association between ACEi/ARB use and 28-day mortality in both crude and adjusted models (in transplant recipients, adjusted hazard ratio, 1.12; 95% confidence interval [95% CI], 0.69 to 1.83; in patients on dialysis, adjusted hazard ratio, 1.04; 95% CI, 0.73 to 1.47). Among transplant recipients, ACEi/ARB discontinuation was associated with a higher mortality risk after adjustment for demographics and comorbidities, but the association was no longer statistically significant after adjustment for severity of COVID-19 (adjusted hazard ratio, 1.36; 95% CI, 0.40 to 4.58). Among patients on dialysis, ACEi/ARB discontinuation was not associated with mortality in any model. We obtained similar results across subgroups when ACEis and ARBs were studied separately, and when other outcomes for severity of COVID-19 were studied, e.g., hospital admission, admission to the intensive care unit, or need for ventilator support. CONCLUSIONS Among kidney transplant recipients and patients on dialysis with COVID-19, there was no significant association of ACEi/ARB use or discontinuation with mortality.
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Affiliation(s)
- Maria Jose Soler
- Department of Nephrology, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Research, Vall d’Hebron Barcelona Hospital Campus, Red de Investigación Renal (REDINREN), Barcelona, Spain
| | - Marlies Noordzij
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Gabriel de Arriba
- Department of Nephrology, University Hospital Guadalajara, University of Alcala, Guadalajara, Spain
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Marjolijn van Buren
- Department of Nephrology, University Medical Center Leiden, University of Leiden, Leiden, The Netherlands
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| | - Adrian Covic
- Grigore T. Popa University of Medicine and Pharmacy, Dr. C.I. Parhon Hospital, Iasi, Romania
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Mar Institute for Medical Research, Red de Investigación Renal (REDINREN) (RD16/0009/0013), Barcelona, Spain
| | - Raphaël Duivenvoorden
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ziad A. Massy
- Department of Nephrology, Centre Hospitalier Universitaire (CHU) Ambroise Paré, Assistance Publique–Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
- Centre for Research in Epidemiology and Population Health (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS 1018, Team 5, University Versailles-Saint Quentin, University of Paris Saclay, Villejuif, France
| | - Alberto Ortiz
- Instituto de Investigación Sanitaria (IIS)–Fundación Jiménez Díaz, Autonomous University of Madrid (UAM), Red de Investigación Renal (REDINREN), Madrid, Spain
| | | | - Emily Petridou
- Representative of the European Kidney Patients’ Federation, Nicosia, Cyprus
| | - Kate Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Colin White
- Representative of the European Kidney Patients’ Federation, Dublin, Ireland
| | - Priya Vart
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Ron T. Gansevoort
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Sánchez-Álvarez E, Quiroga B, de Sequera P. Position statement of the Spanish Society of Nephrology on the SARS-CoV-2 vaccines. Nefrologia 2021; 41:412-416. [PMID: 34561208 PMCID: PMC8455244 DOI: 10.1016/j.nefroe.2021.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide over the last year causing more than one million deaths. Several treatments have tried to modify the natural history of the coronavirus disease 2019 (COVID-19) but only corticosteroids have demonstrated to be effective in moderate or severe affectation. In that situation, the development of vaccines for preventing the SARS-CoV-2 infection has focused the attention of the scientific community. At present, available messenger RNA-based technology vaccines have received the approval of local and international sanitary authorities. In this position statement, the Spanish Society of Nephrology wants to state that patients with chronic kidney disease and healthcare workers are at high-risk for contagion and complications of COVID-19 so they must have priority in the vaccine administration.
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Affiliation(s)
- Emilio Sánchez-Álvarez
- Servicio de Nefrología, Hospital Universitario de Cabueñes, Gijón, Spain; Junta Directiva de la Sociedad Española de Nefrología, Spain
| | - Borja Quiroga
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, Spain; Junta Directiva de la Sociedad Española de Nefrología, Spain.
| | - Patricia de Sequera
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain; Junta Directiva de la Sociedad Española de Nefrología, Spain
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31
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Villanego F, Mazuecos A, Pérez‐Flores IM, Moreso F, Andrés A, Jiménez‐Martín C, Molina M, Canal C, Sánchez‐Cámara LA, Zárraga S, Ruiz‐Fuentes MDC, Aladrén MJ, Melilli E, López V, Sánchez‐Álvarez E, Crespo M, Pascual J, for the Spanish Society of Nephrology COVID‐19 Group. Predictors of severe COVID-19 in kidney transplant recipients in the different epidemic waves: Analysis of the Spanish Registry. Am J Transplant 2021; 21:2573-2582. [PMID: 33756067 PMCID: PMC8250925 DOI: 10.1111/ajt.16579] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/22/2021] [Accepted: 03/18/2021] [Indexed: 01/25/2023]
Abstract
SARS-CoV-2 infection has produced high mortality in kidney transplant (KT) recipients, especially in the elderly. Until December 2020, 1011 KT with COVID-19 have been prospectively included in the Spanish Registry and followed until recovery or death. In multivariable analysis, age, pneumonia, and KT performed ≤6 months before COVID-19 were predictors of death, whereas gastrointestinal symptoms were protective. Survival analysis showed significant increasing mortality risk in four subgroups according to recipient age and time after KT (age <65 years and posttransplant time >6 months, age <65 and time ≤6, age ≥65 and time >6 and age ≥65 and time ≤6): mortality rates were, respectively, 11.3%, 24.5%, 35.4%, and 54.5% (p < .001). Patients were significantly younger, presented less pneumonia, and received less frequently specific anti-COVID-19 treatment in the second wave (July-December) than in the first one (March-June). Overall mortality was lower in the second wave (15.1 vs. 27.4%, p < .001) but similar in critical patients (66.7% vs. 58.1%, p = .29). The interaction between age and time post-KT should be considered when selecting recipients for transplantation in the COVID-19 pandemic. Advanced age and a recent KT should foster strict protective measures, including vaccination.
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Affiliation(s)
| | | | | | - Francesc Moreso
- Department of NephrologyHospital Vall d´HebronBarcelonaSpain
| | - Amado Andrés
- Department of NephrologyHospital Universitario Doce de OctubreMadridSpain
| | | | - María Molina
- Department of NephrologyHospital Germans Trias i PujolBarcelonaSpain
| | | | | | - Sofía Zárraga
- Department of NephrologyHospital Universitario de CrucesBilbaoSpain
| | | | - María José Aladrén
- Department of NephrologyHospital Universitario Miguel ServetZaragozaSpain
| | - Edoardo Melilli
- Department of NephrologyHospital Universitario BellvitgeBarcelonaSpain
| | - Verónica López
- Department of NephrologyHospital Regional Universitario de MálagaUniversity of MálagaIBIMAREDinRENMálagaSpain
| | | | - Marta Crespo
- Department of NephrologyHospital del MarInstitute Mar for Medical ResearchREDinRENBarcelonaSpain
| | - Julio Pascual
- Department of NephrologyHospital del MarInstitute Mar for Medical ResearchREDinRENBarcelonaSpain
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Sánchez-Álvarez E, Quiroga B, de Sequera P. [Position statement of the Spanish Society of Nephrology on the SARS-CoV-2 vaccines]. Nefrologia 2021; 41:412-416. [PMID: 38620386 PMCID: PMC7775792 DOI: 10.1016/j.nefro.2020.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 01/17/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide over the last year causing more than one million deaths. Several treatments have tried to modify the natural history of the coronavirus disease 2019 (COVID-19) but only corticosteroids have demonstrated to be effective in moderate or severe affectation. In that situation, the development of vaccines for preventing the SARS-CoV-2 infection has focused the attention of the scientific community. At present, available messenger RNA-based technology vaccines have received the approval of local and international sanitary authorities. In this position statement, the Spanish Society of Nephrology wants to state that patients with chronic kidney disease and healthcare workers are at high-risk for contagion and complications of COVID-19 so they must have priority in the vaccine administration.
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Affiliation(s)
- Emilio Sánchez-Álvarez
- Servicio de Nefrología, Hospital Universitario de Cabueñes, Gijón, España
- Junta Directiva de la Sociedad Española de Nefrología
| | - Borja Quiroga
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, España
- Junta Directiva de la Sociedad Española de Nefrología
| | - Patricia de Sequera
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España
- Junta Directiva de la Sociedad Española de Nefrología
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33
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Alcázar-Arroyo R, Portolés J, López-Sánchez P, Zalamea F, Furaz K, Méndez Á, Nieto L, Sánchez-Hernández R, Pizarro S, García A, Pereira M, Gallego-Valcárcel E, Llópez-Carratala R, Gadea-Gironés I, Martín R, Miranda B. Rapid decline of anti-SARS-CoV-2 antibodies in patients on haemodialysis: the COVID-FRIAT study. Clin Kidney J 2021; 14:1835-1844. [PMID: 34211708 PMCID: PMC7989535 DOI: 10.1093/ckj/sfab048] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) patients on haemodialysis (HD) have high mortality. We investigated the value of reverse transcription polymerase chain reaction (RT-PCR) and the dynamic changes of antibodies (enzyme-linked immunosorbent assay immunoglobulin M (IgM) + IgA and/or IgG) in a large HD cohort. METHODS We conducted a prospective observational study in 10 Madrid HD centres. Infection rate, anti-SARS-CoV-2 antibody dynamics and the incidence of asymptomatic SARS-CoV-2 infection (defined by positive RT-PCR, IgM + IgA and/or IgG) were assessed. RESULTS From 1 March to 15 April 2020, 136 of 808 (16.8%) HD patients were diagnosed with symptomatic COVID-19 by RT-PCR of nasopharyngeal swabs and 42/136 (31%) died. In the second fortnight of April, RT-PCR and anti-SARS-CoV-2 antibodies were assessed in 763 of the surviving patients. At this point, 69/91 (75.8%) symptomatic COVID-19 patients had anti-SARS-CoV-2 antibodies. Four weeks later, 15.4% (10/65) of initially antibody-positive patients had become negative. Among patients without prior symptomatic COVID-19, 9/672 (1.3%) were RT-PCR positive and 101/672 patients (15.0%) were antibody positive. Four weeks later, 62/86 (72.1%) of initially antibody-positive patients had become negative. Considering only IgG titres, serology remained positive after 4 weeks in 90% (54/60) of patients with symptomatic COVID-19 and in 52.5% (21/40) of asymptomatic patients. The probability of an adequate serologic response (defined as the development of anti-SARS-CoV-2 antibodies that persisted at 4 weeks) was higher in patients who had symptomatic COVID-19 than in asymptomatic SARS-CoV-2 infection {odds ratio [OR) 4.04 [95% confidence interval (CI) 2.04-7.99]} corrected for age, Charlson comorbidity index score and time on HD. Living in a nursing home [OR 5.9 (95% CI 2.3-15.1)] was the main risk factor for SARS-CoV-2 infection. CONCLUSIONS The anti-SARS-CoV-2 antibody immune response in HD patients depends on clinical presentation. The antibody titres decay earlier than previously reported for the general population. This inadequate immune response raises questions about the efficacy of future vaccines.
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Affiliation(s)
- Roberto Alcázar-Arroyo
- Department of Nephrology, University Hospital Infanta Leonor, Madrid, Spain
- Department of Medicine, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | - José Portolés
- Department of Nephrology, University Hospital Puerta de Hierro, Madrid, Spain
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
| | - Paula López-Sánchez
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
| | - Felipe Zalamea
- Department of Nephrology, Dialysis Center–Los Lauros, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | - Karina Furaz
- Department of Nephrology, Dialysis Center–Los Llanos, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | - Ángel Méndez
- Department of Nephrology, Dialysis Center–Los Llanos II, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | - Luis Nieto
- Department of Nephrology, Dialysis Center–Santa Engracia, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | | | - Soledad Pizarro
- Department of Nephrology, University Hospital Rey Juan Carlos, Madrid, Spain
| | - Alicia García
- Department of Nephrology, University Hospital Infanta Elena, Madrid, Spain
| | - Mónica Pereira
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
- Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain
| | - Eduardo Gallego-Valcárcel
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
- Department of Nephrology, Fundación Hospital Alcorcón, Madrid, Spain
| | - Rosario Llópez-Carratala
- Department of Nephrology, University Hospital Puerta de Hierro, Madrid, Spain
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
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Nopsopon T, Kittrakulrat J, Takkavatakarn K, Eiamsitrakoon T, Kanjanabuch T, Pongpirul K. Covid-19 in end-stage renal disease patients with renal replacement therapies: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009156. [PMID: 34129609 PMCID: PMC8232454 DOI: 10.1371/journal.pntd.0009156] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/25/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background The novel coronavirus (COVID-19), caused by SARS-CoV-2, showed various prevalence and case-fatality rates (CFR) among patients with different pre-existing chronic conditions. End-stage renal disease (ESRD) patients with renal replacement therapy (RRT) might have a higher prevalence and CFR due to reduced immune function from uremia and kidney tropism of SARS-CoV-2, but there was a lack of systematic study on the infection and mortality of the SARS-CoV-2 infection in ESRD patients with various RRT. Methodology/Principal findings We searched five electronic databases and performed a systematic review and meta-analysis up to June 30, 2020, to evaluate the prevalence and case fatality rate (CFR) of the COVID-19 infection among ESRD patients with RRT. The global COVID-19 data were retrieved from the international database on June 30, 2020, for estimating the prevalence and CFR of the general population as referencing points. Of 3,272 potential studies, 34 were eligible studies consisted of 1,944 COVID-19 confirmed cases in 21,873 ESRD patients with RRT from 12 countries in four WHO regions. The overall pooled prevalence in ESRD patients with RRT was 3.10% [95% confidence interval (CI) 1.25–5.72] which was higher than referencing 0.14% global average prevalence. The overall estimated CFR of COVID-19 in ESRD patients with RRT was 18.06% (95% CI 14.09–22.32) which was higher than the global average at 4.98%. Conclusions This meta-analysis suggested high COVID-19 prevalence and CFR in ESRD patients with RRT. ESRD patients with RRT should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths. Chronic kidney disease (CKD) was associated with increasing severity and mortality of COVID-19. End-stage renal disease (ESRD) patients were at the terminal stage of CKD and had reduced immune function due to uremia. Additionally, ESRD patients with kidney transplantation had a diminished immune system from immunosuppressive agents. Kidneys might be the secondary target of SARS-CoV-2 after the respiratory tract regardless of the previous history of kidney disease, preferably the glomerulus, which was associated with the richness of some specific protein-coding genes in the kidney. The overall pooled prevalence in ESRD patients with renal replacement therapy was approximately 22 times the referencing global average prevalence. The overall estimated case fatality rate of COVID-19 in ESRD patients with renal replacement therapy was approximately 3.6 times the global average. ESRD patients with renal replacement therapy had high COVID-19 prevalence and case fatality rate. We suggested that ESRD patients with renal replacement therapy should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths.
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Affiliation(s)
- Tanawin Nopsopon
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jathurong Kittrakulrat
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanee Eiamsitrakoon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Bumrungrad International Hospital, Bangkok, Thailand
- * E-mail:
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Slon Roblero MF, Gómez Larrambe N, Labat Yanguas H, Hernández Barcos A, Fierro González S, Espadas Sucunza M. "Stay at home". Home dialysis, an added benefit in times of pandemic. Nefrologia 2021; 41:699-700. [PMID: 34119359 PMCID: PMC8189752 DOI: 10.1016/j.nefro.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Maria Fernanda Slon Roblero
- Complejo Hospitalario de Navarra, Servicio de Nefrología, Unidad de Diálisis Domiciliaria, Pamplona, Navarra, España; Instituto Navarro para la Investigación de la Salud (IDISNA), Área de las Enfermedades Cardiovasculares y Renales, Pamplona, Navarra, España.
| | - Nerea Gómez Larrambe
- Complejo Hospitalario de Navarra, Servicio de Nefrología, Unidad de Diálisis Domiciliaria, Pamplona, Navarra, España; Instituto Navarro para la Investigación de la Salud (IDISNA), Área de las Enfermedades Cardiovasculares y Renales, Pamplona, Navarra, España
| | - Helena Labat Yanguas
- Complejo Hospitalario de Navarra, Servicio de Nefrología, Unidad de Diálisis Domiciliaria, Pamplona, Navarra, España
| | - Asunción Hernández Barcos
- Complejo Hospitalario de Navarra, Servicio de Nefrología, Unidad de Diálisis Domiciliaria, Pamplona, Navarra, España
| | - Susana Fierro González
- Complejo Hospitalario de Navarra, Servicio de Nefrología, Unidad de Diálisis Domiciliaria, Pamplona, Navarra, España
| | - Maria Espadas Sucunza
- Complejo Hospitalario de Navarra, Servicio de Nefrología, Unidad de Diálisis Domiciliaria, Pamplona, Navarra, España
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Osmanodja B, Mayrdorfer M, Halleck F, Choi M, Budde K. Undoubtedly, kidney transplant recipients have a higher mortality due to COVID-19 disease compared to the general population. Transpl Int 2021; 34:769-771. [PMID: 34037292 DOI: 10.1111/tri.13881] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Bilgin Osmanodja
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Manuel Mayrdorfer
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mira Choi
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Hernández M, Fors E, Massuht F, Figueredo I, Caballero R, Berruz C, Ramirez Y, Bernal E, Fors M. COVID-19 infected patients in a Hemodialysis facility in Ecuador, 2020. BIONATURA 2021. [DOI: 10.21931/rb/2021.06.02.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We retrospectively analyzed the data of 38 hemodialysis patients with COVID-19, including demographic and clinical characteristics were collected from the medical records of patients from Reynadial center from April to June 2020. Of 125 patients from the clinic, 38 (30.4%) were diagnosed with COVID-19. The third part of patients (12) died, the mortality rate was 31%. The mean (±SD) age of the patients was 61±13 years, 57.9% were men. The most common symptoms were shortness of breath and cough; 80% of patients had fever on admission, and more than 90% had hypertension. No significant differences were observed between survivors and non-survivors in demographic and epidemiological characteristics except for gender. We found statistically significant differences between blood pressure and weight before and after the infection by COVID-19. We found a high COVID-19 prevalence in our hemodialysis patients and a high rate of deaths among them, with non-significant statistical differences between survivors and non-survivors of the disease regarding most of the variables studied.
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Affiliation(s)
- Mario Hernández
- Clinica Reynadial, Guayaquil, Ecuador. Hospital General IESS Babahoyo, Los Ríos, Ecuador
| | - Emilio Fors
- Clinica Reynadial, Guayaquil, Ecuador. Hospital General IESS Babahoyo, Los Ríos, Ecuador
| | - Fresia Massuht
- Clinica Reynadial. Hospital General IESS Sur Valdivia, Guayaquil, Ecuador
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38
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Coll E, Fernández-Ruiz M, Sánchez-Álvarez JE, Martínez-Fernández JR, Crespo M, Gayoso J, Bada-Bosch T, Oppenheimer F, Moreso F, López-Oliva MO, Melilli E, Rodríguez-Ferrero ML, Bravo C, Burgos E, Facundo C, Lorenzo I, Yañez Í, Galeano C, Roca A, Cabello M, Gómez-Bueno M, García-Cosío M, Graus J, Lladó L, de Pablo A, Loinaz C, Aguado B, Hernández D, Domínguez-Gil B, the Spanish Group for the Study of COVID-19 in Transplant Recipients. COVID-19 in transplant recipients: The Spanish experience. Am J Transplant 2021; 21:1825-1837. [PMID: 33098200 PMCID: PMC9906239 DOI: 10.1111/ajt.16369] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
We report the nationwide experience with solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients diagnosed with coronavirus disease 2019 (COVID-19) in Spain until 13 July 2020. We compiled information for 778 (423 kidney, 113 HSCT, 110 liver, 69 heart, 54 lung, 8 pancreas, 1 multivisceral) recipients. Median age at diagnosis was 61 years (interquartile range [IQR]: 52-70), and 66% were male. The incidence of COVID-19 in SOT recipients was two-fold higher compared to the Spanish general population. The median interval from transplantation was 59 months (IQR: 18-131). Infection was hospital-acquired in 13% of cases. No donor-derived COVID-19 was suspected. Most patients (89%) were admitted to the hospital. Therapies included hydroxychloroquine (84%), azithromycin (53%), protease inhibitors (37%), and interferon-β (5%), whereas immunomodulation was based on corticosteroids (41%) and tocilizumab (21%). Adjustment of immunosuppression was performed in 85% of patients. At the time of analysis, complete follow-up was available from 652 patients. Acute respiratory distress syndrome occurred in 35% of patients. Ultimately, 174 (27%) patients died. In univariate analysis, risk factors for death were lung transplantation (odds ratio [OR]: 2.5; 95% CI: 1.4-4.6), age >60 years (OR: 3.7; 95% CI: 2.5-5.5), and hospital-acquired COVID-19 (OR: 3.0; 95% CI: 1.9-4.9).
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Affiliation(s)
- Elisabeth Coll
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre (imas12), President of the Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
- Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
| | - J. Emilio Sánchez-Álvarez
- Department of Nephrology, Hospital Universitario de Cabueñes, Gijón, Spain
- Spanish Society of Nephrology (SEN), Gijón, Spain
| | | | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Transplant Working Group of the Spanish Society of Nephrology (SEN), Barcelona, Spain
- REDinREN (RD16/0009/0013), Barcelona, Spain
| | - Jorge Gayoso
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
| | - Teresa Bada-Bosch
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Francesc Moreso
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
| | | | - Edoardo Melilli
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Carlos Bravo
- Department of Pulmonology, Lung transplant Unit, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
| | - Elena Burgos
- Department of Nephrology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carme Facundo
- Kidney Transplant Unit, Fundación Puigvert, Barcelona, Spain
| | - Inmaculada Lorenzo
- Department of Nephrology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Íñigo Yañez
- Department of Nephrology, Hospital Universitario de Cruces, Barakaldo, Spain
| | - Cristina Galeano
- Kidney Transplant Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Roca
- Department of Nephrology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Mercedes Cabello
- Department of Nephrology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Manuel Gómez-Bueno
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - MaDolores García-Cosío
- Cardiology Service, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Javier Graus
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Laura Lladó
- Liver Transplant Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Alicia de Pablo
- Lung Transplant Unit, Department of Pneumology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmelo Loinaz
- Transplant Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Beatriz Aguado
- Transplant Unit. Department of Hematology, Hospital Universitario La Princesa, Madrid, Spain
| | - Domingo Hernández
- Department of Nephrology, Hospital Regional Universitario, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Spanish Society of Transplantation (SET), Málaga, Spain
| | - Beatriz Domínguez-Gil
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
| | - the Spanish Group for the Study of COVID-19 in Transplant Recipients
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre (imas12), President of the Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
- Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
- Department of Nephrology, Hospital Universitario de Cabueñes, Gijón, Spain
- Spanish Society of Nephrology (SEN), Gijón, Spain
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Transplant Working Group of the Spanish Society of Nephrology (SEN), Barcelona, Spain
- REDinREN (RD16/0009/0013), Barcelona, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Department of Nephrology, Hospital Clinic, Barcelona, Spain
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
- Department oof Nephrology, Hospital Universitario La Paz, Madrid, Spain
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Pulmonology, Lung transplant Unit, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
- Department of Nephrology, Hospital Germans Trias i Pujol, Badalona, Spain
- Kidney Transplant Unit, Fundación Puigvert, Barcelona, Spain
- Department of Nephrology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Department of Nephrology, Hospital Universitario de Cruces, Barakaldo, Spain
- Kidney Transplant Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Nephrology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
- Department of Nephrology, Hospital Regional Universitario de Málaga, Málaga, Spain
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Cardiology Service, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Liver Transplant Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
- Lung Transplant Unit, Department of Pneumology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Transplant Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
- Transplant Unit. Department of Hematology, Hospital Universitario La Princesa, Madrid, Spain
- Department of Nephrology, Hospital Regional Universitario, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Spanish Society of Transplantation (SET), Málaga, Spain
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Baldallo C, León Román JC, Serón D, Agraz I, Solans R, Ramos N, Soler MJ. [COVID-19 in a patient with hypocomplementemic urticarial syndrome and MPO-ANCA vasculitis on hemodialysis treated with omalizumab]. Nefrologia 2021; 41:354-356. [PMID: 32826086 PMCID: PMC7383167 DOI: 10.1016/j.nefro.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/03/2020] [Indexed: 01/16/2023] Open
Affiliation(s)
- Cinthia Baldallo
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - Juan Carlos León Román
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - Daniel Serón
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España; Grup de Nefrologia. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, España
| | - Irene Agraz
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España; Grup de Nefrologia. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, España
| | - Roser Solans
- Servicio de Medicina Interna, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - Natalia Ramos
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España; Grup de Nefrologia. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, España
| | - María José Soler
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España; Grup de Nefrologia. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, España.
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Sandino Pérez J, Aubert Girbal L, Caravaca-Fontán F, Polanco N, Sevillano Prieto Á, Andrés A. Pericarditis secondary to COVID-19 infection in a kidney transplant recipient. Nefrologia 2021; 41:349-351. [PMID: 36166251 PMCID: PMC8299182 DOI: 10.1016/j.nefroe.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/05/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
- Justo Sandino Pérez
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | | | - Fernando Caravaca-Fontán
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain; Fundación de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Natalia Polanco
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Amado Andrés
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain; Fundación de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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41
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Baldallo C, León Román JC, Seron D, Agraz I, Solans R, Ramos N, Soler MJ. COVID-19 in a patient with hypocomplementemic urticarial syndrome and MPO-ANCA vasculitis on hemodialysis treated with omalizumab. Nefrologia 2021; 41:354-355. [PMID: 36166252 PMCID: PMC8292098 DOI: 10.1016/j.nefroe.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/03/2020] [Indexed: 04/18/2023] Open
Affiliation(s)
- Cinthia Baldallo
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Juan Carlos León Román
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Daniel Seron
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Grup de Nefrologia, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain
| | - Irene Agraz
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Grup de Nefrologia, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain
| | - Roser Solans
- Servicio de Medicina Interna, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Natalia Ramos
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Grup de Nefrologia, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain
| | - María José Soler
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Grup de Nefrologia, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain.
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Nordio M, Reboldi G, Di Napoli A, Quintaliani G, Alberici F, Postorino M, Aucella F, Messa P, Brunori G. Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey. J Nephrol 2021; 34:325-335. [PMID: 33387336 PMCID: PMC7776284 DOI: 10.1007/s40620-020-00946-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Over 80% (365/454) of the nation's centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. METHODS We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. RESULTS Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20-1.51], positive healthcare workers (IRR 1.09, 95% CI 1.02-1.17), test-all policy (IRR 5.94, 95% CI 3.36-10.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001-1.003) (all p < 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94-0.98) (p < 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence ≥ 229 per 100,000 and at ≥ 3 positive healthcare workers. CONCLUSIONS Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center's testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely.
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Affiliation(s)
- Maurizio Nordio
- Unit of Nephrology, General Hospital, Piazzale Ospedale, 23, 31100, Treviso, Italy
| | | | - Anteo Di Napoli
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | - Giuseppe Quintaliani
- Italian Society of Nephrology, Viale dell'Università, 11, 00185, Rome, RM, Italy
| | - Federico Alberici
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Maurizio Postorino
- Unit of Nephrology, Grande Ospedale Metropolitano Reggio Calabria, Reggio Calabria, Italy
| | - Filippo Aucella
- Nephrology and Dialysis Unit, IRCCS "Casa Sollievo Della Sofferenza" Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy
| | - Piergiorgio Messa
- Division of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuliano Brunori
- Italian Society of Nephrology, Viale dell'Università, 11, 00185, Rome, RM, Italy.
- Nephrology and Dialysis Unit, Hospital of Trento, Trento, Italy.
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43
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Analysis of the Clinical and Epidemiological Meaning of Screening Test for SARS-CoV-2: Considerations in the Chronic Kidney Disease Patients during the COVID-19 Pandemic. J Clin Med 2021; 10:jcm10051139. [PMID: 33803083 PMCID: PMC7963145 DOI: 10.3390/jcm10051139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/15/2021] [Accepted: 02/25/2021] [Indexed: 12/17/2022] Open
Abstract
The COronaVIrus Disease 19 (COVID-19) pandemic is an emerging reality in nephrology. In a continuously changing scenario, we need to assess our patients’ additional risk in terms of attending hemodialysis treatments, follow-up peritoneal dialysis, and kidney transplant visits. The prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-20 infection in the general population plays a pivotal role in estimating the additional COVID-19 risk in chronic kidney disease (CKD) patients. Unfortunately, local prevalence is often obscure, and when we have an estimation, we neglect the number of asymptomatic subjects in the same area and, consequently, the risk of infection in CKD patients. Furthermore, we still have the problem of managing COVID-19 diagnosis and the test’s accuracy. Currently, the gold standard for SARS-CoV-2 detection is a real-time reverse transcription-polymerase chain reaction (rRT-PCR) on respiratory tract samples. rRT-PCR presents some vulnerability related to pre-analytic and analytic problems and could impact strongly on its diagnostic accuracy. Specifically, the operative proceedings to obtain the samples and the different types of diagnostic assay could affect the results of the test. In this scenario, knowing the local prevalence and the local screening test accuracy helps the clinician to perform preventive measures to limit the diffusion of COVID-19 in the CKD population.
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44
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Florit EA, Diekmann F. Is the immune hyporesponsiveness of uraemic patients a protective factor for severe COVID-19 pneumonia? Nefrologia 2021; 41:223-224. [PMID: 36165389 PMCID: PMC8055161 DOI: 10.1016/j.nefroe.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/10/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
- Enrique A Florit
- Instituto de Nefrología y Urología (ICNU), Hospital Clinic, Barcelona, Spain.
| | - Fritz Diekmann
- Instituto de Nefrología y Urología (ICNU), Hospital Clinic, Barcelona, Spain
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45
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Sánchez Cadena AD, Negreira Caamaño M, Pérez Serrano R, Porras Leal ML. Intravenous immunoglobulins: A therapeutic alternative to consider in kidney transplant patients with COVID-19. Nefrologia 2021; 41:220-222. [PMID: 36165388 PMCID: PMC8062028 DOI: 10.1016/j.nefroe.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 04/23/2023] Open
Affiliation(s)
| | | | - Raúl Pérez Serrano
- Servicio de Farmacia, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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46
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Toapanta N, Torres IB, Sellarés J, Chamoun B, Serón D, Moreso F. Kidney transplantation and COVID-19 renal and patient prognosis. Clin Kidney J 2021; 14:i21-i29. [PMID: 33815780 PMCID: PMC7995521 DOI: 10.1093/ckj/sfab030] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/27/2021] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVD-19) emerged as a pandemic in December 2019. Infection has spread quickly and renal transplant recipients receiving chronic immunosuppression have been considered a population at high risk of infection, complications and infection-related death. During this year a large amount of information from nationwide registries, multicentre and single-centre studies have been reported. The number of renal transplant patients diagnosed with COVID-19 was higher than in the general population, but the lower threshold for testing may have contributed to its better identification. Major complications such as acute kidney injury and acute respiratory distress syndrome were very frequent in renal transplant patients, with a high comorbidity burden, but further studies are needed to support that organ transplant recipients receiving chronic immunosuppression are more prone to develop these complications than the general population. Kidney transplant recipients experience a high mortality rate compared with the general population, especially during the very early post-transplant period. Despite the fact that some studies report more favourable outcomes in patients with a kidney transplant than in patients on the kidney waiting list, the higher mortality described in the very early post-transplant period would advise against performing a kidney transplant in areas where the spread of infection is high, especially in recipients >60 years of age. Management of transplant recipients has been challenging for clinicians and strategies such as less use of lymphocyte-depleting agents for new transplants or anti-metabolite withdrawal and calcineurin inhibitor reduction for transplant patients with COVID-19 are not based on high-quality evidence.
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Affiliation(s)
- Néstor Toapanta
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Irina B Torres
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Joana Sellarés
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Betty Chamoun
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Daniel Serón
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Francesc Moreso
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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47
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Pascual J. Kidney transplant after a COVID-19. Nefrologia 2021; 41:91-94. [PMID: 36166213 PMCID: PMC8162902 DOI: 10.1016/j.nefroe.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/24/2020] [Indexed: 04/23/2023] Open
Affiliation(s)
- Julio Pascual
- Servicio de Nefrología, Hospital del Mar, Barcelona, Spain.
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48
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Aoun M, Khalil R, Mahfoud W, Fatfat H, Bou Khalil L, Alameddine R, Afiouni N, Ibrahim I, Hassan M, Zarzour H, Jebai A, Khalil NM, Tawil L, Mechref Z, El Imad Z, Chamma F, Khalil A, Zeidan S, El Ghoul B, Dahdah G, Mouawad S, Azar H, Chahine KA, Kallab S, Moawad B, Fawaz A, Homsi J, Tabaja C, Delbani M, Kallab R, Hoballah H, Haykal W, Fares N, Rahal W, Mroueh W, Youssef M, Rizkallah J, Sebaaly Z, Dfouni A, Ghosn N, Nawfal N, Jaoude WA, Bassil N, Maroun T, Bassil N, Beaini C, Haddad B, Moubarak E, Rabah H, Attieh A, Finianos S, Chelala D. Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study. BMC Nephrol 2021; 22:73. [PMID: 33639881 PMCID: PMC7912967 DOI: 10.1186/s12882-021-02270-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/16/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. METHODS This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients' medical records. A binary logistic regression analysis was performed to assess risk factors for mortality. RESULTS A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83). CONCLUSIONS This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.
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Affiliation(s)
- Mabel Aoun
- Department of Nephrology, Saint-George Hospital Ajaltoun, Ajaltoun, Lebanon
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | | | | | | | | | | | | | | | | | | | | | | | - Luay Tawil
- Siblin Governmental Hospital, Sebline, Lebanon
| | | | | | | | | | | | | | | | - Sarah Mouawad
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Hiba Azar
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hotel-Dieu de France Hospital, Beirut, Lebanon
| | | | | | | | | | | | - Carmen Tabaja
- Hammoud Hospital University Medical Center, Sidon, Lebanon
| | - Maya Delbani
- Hammoud Hospital University Medical Center, Sidon, Lebanon
| | | | | | | | - Najat Fares
- Saint-Georges Orthodoxe Hospital, Beirut, Lebanon
| | | | | | | | | | | | - Antoine Dfouni
- Centre Hospitalier Universitaire Notre Dame de Secours Hospital, Byblos, Lebanon
| | - Norma Ghosn
- Centre Hospitalier Universitaire Notre Dame de Secours Hospital, Byblos, Lebanon
| | | | | | - Nadine Bassil
- Middle-East Institute of Health, Bsalim, Lebanon
- Saint-Joseph Hospital, Dora, Lebanon
| | - Therese Maroun
- Middle-East Institute of Health, Bsalim, Lebanon
- Saint-Joseph Hospital, Dora, Lebanon
| | - Nabil Bassil
- Middle-East Institute of Health, Bsalim, Lebanon
- Saint-Joseph Hospital, Dora, Lebanon
| | | | | | | | | | | | - Serge Finianos
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Dania Chelala
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hotel-Dieu de France Hospital, Beirut, Lebanon
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49
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Pizarro-Sánchez MS, Avello A, Mas-Fontao S, Stock da Cunha T, Goma-Garcés E, Pereira M, Ortíz A, González-Parra E. Clinical Features of Asymptomatic SARS-CoV-2 Infection in Hemodialysis Patients. Kidney Blood Press Res 2021; 46:126-134. [PMID: 33503627 PMCID: PMC7900451 DOI: 10.1159/000512535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/24/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND CKD is a risk factor for severe COVID-19. However, the clinical spectrum of COVID-19 in hemodialysis patients is still poorly characterized. OBJECTIVE To analyze the clinical spectrum of COVID-19 on hemodialysis patients. METHOD A retrospective observational study was conducted on 66 hemodialysis patients. Nasopharyngeal swab PCR and serology for SARS-CoV-2, blood analysis, chest radiography, treatment, and outcomes were assessed. RESULTS COVID-19 was diagnosed in 50 patients: 38 (76%) were PCR-positive and 12 (24%) were PCR-negative but developed anti-SARS-CoV-2 antibodies. By contrast, 17% of PCR-positive patients failed to develop detectable antibodies against SARS-CoV-2. Among PCR-positive patients, 5/38 (13%) were asymptomatic, while among PCR-negative patients 7/12 (58%) were asymptomatic (p = 0.005) for a total of 12/50 (24%) asymptomatic patients. No other differences were found between PCR-positive and PCR-negative patients. No differences in potential predisposing factors were found between asymptomatic and symptomatic patients except for a lower use of ACE inhibitors among asymptomatic patients. Asymptomatic patients had laboratory evidence of milder disease such as higher lymphocyte counts and oxygen saturation and lower troponin I and interleukin-6 levels than symptomatic patients. Overall mortality was 7/50 (14%) and occurred only in symptomatic PCR-positive patients in whom mortality was 7/33 (21%). CONCLUSIONS Asymptomatic SARS-CoV-2 infection is common in hemodialysis patients, especially among patients with initial negative PCR that later seroconvert. Thus COVID-19 mortality in hemodialysis patients may be lower than previously estimated based on PCR tests alone.
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Affiliation(s)
| | - Alejandro Avello
- Nephrology and Hypertension, UH-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | | | | | - Elena Goma-Garcés
- Nephrology and Hypertension, UH-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - Mónica Pereira
- Iñígo Álvarez de Toledo Renal Foundation (FRIAT), Madrid, Spain
| | - Alberto Ortíz
- Nephrology and Hypertension, UH-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Autónoma University of Madrid, Madrid, Spain
| | - Emilio González-Parra
- Nephrology and Hypertension, UH-Fundacion Jimenez Diaz UAM, Madrid, Spain,
- Autónoma University of Madrid, Madrid, Spain,
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50
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Quiroga B, Muñoz Ramos P, Giorgi M, de Santos A, Núñez A, Ortiz A, Redondo Polo C, Almería Gómez O, Marcos-Jiménez A, Esparcia Pinedo L, Barril G. Dynamic assessment of interleukin-6 during hemodialysis and mortality in coronavirus disease-19. Ther Apher Dial 2021; 25:908-916. [PMID: 33497039 PMCID: PMC8013682 DOI: 10.1111/1744-9987.13626] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/14/2020] [Accepted: 01/24/2021] [Indexed: 12/15/2022]
Abstract
The impact of the newly discovered severe acute respiratory syndrome coronavirus 2 causing coronavirus disease‐19 (COVID‐19) in hemodialysis patients remains poorly characterized. Some hemodialysis techniques reduce systemic inflammation but their impact on COVID‐19 has not been addressed. The aim of this prospective study was to evaluate factors associated with mortality in COVID‐19 hemodialysis patients, including the impact of reducing interleukin‐6 using a cytokine adsorbent filter. This is a prospective single‐center study including 16 hemodialysis patients with COVID‐19. All were dialyzed using a polymethyl methacrylate (PMMA) filter. Interleukin‐6 levels were obtained before and after the first admission hemodialysis session and at 1 week. Baseline comorbidities, laboratory values, chest X‐ray, and treatments were recorded and compared between survivors and non‐survivors. Out of 16 patients (13 males, mean age 72 ± 15 years), 4 (25%) died. Factors associated with mortality were dialysis vintage (P = 0.01), chest X‐ray infiltrates (P = 0.032), serum C‐reactive protein (P = 0.05), and lactate dehydrogenase (P = 0.02) at 1 week, oxygen therapy requirement (P = 0.02) and anticoagulation (P < 0.01). At admission, non‐survivors had higher predialysis and postdialysis interleukin‐6 levels (P = 0.02 for both) and did not present the reduction of interleukin‐6 levels during the dialysis session with PMMA filter that was observed in survivors (survivors vs. non‐survivors: 25.0 [17.5–53.2]% vs. −2.8 [−109.4–12.8]% reduction, P = 0.04). A positive balance of interleukin‐6 during the admission dialysis was associated with mortality (P = 0.008). In conclusion, in hemodialysis COVID‐19 patients, a positive interleukin‐6 balance during the admission hemodialysis session was associated with higher mortality.
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Affiliation(s)
- Borja Quiroga
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Martin Giorgi
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Antonio de Santos
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Almudena Núñez
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.,Fundacion Renal Iñigo Alvarez de Toledo-IRSIN and REDINREN, Madrid, Spain
| | | | - Olga Almería Gómez
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Ana Marcos-Jiménez
- Inmunology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Guillermina Barril
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
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