ABSTRACT
Background: The epidemiology, clinical presentation, management and outcomes of COVID-19 comes from early reports from China and Europe with AKI prevalence ranging widely from 0.5% to 29%. However, knowledge about this pandemic is still emerging. With the epicenter now in the western hemisphere, we aim to determine the behavior and possible differences in presentation of AKI in COVID-19 patients in Latin America. To our knowledge, this is the first of such study. Methods: Descriptive analysis extracted from an online survey carried out among nephrologists, renal pathologists and other health workers treating kidney diseases between May 20-27, 2020 from sixteen Spanish speaking Latin American countries divided into 6 categories. We present the results for the AKI category. Results: 430 responses were obtained of which 360 (84%) were considered for analysis. 86% of the participants were nephrologists. 35% of the respondents reported the prevalence of AKI to be <5%, while 32% estimated it at 6-10%. The majority of AKI in these patients was stage 3 according to 31% of the respondents. Roughly half of the nephrologists witnessed new onset proteinuria which was almost exclusively (96%) subnephrotic. The majority (64%) reported no hematuria. Half of the participants (50.2%) reported that renal replacement therapy (RRT) was never or rarely required. Intermittent hemodialysis was the main RRT used reported by 88% of those surveyed followed by continuous renal replacement therapy (33%), peritoneal dialysis (24%) and prolonged intermittent RRT (19%). The most common complications during RRT were hypotension (60.3%) and circuit clotting (36.6%). Over one third of the participants (35%) estimated the mortality of patients with AKI and COVID to be <20%. Conclusions: Our survey highlights potential differences in the presentation, management and outcomes of AKI in patients with COVID-19 in LA;among those, a lower prevalence, higher need for RRT and lower mortality. More studies are warranted to better understand AKI in hispanic COVID-19 patients as well as its distinct characteristics compared to the rest of the world.
ABSTRACT
Background: The rapid spread of the COVID-19 pandemic into LA countries where health systems were already facing major limitations might further challenge their physician's emotional and mental wellbeing. We aimed to describe the perception of health workers managing kidney diseases in the context of the COVID-19 pandemic. Methods: Descriptive analysis extracted from an online survey carried out among nephrologists, renal pathologists, and other health workers treating kidney diseases between May 20-27, 2020 from sixteen Spanish speaking Latin American countries divided into 6 categories. We present the results for the mental health category. Results: 430 responses were obtained of which 360 (84%) were considered for analysis. The participants were mainly nephrologists 276 (86%), renal pathologists 13 (4%), and physicians in training 11 (3%). Ages ranged between 30-49 years old in 271 (75%), mostly working on tertiary centers 258 (71%). 329 (90%) participated in inpatient care. 277 (86%) considered that the COVID-19 pandemic has impacted their mental health. Prevailing symptoms were anxiety, insomnia, and depression, with 75.2%, 42.5%, and 18.2%, respectively. Physical or verbal violence from the community was reported by 18 (5%) of the participants because they were seen as a source of viral transmission. 179 (55%) considered personal protective equipment (PPE) was sufficiently provided and 275 (79%) had to invest up to 20% of their income to obtain PPE. In addition, 144 (44%) of the respondents reported a shortage of COVID-19 tests and only 99 (30%) felt their hospital was well equipped to care for COVID-19 patients. 126 (39%) of the health workers responded that they received adequate training, while 105 (32%) endorsed they did not feel prepared in the management of patients with COVID-19. Conclusions: This survey reveals the considerable impact that the COVID-19 pandemic is generating among physicians treating patients with kidney diseases in LA. Possible aggravating factors also found in our survey included lack of testing, PPE availability, and overall hospital preparedness.
ABSTRACT
Background: A significant fraction of patients with COVID-19 display renal involvement (60%);however, the histological findings and pathology practice in Latin America (LA) have not been reported. The aim is to know how COVID-19 pandemic has affected the protocols for renal pathology and the main pathology findings in the kidney. Methods: An online survey with 75 questions in 6 sections, directed to pathologists, nephrologists and other specialists from 16 Spanish speaking LA countries treating COVID patients with kidney involvement. We are analyzing the impact of COVID-19 in renal pathology and pathology practice in LA. Results: From 430 responses, 360 (84%) were considered for analysis. Only13 participants from 16 countries were renal pathologists but the rest of responders also contributed with the pathology section. Only 10% is performing renal biopsies (RBx) of COVID-19 patients. Acute kidney injury (AKI) (85%) was the most frequent indication for RBx, hematuria-proteinuria (42%), nephrotic syndrome (28%) and subnephrotic proteinuria (21%). Combination of AKI and other syndrome was seen. Handling fresh tissue for immunofluorescence (IF) is a regular practice in the centers that perform IF (66%). No ultrastructural examination in 90% due to the lack of EM equipment. Postmortem studies only in 3% of the centers. Autopsy and biopsies shiwed thrombotic microangiopathy (TMA), with acute tubular injury (ATI). Pathology redeployment to clinical areas, ICU and inpatient care is seen in 12%. Only 70% of those received guidance or updating clinical courses. Conclusions: The survey has highlighted the deep shortage of renal pathologists and the lack of equipment (EM) compromising the best practice of renal pathology in LA. Protocols for tissue handling for COVID have not been established in any center, adding a burden to the practice. Most frequent indication for renal biopsy is AKI while the presence of TMA and ATI is found in autopsy and renal samples. Collapsing glomerulopathy (CG) has a high prevalence in hispanics and has been described in COVID patients, however CG was not seen. Outbreaks had forzed pathology redeployment to clinical care without proper preparation.
ABSTRACT
Background: As COVID-19 spreads across the world, nephrologists are facing difficult decisions regarding the management of active glomerular diseases (GD). We aimed to report how COVID-19 pandemic may have changed the use of immunotherapies among nephrologists In Latin America (LA) for the treatment of glomerulopathies. Methods: Descriptive analysis extracted from an online survey carried out among nephrologists, renal pathologists and other health workers treating kidney diseases between May 20-27, 2020 from sixteen Spanish speaking LA countries divided into 6 categories. We present the results for the GD and immunosuppression category. Results: 430 responses were obtained of which 360 (84%) were considered for analysis. The participants were mainly nephrologists 276 (86%), renal pathologists 13 (4%) and physicians in training 11 (3%). 213 (59%) of the respondents treat patients with GD. For patients at risk but without COVID-19 infection, the induction immunosuppression for GD treatment was not changed by 54.1% of the respondents while 24.2% gave only a fraction of it and 21.7% deferred the induction treatment. For maintenance immunosuppression, the same regimen was maintained by 74.2% of the respondents, 24.3% decreased it and 1.5% suspended it completely. In case of relapse or flare, 53.6% used standard increase of immunosuppression, 39.7% increased it but at lower levels than usual and 6.7% continued the maintenance regimen. For patients already on immunosuppression diagnosed with COVID-19 infection, 42% would decrease immunosuppressive regimens for mild disease, 62.3% in case of moderate disease and 70.8% would consider completely discontinuing immunosuppression in case of severe disease. Conclusions: Over 40% of the respondents in LA are already prescribing lower than recommended doses of immunosuppression for induction, relapses or flares as a preventive strategy in the context of COVID-19 pandemic. How this change in practice would affect the renal outcomes remains to be seen. The experience in the treatment of GD in patients with concurrent COVID-19 infection remains limited.
ABSTRACT
Background: Patients on dialysis belong to the high-risk group to develop severe COVID-19 infection due to their multiple comorbidities. International societies have issued recommendations for the control and prevention of SARS-CoV-2 infection at dialysis units but implementing them may not always be feasible as many healthcare systems in Latin America (LA) have limited resources. This study aims to reflect the experience of nephrologists in LA at taking care of these patients and if the recommendations were adopted in their practices. Methods: Descriptive analysis extracted from an online survey carried out among nephrologists, renal pathologists and other health workers treating kidney diseases between May 20-27, 2020 from sixteen Spanish speaking LA countries divided into 6 categories. We present the results for the ESRD category. Results: 430 responses were obtained, 360 were considered for analysis. 276 (86.5%) of the participants were nephrologists and 178 (64%) of them practiced in dialysis units. 163 (92.6%) already implemented strategies to control and prevent COVID-19 in their units. 125 (71%) received training on it and 128 (72.7%) reported personal protective equipment availability. The most common implemented strategies were: education sessions about COVID-19 for patients and caregivers (68.5%), designated isolation areas (77.8%) or shifts (68.75%) for patients with suspected or confirmed COVID-19 and a 7-feet separation between hemodialysis (HD) machines (61.9%). 49 (28%) of the nephrologists reported an outbreak among patients and 60 (34.2%) among medical staff. Patient absenteeism to their HD sessions due to fear of infection, a decrease in the frequency and a shortening of the time of the sessions was reported in 41.7%, 30.2% and 36%, respectively. 29 (16.5%) of the respondents considered that those practices were associated with patient mortality. Conclusions: Most dialysis units in LA are partially implementing the recommended strategies for control and prevention of COVID-19 but this seems to be insufficient since at least one third of them already faced outbreaks among patients and medical staff.