Diabetic Kidney Disease and Covid-19

Diabetic kidney disease (DKD) is the leading cause of morbidity and mortality in patients with diabetes. Moreover, chronic kidney disease (CKD) is associated with cardiovascular disease (CVD) in these patients. Of interest, DKD patients express a chronic systemic inflammation that contributes to the immunosuppressed state that accounts for infectious complications. Hospital admissions and mortality from the coronavirus disease 2019 (COVID-19) pandemic are spreading throughout the world. Risk factors for severe COVID-19 include diabetes, CKD, and CVD. In susceptible patients, preexisting immune deficiency and other chronic conditions can promote the well-known "cytokine storm” observed in COVID-19. As with many other organs, the kidneys are susceptible to be affected since they express the ACE2 receptor (SARS-CoV-2 cell receptor). Beyond the reported acute kidney involvement, growing evidence showed that CKD progression might be accelerated due to the associated chronic endothelial dysfunction observed in COVID-19 patients. This chapter explores the existing evidence regarding the COVID-19 pandemic crashing with the old diabetes pandemic. Likewise, a special approach to the possible benefits of antidiabetic and other drugs is discussed. © Springer Nature Switzerland AG 2014, 2022.

COVID-19 VACCINATION IMPROVED PSYCHOLOGICAL DISTRESS (ANXIETY AND DEPRESSION SCORES) IN CHRONIC KIDNEY DISEASE PATIENTS: A PROSPECTIVE STUDY

BACKGROUND AND AIMS: To our knowledge, the psychological impact of coronavirus disease (COVID-19) vaccination has not yet been evaluated for the general population nor for chronic kidney disease (CKD) patients. The purpose of the study is to analyse the impact of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on anxiety and depression scores in patients with different modalities of CKD. METHOD: A total of 117 renal patients (50 haemodialysis patients, 13 peritoneal dialysis patients, 32 kidney transplants and 22 advanced CKD patients at pre-dialysis care) were evaluated for depression, anxiety, health-related quality of life (HRQOL) and perceived fears and resources with standardized (The Hospital Anxiety and Depression Scale;HADS) and self-reported questionnaires. The measure points were before vaccination and 15 days after vaccination. RESULTS: The main finding of the study is that there is a decrease in the global mean of normal scores for anxiety and depression symptoms in CKD patients, postvaccination. We did not find statistically significant differences in depression or anxiety scores, nor HRQOL differences between the treatment groups. The three main fears reported by the participants at baseline were those of adverse effects, not getting the vaccine and lack of information. CONCLUSION: These findings highlight the potential interest of assessing psychological variables related to the impact of vaccination against SARS-CoV-2. New studies will be required to assess the impact of comprehensive vaccine coverage and its psychological impact.

DYNAMICS OF SARS-COV-2-SPIKE-REACTIVE ANTIBODY AND T-CELL RESPONSES IN CHRONIC KIDNEY DISEASE PATIENTS WITHIN 3 MONTHS AFTER COVID-19 FULL VACCINATION

BACKGROUND AND AIMS: Little is known regarding the dynamics of antibody and T-cell responses in chronic kidney disease (CKD) following COVID-19 vaccination. METHOD: Prospective observational cohort study including 144 participants on haemodialysis (HD) (n = 52), peritoneal dialysis (PD) (n = 14), kidney transplantation (KT) (n = 30) or advanced chronic kidney disease not on dialysis (ACKD), and healthy controls (n = 18). Anti-Spike(S) antibody and T-cell responses were assessed at 15 days (15D) and 3 months (3M) after vaccination. RESULTS: Anti-S antibodies at 15D and 3M were detectable in 95% (48/50)/98% (49/50) of HD patients, 93% (13/14)/100% of PD patients, 67% (17/26)/75% (21/28) of KT patients and 96% (25/26)/100% (24/24) of ACKD patients. Rates for healthy controls were 81% (13/16)/100% (17/17). Antibody levels decreased at 3M in HD (P = 0.04), PD (P = 0.008) and ACKD patients (P = 0.0009). In KT, patients levels increased (P = 0.04) between 15D and 3M, although they were low at both time points. Detectable T-cell responses notably increased at 3M in HD patients (P < 0.022). In PD, patients response increased by 15D (13/14;93%) and 3M (9/9;100%), while they were present in KT patients at 41% (12/27), 84% (22/26) and 96% (25/26) at baseline. Detectable T-cell responses in ACKD patients reached 80% (20/25) and 89% (17/19) at 15D and 3M, respectively. whereas in healthy controls it was 67% and 89% at 15D and 3M. CONCLUSION: Most HD, PD and ACKD patients develop SARS-CoV-2-S antibody responses comparable to that of healthy controls, in contrast to KT recipients. Antibody waning at 3M was faster in HD, PD, ACKD patients. No differences in SARS-CoV-2 T-cell immunity responses were noticed across study groups.

[Pathogenic mechanisms of SARS-CoV-2 infection and kidney disease: a clinical and molecular perspective].

The SARS-CoV-2 infection has become as a worldwide public health emergency. It exhibits a variety of clinical presentations, ranging from benign to acute respiratory distress syndrome, systemic involvement, and multiorganic failure. The severity of the clinical picture depends on host and virus biological features and the presence of comorbidities such as chronic kidney disease. In addition, the interaction between the virus, angiotensin-converting enzyme 2, and the exacerbated immune response could lead to the development of acute kidney injury. However, the implications of SARS-CoV-2 infection on renal cells, the prognosis of patients with chronic kidney disease, and the long-term behavior of renal function are not entirely understood. This review aims to explore the role of SARS-CoV-2 in acute and chronic kidney disease and the possible pathogenic mechanisms of renal involvement.

Clinical and Nutritional Implications of Kidney Disease and COVID-19

By the end of 2019 emerged a cluster of pneumonia that was caused by a novel SARS-CoV-2 virus. The disease, subsequently named COVID-19, has a wide range of signs and symptoms, including fever, respiratory and gastrointestinal manifestations, and kidney disease that can evolve to a nutritional imbalance through direct and indirect mechanisms. Moreover, the prognosis of COVID-19 could worsen in high-risk populations like kidney disease patients, given their depressed immunity and impaired nutritional state. Therefore, previous reports suggest prioritizing a nutritional approach in these patients, adjusting for individual dietary needs. Thus, we aim to explore the current knowledge about the clinical and nutritional implications of patients with COVID-19 who develop acute or chronic kidney disease, highlighting proposed dietary recommendations in this group of patients.