Patients with Chronic Kidney Disease Have Higher Acute Kidney Injury Morbidity than those without after SARS-CoV-2 Infection

Background and Objectives: Chronic kidney disease (CKD) and acute kidney injury (AKI) increase the risk of serious disease and mortality in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-infected patients. This study evaluated the occurrence and outcome of AKI in CKD and non-CKD patients infected with SARS-CoV-2. Subjects and Methods: We retrospectively analyzed the medical records of 845 patients with SARS-CoV-2 infection regarding the occurrence and outcome of AKI in a coronavirus disease-2019 (COVID-19)-designated hospital in Wuhan, China, from December 31, 2019, to March 20, 2020. Results: Of the 845 COVID-19 patients, 91 had CKD and 754 had no CKD (non-CKD), of whom 22 and 14 developed AKI, respectively. Finally, 36 patients were included in the analysis. Older patients and those with cardiovascular or cerebrovascular diseases were more likely to develop AKI. More CKD patients progressed to critical illness (72.73%) than non-CKD patients (57.14%), but the degree of AKI in CKD patients was lesser than that in non-CKD patients. Higher urea nitrogen, creatinine, and proteinuria levels were observed in CKD patients. More non-CKD patients were treated with human albumin than CKD patients. The survival probability of CKD patients was lower than that of non-CKD patients, but it was not statistically significant. Conclusion: There were significant differences in the incidence rate of AKI after SARS-CoV-2 infection between CKD and non-CKD patients, and the clinical manifestations and treatments of AKI also differed. These results highlight the necessity of variable treatment methods for optimal clinical management.

Changes before and after COVID-19 pandemic on the personal hygiene behaviors and incidence of peritonitis in peritoneal-dialysis patients: a multi-center retrospective study.

BACKGROUND: The impact of Coronavirus disease (COVID-19) pandemic and its influence on personal hygiene behaviors and peritonitis rate in peritoneal-dialysis patients is unknown. METHODS: A multi-center retrospective study was conducted. We reviewed all the cases of peritoneal-dialysis (PD) patients from four major PD centers in Wuhan before and after COVID-19. There were 567 patients enrolled in total. Information was collected on personal hygiene behaviors, basic clinical characteristics, lab results, peritonitis details. We used Chi-square analysis to compare the personal hygiene behaviors, and used Chi-square goodness-of-fit analysis to compare the peritonitis rates before and after COVID-19. Multivariate logistic regression analysis was used to analyze the risk factors for peritonitis rate. RESULTS: There were no significant differences on peritonitis rates in six-month period before and after COVID-19 (p = 0.0756, Fig. 2 and Table 3). But Gram-positive infections decreased dramatically (p = 0.0041, Table 4). Personal hygiene behaviors such as length of time for washing hands when performing PD treatment, the frequency of washing hands before PD treatment and six general behaviors had significant differences (P < 0.05 Table 2). The multivariate logistic regression analysis showed never washing hands before PD treatment and serum albumin level were the risk factors of peritonitis during COVID-19 (OR 14.408, 95%CI 3.930 -52.821, P = 0.0002; OR 4.681, 95% CI 1.755 -12.485, P = 0.002, Table 5). CONCLUSIONS: The COVID-19 pandemic had a significant positive influence on personal hygiene behaviors. Peritonitis rate did not significantly decrease but Gram-positive infections dramatically decreased. Never hand washing before PD treatment and serum albumin were the risk factors for peritonitis. We should emphasize hand washing before PD treatment in training and re-training program.

Bed-sided short-duration renal replacement therapy provide a possible option to treat non-critical coronavirus disease 2019 in maintenance hemodialysis patients in public health crisis.

HD care may experience great stress with the coronavirus disease 2019 (COVID-19) pandemic. A modified HD modality named bed-sided short-duration renal replacement therapy (BSRRT) was used in noncritical maintenance HD (MHD) patients diagnosed with COVID-19 in Wuhan due to extreme situation. To determine the safety and efficacy as a substitution for intermittent HD (IHD), we conducted this study. We used the data of 88 noncritical COVID-19 MHD patients collected from 65 medical units at the hospitals in Wuhan, China, from January 1 to March 10, 2020. t-test, Wilcoxon rank sum test, and Fisher exact probability method were used to compare the baseline characteristics, treatment, and death. Log-rank test and Cox regression multivariate analysis was used to compare the survival of noncritical patients who were transferred to BSRRT modality versus those who were continued on the IHD. Univariate analysis showed the level of reported fatigue symptom at present, bilateral lung computed tomography infiltration and steroid treatment differed between the two groups. The outcome of death of the two groups did not show significant differences in univariate analysis (P = .0563). Multivariate Cox regression analysis dialysis showed modality of treatment after COVID-19 diagnosis was not a significant predictor of death (P = .1000). These data suggest that for noncritical COVID-19 MHD patients, the transfer from IHD to BSRRT does not have significant difference in the risk of death compared with IHD group. This finding suggests this modified modality could be an option for the substitution for IHD during the COVID-19 pandemic period.

Kidney damage in COVID-19 patients with or without chronic kidney disease: Analysis of clinical characteristics and related risk factors

COVID-19 poses more risk to patients who already suffer from other diseases, particularly respiratory disorder. In this study, we analyzed the clinical characteristics and related risk factors during hospitalization of COVID-19 patients admitted with kidney damage. A total of 102 COVID-19 patients with kidney damage [irrespective of their chronic kidney disease (CKD) history] during hospitalization were included in this study. The patients were divided into a core group and a group who developed critical illness or death. Clinical data included age, gender, length of hospitalization, clinical manifestations, medical history, hypersensitive C-reactive protein (hs -CRP), high serum creatinine, low cardiac troponin I (cTnI), and hemoglobin. Univariate and multivariate logistic regression models were used to analyze the risk factors of patients' outcome. Among the outcomes, 75 patients (73.53%) were cured, 27 (26.47%) developed to critical illness or death, 20 (19.61%) of them died. A total of 36 (4.26%) out of 845 COVID-19 patients, developed acute kidney injury (AKI). Decreased oxygen saturation, elevated hs-CRP, elevated serum creatinine, elevated cTnI, and anemia were related factors for COVID-19 patients who developed to critical illness or death (P <0.05). Decreased oxygen saturation, elevated hs-CRP and anemia were not independent factors, but elevated serum creatinine and elevated cTnI were independent factors for COVID-19 patients who developed to critical illness or death (P <0.05). Among COVID-19 patients with or without CKD but with kidney damage during hospitalization, patients with elevated serum creatinine and elevated Tnl, more likely to developed critical illness or death.

COVID-19-Related Glomerulopathy: A Report of 2 Cases of Collapsing Focal Segmental Glomerulosclerosis.

Coronavirus disease 19 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been associated with acute kidney injury, presumably due to acute tubular injury. However, this does not explain proteinuria, sometimes severe, and hematuria often observed. We present 2 African American patients with glomerulopathy demonstrated by kidney biopsy in the setting of acute kidney injury and COVID-19 infection. Kidney biopsy specimens showed a collapsing variant of focal segmental glomerulosclerosis in addition to acute tubular injury. Both patients were homozygous for apolipoprotein L1 (APOL1). COVID-19 infection likely caused the interferon surge as a second hit causing podocyte injury leading to collapsing focal segmental glomerulosclerosis. APOL1 testing should be strongly considered in African American patients with nephrotic-range proteinuria. More data from future kidney biopsies will further elucidate the pathology of kidney injury and glomerular involvement from COVID-19 infections.