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: Coronavirus disease 2019 (COVID-19) is caused by Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). Kidney transplant recipients are at a higher risk for complications due to comorbid conditions and concurrent immunosuppression. We like to describe a small cohort of kidney transplant recipients with COVID-19 Methods: A single-center, retrospective observational cohort study describing short term outcomes of COVID-19 infection in kidney transplant recipients. Results: A total of 8 kidney transplant recipients were diagnosed with COVID-19 with a mean age of 58 yrs (26-78), predominantly African American (7/8), mean durationfrom transplant 3.5 yrs (1.5-11 yrs). All patients have HTN (8/8), half the patients have Diabetes mellitus-2 (4/8). Common presenting symptoms are fever and shortness of breath. 6/8 patients required hospitalization. 8/8 patients were managed with a reduction of immunosuppression, primarily by decreasing the dose or holding the anti-proliferative agent. 1/8 patients died, 4/6 discharged from hospital, 1/6 still admitted to the hospital with respiratory failure. 5/6 patients required supplemental oxygen. 2/6 patients required ICU stay and 1/6 required mechanical ventilation and renal replacement therapy. 3/6 hospitalized patients received hydroxychloroquine/ Azithromycin combination and 1/6 received Remdesivir. Median hospital stay is 5 days with a mean of 9 days. The patient who required mechanical ventilation and renal replacement is the only recipient who died from COVID-19 at our transplant center. Conclusions: COVID-19 is a novel infection primarily presenting with fever and shortness of breath. The course of illness appears to be severe with the majority of patients requiring supplemental oxygen and a third of hospital admitted patients required ICU stay. Reduction of immunosuppression appears to be helpful, however, no control group available. COVID-19 affected population is predominantly African American (7/8) and older recipients with age > 50 yrs (7/8).
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.