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Clin Kidney J ; 13(4): 550-563, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-1109189


BACKGROUND: Acute kidney injury (AKI) can affect hospitalized patients with coronavirus disease 2019 (COVID-19), with estimates ranging between 0.5% and 40%. We performed a systematic review and meta-analysis of studies reporting incidence, mortality and risk factors for AKI in hospitalized COVID-19 patients. METHODS: We systematically searched 11 electronic databases until 29 May 2020 for studies in English reporting original data on AKI and kidney replacement therapy (KRT) in hospitalized COVID-19 patients. Incidences of AKI and KRT and risk ratios for mortality associated with AKI were pooled using generalized linear mixed and random-effects models. Potential risk factors for AKI were assessed using meta-regression. Incidences were stratified by geographic location and disease severity. RESULTS: A total of 3042 articles were identified, of which 142 studies were included, with 49 048 hospitalized COVID-19 patients including 5152 AKI events. The risk of bias of included studies was generally low. The pooled incidence of AKI was 28.6% [95% confidence interval (CI) 19.8-39.5] among hospitalized COVID-19 patients from the USA and Europe (20 studies) and 5.5% (95% CI 4.1-7.4) among patients from China (62 studies), whereas the pooled incidence of KRT was 7.7% (95% CI 5.1-11.4; 18 studies) and 2.2% (95% CI 1.5-3.3; 52 studies), respectively. Among patients admitted to the intensive care unit, the incidence of KRT was 20.6% (95% CI 15.7-26.7; 38 studies). Meta-regression analyses showed that age, male sex, cardiovascular disease, diabetes mellitus, hypertension and chronic kidney disease were associated with the occurrence of AKI; in itself, AKI was associated with an increased risk of mortality, with a pooled risk ratio of 4.6 (95% CI 3.3-6.5). CONCLUSIONS: AKI and KRT are common events in hospitalized COVID-19 patients, with estimates varying across geographic locations. Additional studies are needed to better understand the underlying mechanisms and optimal treatment of AKI in these patients.

Eur J Endocrinol ; 183(1): G17-G23, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-205229


Patients with pituitary tumours, ensuing hormonal abnormalities and mass effects are usually followed in multidisciplinary pituitary clinics and can represent a management challenge even during the times of non-pandemic. The COVID-19 pandemic has put on hold routine medical care for hundreds of millions of patients around the globe, while many pituitary patients' evaluations cannot be delayed for too long. Furthermore, the majority of patients with pituitary tumours have co-morbidities potentially impacting the course and management of COVID-19 (e.g. hypopituitarism, diabetes mellitus, hypertension, obesity and cardiovascular disease). Here, we summarize some of the diagnostic and management dilemmas encountered, and provide guidance on safe and as effective as possible delivery of care in the COVID-19 era. We also attempt to address how pituitary services should be remodelled in the event of similar crises, while maintaining or even improving patient outcomes. Regular review of these recommendations and further adjustments are needed, depending on the evolution of the COVID-19 pandemic status. We consider that the utilization of successful models of pituitary multidisciplinary care implemented during the COVID-19 pandemic should continue after the crisis is over by using the valuable and exceptional experience gained during these challenging times.

Adenoma/therapy , Antineoplastic Agents, Hormonal/therapeutic use , Coronavirus Infections , Dopamine Agonists/therapeutic use , Neurosurgical Procedures , Pandemics , Pituitary Apoplexy/therapy , Pituitary Neoplasms/therapy , Pneumonia, Viral , Adenoma/diagnosis , COVID-19 , Cabergoline/therapeutic use , Disease Management , Hormone Replacement Therapy , Human Growth Hormone/analogs & derivatives , Human Growth Hormone/therapeutic use , Humans , Octreotide/therapeutic use , Peptides, Cyclic/therapeutic use , Pituitary Apoplexy/diagnosis , Pituitary Neoplasms/diagnosis , Practice Guidelines as Topic , Radiotherapy , Somatostatin/analogs & derivatives , Somatostatin/therapeutic use , Telemedicine , Time Factors , Visual Field Tests
Eur J Endocrinol ; 183(1): E1-E2, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-76418