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1.
Indian Journal of Nephrology ; 32(2):110-115, 2022.
Article in English | ProQuest Central | ID: covidwho-1810673

ABSTRACT

Introduction: Since COVID-19 has been announced as a pandemic, outcome of dialysis patients in terms of morbidity and mortality from India is lacking. We studied the clinical, epidemiological features of COVID-19 along with outcome in terms of mortality in our dialysis cohort. Methods: Data of End-Stage Kidney Disease (ESKD) patients who were admitted in COVID-19 designated hospital block as positive and suspected patients from 1st April 2020 to 31st July 2020 was retrieved. Data about epidemiological characteristics, clinical features, mortality outcomes of COVID-19 positive and negative patients were analyzed. Results: A total of 97 ESKD patients were admitted during the study period, of which 44 (45.4%) and 53 (54.6%) patients were found to be COVID-19 positive and negative respectively. The mean age of COVID positive patients was 46 years with 54.5% being female. Only three patients (6.8%) remained asymptomatic throughout the course of illness. Amongst COVID-19 positive, 20 (45.45%) were severely ill while 18 (40.9%) were having mild illnesses. Breathlessness (65.9%) and fever (61.4%) were common symptoms. The death occurred in 17 (38.6%) and 25 (47.1%) COVID-19 positive and negative ESKD patients respectively. 14 (82.3%) patients who expired amongst COVID-19 positive were having severe illness and significantly more were associated with negligible residual renal function. Conclusions: Breathlessness and fever were common symptoms amongst COVID-19 ESKD patients. Very few patients remained asymptomatic in our cohort and significantly more mortality is observed in severely ill patients and those with negligible residual renal function.

2.
Kidney Medicine ; : 100470, 2022.
Article in English | ScienceDirect | ID: covidwho-1805342

ABSTRACT

Rationale & Objective Neutralizing monoclonal antibody treatments have shown promising preliminary results in kidney transplant recipients infected with SARS-CoV-2. However, their efficacy in kidney transplant recipients infected with Omicron variant has not been reported yet. Study Design Single-center retrospective study. Setting & Participants We included all consecutive kidney transplant recipients treated with monoclonal antibodies for SARS-CoV-2 infection (positive polymerase chain reaction on nasopharyngeal swab) between June 10th 2021 and January 14th 2022. Forty-seven kidney transplant recipients were included. All patients had symptoms evolving for ≤ 7 days and no oxygen therapy need at monoclonal antibody infusion. Results Symptoms at diagnosis were mainly cough (n=25 [53%]) and fever (n=15 [32%]). Eighty-three percent of the cohort (n=39) had been vaccinated with at least 2 doses before infection, of whom 77% (n=30) had demonstrated a vaccine-induced humoral response. They were treated with either casirivimab-imdevimab (n= 16 [34%]) or sotrovimab (n= 31 [66%]) a median of 2 (ranges 0-6) days after the onset of symptoms. Except for one mild allergic reaction during casirivimab-imdevimab infusion, no side effects were reported. Median viral loads at admission (day 0) and 7 days after mAb infusion were 2,110,027 (ranges 1000-153,798,962) copies/mL and 1,000 (ranges 0-10,000,000) copies/mL, respectively. Genotypes were available for 22 kidney transplant recipients (47%). Omicron, Delta, and Gamma variants were identified in 13 (59%), 8 (36%), 1 (5%) patients, respectively. In kidney transplant recipients infected with Omicron variant, the median viral loads at day 0 and day 7 were 752,789 (ranges 4000-12,859,300) copies/mL and 1,353 (ranges 0-1,211,163) copies/mL, respectively. Two kidney transplant recipients required hospitalization immediately after sotrovimab perfusion for oxygen therapy that was weaned in 3 days allowing patients’ discharge. None were admitted to the intensive care unit or died. Limitations Small sample-size, no control group. Conclusions Neutralizing monoclonal antibody therapy is associated with positive outcomes in kidney transplant recipients with mild COVID-19, including those infected with the Omicron variant.

3.
Eur J Clin Invest ; : e13786, 2022 Apr 02.
Article in English | MEDLINE | ID: covidwho-1774786

ABSTRACT

BACKGROUND: Individuals with chronic kidney disease are affected by acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to multiple comorbidities and altered immune system. The first step of the infection process is the binding of SARS-CoV-2 with angiotensin-converting enzyme 2 (ACE2) receptor, followed by its priming by transmembrane protease serine 2 (TMPRSS2). We hypothesized that circulating soluble ACE2 levels, as well as the expressions of ACE2 and TMPRSS2 in the microvasculature, are increased in patients with end-stage kidney disease (ESKD). METHODS: A total of 210 participants were enrolled, representing 80 ESKD patients and 73 non-CKD controls for soluble ACE2, and 31 ESKD and 26 non-CKD controls for vasculature and fat tissue bioassays. We have assessed ACE2 expression in blood using ELISA and in tissue using immunofluorescence. RESULTS: Soluble ACE2 levels were higher in ESKD patients compared to controls; however, there is no sex difference observed. In ESKD and controls, soluble ACE2 positively correlated with Interleukin 6 (IL-6) and C-reactive protein (CRP), respectively. Similarly, ACE2 tissue expression in the vasculature was higher in ESKD patients; moreover, this higher ACE2 expression was observed only in male ESKD patients. In addition, TMPRSS2 expression was observed in vessels from males and females but showed no sex difference. The expression of ACE2 receptor was higher in ESKD patients on ACE-inhibitor/angiotensin blocker treatment. CONCLUSION: ESKD is associated with increased ACE2 levels in the circulation and pronounced in male vasculature; however, further studies are warranted to assess possible sex differences on specific treatment regime(s) for different comorbidities present in ESKD.

4.
Cureus ; 14(3): e23575, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1771741

ABSTRACT

Background Patients with end-stage kidney disease (ESKD) are disproportionately vulnerable to COVID-19 and its complications due to the older age and significant burden of comorbid conditions. Data about the impact of COVID-19 on the ESKD population in the Kingdom of Saudi Arabia is scarce, and this study aims to bridge this gap. Method This is a retrospective cohort study that included ESKD patients who were receiving either in-center hemodialysis (HD) or peritoneal dialysis (PD) for at least three months and were hospitalized due to COVID-19 at King Abdulaziz Medical City in Riyadh (KAMC) between March 2020 and March 2021. Of note, the in-center hemodialysis means that the patients come to the dialysis center three times per week to receive their dialysis sessions, as home hemodialysis is not available at our center. Multivariate logistic regression was performed to explore the association of clinical characteristics and laboratory parameters with ICU admission and mortality. Results A total of 104 patients were included in the analysis. The mean age was 62.6 (SD=17.4) years, 101 (97%) were on HD, predominantly through a central venous catheter (72%), and 53 patients (51%) were male. Patients with COVID-19 were either asymptomatic (42%) or had mild symptoms (37%), mainly cough and fever. At the time of admission, 37 patients (36%) had extrapulmonary symptoms, and 13 patients (12%) had altered mental status. Normal chest X-ray (48%), followed by bilateral lung infiltrates (24%), and unilateral lung infiltrate (11%) were the most common radiological findings. We did not observe any thromboembolic events. Twenty patients (19%) required ICU admission and 19 patients (18%) died during hospitalization. Predictors for in-hospital mortality were: 1) the need for inotropes (adjusted OR: 53.01, p=0.006), 2) age (adjusted OR: 1.07, p=0.019), and 3) C-reactive protein (CRP) level on admission (adjusted OR: 1.02, p=0.04). We did not find any strong predictor for ICU admission. Conclusion Our study demonstrated that COVID-19 carries significant mortality and morbidity in the ESKD population. Age, inotropic support requirement and elevated CRP on admission predicted mortality in our population. The high rate of adverse outcomes of COVID-19 among ESRD patients calls for strict implementation of preventive measures, including vaccination, social distancing, and universal masking at the level of both the healthcare providers and patients. Further studies are needed to assess the association of COVID-19 and hypercoagulability ESKD population.

5.
Turkish Journal of Nephrology ; 31(1):17-22, 2022.
Article in English | Web of Science | ID: covidwho-1761038

ABSTRACT

Objective: Novel coronavirus disease-19 is spreading rapidly, and therefore, optimal management of the disease in endstage kidney disease patients requiring hemodialysis is not fully explained. We report the clinical characteristics and the short-term outcomes in patients with end-stage renal disease who require hospitalization for coronavirus disease-19 and who underwent hemodialysis. Methods: In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of 116 consecutive end-stage kidney disease patients hospitalized with laboratory-confirmed coronavirus disease-19 who underwent at least 1 hemodialysis session in our hospital between June 26 and August 10, 2020. Baseline clinical features, laboratory data, and treatment given were compared between survivors and non-survivors to identify risk factors associated with mortality. Results: Among the 116 patients who were enrolled in our study, males constituted 81% (n = 94). Many had underlying comorbidities, of which hypertension (90.4%) was the most common. The most common symptoms were fever (76.1%), dyspnoea (61.2%), cough (58.6%), and diarrhea (18.1%). In total, 66.4% of patients had arteriovenous fistula or grafts. Inflammatory markers like C-reactive protein and serum ferritin were significantly higher in non-survivors group. Multivariate logistic regression analysis revealed that dialysis vintage less than 6 months was the most important predictor for mortality. Mortality was 27.5% in our cohort. Conclusion: Mortality among hospitalized end-stage kidney disease patients who underwent hemodialysis was higher when compared to the general population. The presence of comorbid conditions like hypertension, diabetes mellitus, and pre-existing pulmonary disease had a poor prognosis. Patients having central venous catheters as their dialysis access had a poor prognosis. Dialysis vintage less than 6 months was the most important predictor of mortality.

7.
J Am Soc Nephrol ; 32(11): 2851-2862, 2021 11.
Article in English | MEDLINE | ID: covidwho-1690622

ABSTRACT

BACKGROUND: COVID-19 is associated with increased risk of post-acute sequelae involving pulmonary and extrapulmonary organ systems-referred to as long COVID. However, a detailed assessment of kidney outcomes in long COVID is not yet available. METHODS: We built a cohort of 1,726,683 US Veterans identified from March 1, 2020 to March 15, 2021, including 89,216 patients who were 30-day survivors of COVID-19 and 1,637,467 non-infected controls. We examined risks of AKI, eGFR decline, ESKD, and major adverse kidney events (MAKE). MAKE was defined as eGFR decline ≥50%, ESKD, or all-cause mortality. We used inverse probability-weighted survival regression, adjusting for predefined demographic and health characteristics, and algorithmically selected high-dimensional covariates, including diagnoses, medications, and laboratory tests. Linear mixed models characterized intra-individual eGFR trajectory. RESULTS: Beyond the acute illness, 30-day survivors of COVID-19 exhibited a higher risk of AKI (aHR, 1.94; 95% CI, 1.86 to 2.04), eGFR decline ≥30% (aHR, 1.25; 95% CI, 1.14 to 1.37), eGFR decline ≥40% (aHR, 1.44; 95% CI, 1.37 to 1.51), eGFR decline ≥50% (aHR, 1.62; 95% CI, 1.51 to 1.74), ESKD (aHR, 2.96; 95% CI, 2.49 to 3.51), and MAKE (aHR, 1.66; 95% CI, 1.58 to 1.74). Increase in risks of post-acute kidney outcomes was graded according to the severity of the acute infection (whether patients were non-hospitalized, hospitalized, or admitted to intensive care). Compared with non-infected controls, 30-day survivors of COVID-19 exhibited excess eGFR decline (95% CI) of -3.26 (-3.58 to -2.94), -5.20 (-6.24 to -4.16), and -7.69 (-8.27 to -7.12) ml/min per 1.73 m2 per year, respectively, in non-hospitalized, hospitalized, and those admitted to intensive care during the acute phase of COVID-19 infection. CONCLUSIONS: Patients who survived COVID-19 exhibited increased risk of kidney outcomes in the post-acute phase of the disease. Post-acute COVID-19 care should include attention to kidney disease.


Subject(s)
COVID-19/complications , Kidney Diseases/epidemiology , Kidney Diseases/virology , Veterans/statistics & numerical data , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Case-Control Studies , Cohort Studies , Critical Care , Female , Glomerular Filtration Rate , Hospitalization , Humans , Kidney Diseases/diagnosis , Male , Middle Aged , United States
8.
Indian J Nephrol ; 32(1): 16-21, 2022.
Article in English | MEDLINE | ID: covidwho-1662749

ABSTRACT

Introduction: Several months into the coronavirus disease 2019 (COVID-19) pandemic, there remains a paucity of data on the behavior of the disease in patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (MHD). Here, we describe the clinical presentations, biochemical profile, and outcomes of 183 such patients from a large tertiary-care center in South India. Materials and Methods: This prospective, observational study, included all patients with COVID-19 and ESKD who received at least one session of hemodialysis at our center, from the start of the outbreak to July 9, 2020. Clinical features at presentation, laboratory and radiological data, and outcomes were analyzed. Results: A total of 183 patients were included in the analysis. Patients who had symptoms at presentation accounted for 49.18% of the cohort, with the most common symptoms being fever (87.1%), cough (67.7%), and breathlessness (63.4%). Factors independently associated with mortality on univariate analysis included age ≥60 years, having symptoms at presentation, neutrophil-lymphocyte ratio >6, C-reactive protein >20 mg/L, serum lactate dehydrogenase >250 IU/L, CT (computed tomography) Grades 3 and 4, and the need for respiratory support. However, on multivariate logistic regression analysis, the only factor that retained significance was an age >60 years. Conclusions: This analysis confirms the previous reports of higher COVID-19-related mortality in the dialysis population and identifies older age, higher inflammatory markers, and greater degrees of radiological lung involvement to correlate with increased mortality.

11.
J Am Soc Nephrol ; 32(11): 2948-2957, 2021 11.
Article in English | MEDLINE | ID: covidwho-1496700

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused major disruptions to care for patients with advanced CKD. METHODS: We investigated the incidence of documented ESKD, ESKD treatment modalities, changes in eGFR at dialysis initiation, and use of incident central venous catheters (CVCs) by epidemiologic week during the first half of 2020 compared with 2017-2019 historical trends, using Centers for Medicare and Medicaid Services data. We used Poisson and logistic regression for analyses of incidence and binary outcomes, respectively. RESULTS: Incidence of documented ESKD dropped dramatically in 2020 compared with the expected incidence, particularly during epidemiologic weeks 15-18 (April, incidence rate ratio [IRR], 0.75; 95% CI, 0.73 to 0.78). The decrease was most pronounced for individuals aged ≥75 years (IRR, 0.69; 95% CI, 0.66 to 0.73). Pre-emptive kidney transplantation decreased markedly during weeks 15-18 (IRR, 0.56; 95% CI, 0.46 to 0.67). Mean eGFR at dialysis initiation decreased by 0.33 ml/min per 1.73 m2 in weeks 19-22; non-Hispanic Black patients exhibited the largest decrease, at 0.61 ml/min per 1.73 m2. The odds of initiating dialysis with eGFR <10 ml/min per 1.73 m2 were highest during weeks 19-22 (May, OR, 1.14; 95% CI, 1.05 to 1.17), corresponding to an absolute increase of 2.9%. The odds of initiating peritoneal dialysis (versus hemodialysis) were 24% higher (OR, 1.24; 95% CI, 1.14 to 1.34) in weeks 11-14, an absolute increase of 2.3%. Initiation with a CVC increased by 3.3% (OR, 1.30; 95% CI, 1.20 to 1.41). CONCLUSIONS: During the first wave of the COVID-19 pandemic, the number of patients starting treatment for ESKD fell to a level not observed since 2011. Changes in documented ESKD incidence and other aspects of ESKD-related care may reflect differential access to care early in the pandemic.


Subject(s)
COVID-19/epidemiology , Kidney Failure, Chronic/epidemiology , Adolescent , Adult , Aged , Catheterization, Central Venous/statistics & numerical data , Glomerular Filtration Rate , Humans , Incidence , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Kidney Transplantation/statistics & numerical data , Logistic Models , Middle Aged , Odds Ratio , Procedures and Techniques Utilization , Renal Dialysis/statistics & numerical data , United States , Young Adult
12.
Nephron ; 146(1): 67-71, 2022.
Article in English | MEDLINE | ID: covidwho-1463077

ABSTRACT

CONTEXT: Coronavirus disease 2019 (COVID-19) disproportionately impacts patients with chronic kidney disease (CKD), especially those with kidney failure requiring replacement therapy (KFRT). Patients with KFRT have increased risk of developing COVID-19, and though initial reports suggested that mortality of these patients in the intensive care unit (ICU) setting is prohibitively high, those studies suffered from significant limitations. Subject of Review: The Study of the Treatment and Outcomes in Critically Ill Patients With COVID-19 (STOP-COVID) is a multicenter cohort study that enrolled adults with COVID-19 admitted to ICUs in 68 medical centers across the USA. STOP-COVID investigators compared characteristics at the time of ICU admission and clinical outcomes in 143 patients with KFRT, 521 with nondialysis-dependent CKD (ND-CKD), and 3,600 patients without CKD. Patients with KFRT were less likely to have typical COVID-19 symptoms but more likely to have altered mental status at the time of ICU admission and were less likely to require mechanical ventilation during hospitalization than those without kidney disease. Approximately, 50% of patients with KFRT and ND-CKD died within 28 days of ICU admission, and in fully adjusted models, patients with KFRT and ND-CKD had 1.41- and 1.25-fold higher risk of 28-day mortality than those without CKD. Patients with KFRT and ND-CKD were also less likely to receive emerging therapies for COVID-19 than those without CKD. Second Opinion: This study provides important new data demonstrating differences in clinical presentation in patients with KFRT and ND-CKD with COVID-19. Alhough patients with severe CKD had higher mortality than those without CKD, approximately half survived after 28 days, demonstrating that patients with COVID-19 and severe CKD can benefit from ICU care. The markedly lower use of emerging COVID-19 treatments in patients with severe CKD highlights the need to include these patients in clinical trials of new COVID-19 therapies and for clinicians to ensure equal access to care in patients with severe CKD and COVID-19.


Subject(s)
COVID-19/complications , Intensive Care Units , Renal Insufficiency, Chronic/complications , COVID-19/virology , Humans , Patient Admission , SARS-CoV-2/isolation & purification , Treatment Outcome , United States
13.
J Am Soc Nephrol ; 32(11): 2948-2957, 2021 11.
Article in English | MEDLINE | ID: covidwho-1430594

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused major disruptions to care for patients with advanced CKD. METHODS: We investigated the incidence of documented ESKD, ESKD treatment modalities, changes in eGFR at dialysis initiation, and use of incident central venous catheters (CVCs) by epidemiologic week during the first half of 2020 compared with 2017-2019 historical trends, using Centers for Medicare and Medicaid Services data. We used Poisson and logistic regression for analyses of incidence and binary outcomes, respectively. RESULTS: Incidence of documented ESKD dropped dramatically in 2020 compared with the expected incidence, particularly during epidemiologic weeks 15-18 (April, incidence rate ratio [IRR], 0.75; 95% CI, 0.73 to 0.78). The decrease was most pronounced for individuals aged ≥75 years (IRR, 0.69; 95% CI, 0.66 to 0.73). Pre-emptive kidney transplantation decreased markedly during weeks 15-18 (IRR, 0.56; 95% CI, 0.46 to 0.67). Mean eGFR at dialysis initiation decreased by 0.33 ml/min per 1.73 m2 in weeks 19-22; non-Hispanic Black patients exhibited the largest decrease, at 0.61 ml/min per 1.73 m2. The odds of initiating dialysis with eGFR <10 ml/min per 1.73 m2 were highest during weeks 19-22 (May, OR, 1.14; 95% CI, 1.05 to 1.17), corresponding to an absolute increase of 2.9%. The odds of initiating peritoneal dialysis (versus hemodialysis) were 24% higher (OR, 1.24; 95% CI, 1.14 to 1.34) in weeks 11-14, an absolute increase of 2.3%. Initiation with a CVC increased by 3.3% (OR, 1.30; 95% CI, 1.20 to 1.41). CONCLUSIONS: During the first wave of the COVID-19 pandemic, the number of patients starting treatment for ESKD fell to a level not observed since 2011. Changes in documented ESKD incidence and other aspects of ESKD-related care may reflect differential access to care early in the pandemic.


Subject(s)
COVID-19/epidemiology , Kidney Failure, Chronic/epidemiology , Adolescent , Adult , Aged , Catheterization, Central Venous/statistics & numerical data , Glomerular Filtration Rate , Humans , Incidence , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Kidney Transplantation/statistics & numerical data , Logistic Models , Middle Aged , Odds Ratio , Procedures and Techniques Utilization , Renal Dialysis/statistics & numerical data , United States , Young Adult
14.
Int J Gen Med ; 14: 4837-4845, 2021.
Article in English | MEDLINE | ID: covidwho-1416997

ABSTRACT

BACKGROUND: The prognosis of the novel coronavirus disease 2019 (COVID-19) may be poor in patients with end-stage kidney disease (ESKD). Limited information is available on the clinical characteristics and outcomes of such patients in Arab countries. The present study aimed to address this gap. METHODS: This retrospective cohort study included 101 patients with ESKD who were hospitalized for COVID-19 between May 1, 2020 and December 31, 2020 at King Fahad Central Hospital (single center), Jazan Province, Saudi Arabia. Chi-square test, independent samples t-test, Mann-Whitney U-test, and Cox regression were performed in the statistical analysis. RESULTS: Of the 101 hospitalized COVID-19 patients with ESKD, 20 patients died (19.8%). Patients aged ≥ 65 years had a significant mortality risk. Mortality was higher in male patients (70%) than in female patients (30%). The most common comorbidities were hypertension (88%), diabetes mellitus (47%), and heart disease (17%). The presence of diabetes and cardiovascular diseases along with ESKD increased the mortality risk [relative risk (RR) = 6.5 and RR = 3.8, respectively]. The most frequently reported clinical symptoms were fever (50%), shortness of breath (41%), and cough (35%). In total, 17% of the patients were admitted to the intensive care unit and required mechanical ventilation. Most patients had bilateral lung infiltrates (88%). Hemoglobin levels and platelet counts were significantly lower in the deceased patients than in the surviving ones. Moreover, compared with the surviving patients, higher degree of lymphocytopenia, neutrophilia, ferritin, D-dimer, blood urea nitrogen, and aspartate transaminase were detected in the deceased patients. Septic shock (20%) and respiratory failure (19%) were the most prevalent complications resulting in death. CONCLUSION: COVID-19 patients with ESKD have an increased risk of poor outcomes and mortality. The mortality risk increases with an increase in age and the presence of other comorbidities, such as diabetes and cardiovascular disease. Elevated levels of inflammatory markers correlate with disease severity and are associated with in-hospital mortality in this population.

15.
J Am Soc Nephrol ; 32(11): 2851-2862, 2021 11.
Article in English | MEDLINE | ID: covidwho-1394649

ABSTRACT

BACKGROUND: COVID-19 is associated with increased risk of post-acute sequelae involving pulmonary and extrapulmonary organ systems-referred to as long COVID. However, a detailed assessment of kidney outcomes in long COVID is not yet available. METHODS: We built a cohort of 1,726,683 US Veterans identified from March 1, 2020 to March 15, 2021, including 89,216 patients who were 30-day survivors of COVID-19 and 1,637,467 non-infected controls. We examined risks of AKI, eGFR decline, ESKD, and major adverse kidney events (MAKE). MAKE was defined as eGFR decline ≥50%, ESKD, or all-cause mortality. We used inverse probability-weighted survival regression, adjusting for predefined demographic and health characteristics, and algorithmically selected high-dimensional covariates, including diagnoses, medications, and laboratory tests. Linear mixed models characterized intra-individual eGFR trajectory. RESULTS: Beyond the acute illness, 30-day survivors of COVID-19 exhibited a higher risk of AKI (aHR, 1.94; 95% CI, 1.86 to 2.04), eGFR decline ≥30% (aHR, 1.25; 95% CI, 1.14 to 1.37), eGFR decline ≥40% (aHR, 1.44; 95% CI, 1.37 to 1.51), eGFR decline ≥50% (aHR, 1.62; 95% CI, 1.51 to 1.74), ESKD (aHR, 2.96; 95% CI, 2.49 to 3.51), and MAKE (aHR, 1.66; 95% CI, 1.58 to 1.74). Increase in risks of post-acute kidney outcomes was graded according to the severity of the acute infection (whether patients were non-hospitalized, hospitalized, or admitted to intensive care). Compared with non-infected controls, 30-day survivors of COVID-19 exhibited excess eGFR decline (95% CI) of -3.26 (-3.58 to -2.94), -5.20 (-6.24 to -4.16), and -7.69 (-8.27 to -7.12) ml/min per 1.73 m2 per year, respectively, in non-hospitalized, hospitalized, and those admitted to intensive care during the acute phase of COVID-19 infection. CONCLUSIONS: Patients who survived COVID-19 exhibited increased risk of kidney outcomes in the post-acute phase of the disease. Post-acute COVID-19 care should include attention to kidney disease.


Subject(s)
COVID-19/complications , Kidney Diseases/epidemiology , Kidney Diseases/virology , Veterans/statistics & numerical data , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Case-Control Studies , Cohort Studies , Critical Care , Female , Glomerular Filtration Rate , Hospitalization , Humans , Kidney Diseases/diagnosis , Male , Middle Aged , United States
16.
J Am Soc Nephrol ; 2021 Apr 29.
Article in English | MEDLINE | ID: covidwho-1394648

ABSTRACT

BACKGROUND: Patients on dialysis are at increased risk for COVID-19-related complications. However, a substantial fraction of patients on dialysis belong to groups more likely to be hesitant about vaccination. METHODS: With the goal of identifying strategies to increase COVID-19 vaccine uptake among patients on hemodialysis, we conducted a nationwide vaccine acceptability survey, partnering with a dialysis network to distribute an anonymized English and Spanish language online survey in 150 randomly selected facilities in the United States. We used logistic regression to evaluate characteristics of vaccine-hesitant persons. RESULTS: A total of 1515 (14% of eligible) patients responded; 20% of all responders, 29% of patients aged 18-44 years, and 29% of Black responders reported being hesitant to seek the COVID-19 vaccine, even if the vaccine was considered safe for the general population. Odds of vaccine hesitancy were higher among patients aged 18-44 years versus those 45-64 years (odds ratio [OR], 1.5; 95% confidence interval [95% CI], 1.0 to 2.3), Black patients versus non-Hispanic White patients (OR, 1.9; 95% CI, 1.3 to 2.7), Native Americans or Pacific Islanders versus non-Hispanic White patients (OR, 2.0; 95% CI, 1.1 to 3.7), and women versus men (OR, 1.6; 95% CI, 1.2 to 2.0). About half (53%) of patients who were vaccine hesitant expressed concerns about side effects. Responders' main information sources about COVID-19 vaccines were television news and dialysis staff (68% and 38%, respectively). CONCLUSIONS: A substantial proportion of patients receiving in-center hemodialysis in the United States are hesitant about seeking COVID-19 vaccination. Facilitating uptake requires outreach to younger patients, women, and Black, Native American, or Pacific Islander patients, and addressing concerns about side effects.

17.
Am J Kidney Dis ; 78(6): 804-815, 2021 12.
Article in English | MEDLINE | ID: covidwho-1341023

ABSTRACT

RATIONALE & OBJECTIVE: Coronavirus disease 2019 (COVID-19) disproportionately affects people with chronic diseases such as chronic kidney disease (CKD). We assessed the incidence and outcomes of COVID-19 in people with CKD. STUDY DESIGN: Systematic review and meta-analysis by searching MEDLINE, EMBASE, and PubMed through February 2021. SETTING & STUDY POPULATIONS: People with CKD with or without COVID-19. SELECTION CRITERIA FOR STUDIES: Cohort and case-control studies. DATA EXTRACTION: Incidences of COVID-19, death, respiratory failure, dyspnea, recovery, intensive care admission, hospital admission, need for supplemental oxygen, hospital discharge, sepsis, short-term dialysis, acute kidney injury, and fatigue. ANALYTICAL APPROACH: Random-effects meta-analysis and evidence certainty adjudicated using an adapted version of GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS: 348 studies (382,407 participants with COVID-19 and CKD; 1,139,979 total participants with CKD) were included. Based on low-certainty evidence, the incidence of COVID-19 was higher in people with CKD treated with dialysis (105 per 10,000 person-weeks; 95% CI, 91-120; 95% prediction interval [PrI], 25-235; 59 studies; 468,233 participants) than in those with CKD not requiring kidney replacement therapy (16 per 10,000 person-weeks; 95% CI, 4-33; 95% PrI, 0-92; 5 studies; 70,683 participants) or in kidney or pancreas/kidney transplant recipients (23 per 10,000 person-weeks; 95% CI, 18-30; 95% PrI, 2-67; 29 studies; 120,281 participants). Based on low-certainty evidence, the incidence of death in people with CKD and COVID-19 was 32 per 1,000 person-weeks (95% CI, 30-35; 95% PrI, 4-81; 229 studies; 70,922 participants), which may be higher than in people with CKD without COVID-19 (incidence rate ratio, 10.26; 95% CI, 6.78-15.53; 95% PrI, 2.62-40.15; 4 studies; 18,347 participants). LIMITATIONS: Analyses were generally based on low-certainty evidence. Few studies reported outcomes in people with CKD without COVID-19 to calculate the excess risk attributable to COVID-19, and potential confounders were not adjusted for in most studies. CONCLUSIONS: The incidence of COVID-19 may be higher in people receiving maintenance dialysis than in those with CKD not requiring kidney replacement therapy or those who are kidney or pancreas/kidney transplant recipients. People with CKD and COVID-19 may have a higher incidence of death than people with CKD without COVID-19.


Subject(s)
COVID-19/epidemiology , Hospitalization/statistics & numerical data , Renal Insufficiency, Chronic/complications , COVID-19/diagnosis , COVID-19/therapy , Hospital Mortality , Humans , Incidence , Outcome and Process Assessment, Health Care , Renal Dialysis , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/therapy , SARS-CoV-2/isolation & purification
18.
Kidney Med ; 3(1): 99-104, 2021.
Article in English | MEDLINE | ID: covidwho-1307260

ABSTRACT

New Orleans' first case of coronavirus disease 2019 (COVID-19) was reported on March 9, 2020, with a subsequent rapid increase in the number of cases throughout the state of Louisiana. Traditional educational efforts were no longer viable with social distancing and stay-at-home orders; therefore, virtual didactics were integrated into our curriculum. Due to an exponential increase in the number of patients with acute kidney injury requiring kidney replacement therapy, the nephrology sections at Louisiana State University School of Medicine and Tulane University School of Medicine adapted their clinical workflows to accommodate these increased clinical volumes by using prolonged intermittent kidney replacement therapies and acute peritoneal dialysis, as well as other strategies to mitigate nursing burnout and decrease scarce resource use. Telehealth was implemented in outpatient clinics and dialysis units to protect vulnerable patients with kidney disease while maintaining access to care. Lessons learned from this pandemic and subsequent response may be used for future responses in similar situations.

19.
Braz J Infect Dis ; 25(3): 101595, 2021.
Article in English | MEDLINE | ID: covidwho-1293603

ABSTRACT

BACKGROUND: The reported incidence and fatality rates of SARS-CoV-2 infection in patients receiving maintenance dialysis are higher than those of the general population. OBJECTIVE: This study sought to characterize the clinical characteristics and outcomes following COVID-19 infection in this population in a single center in Brazil. METHODS: Out of 497 dialysis patients evaluated between March 1st, 2020 and February 1st, 2021, those presenting symptoms or history of close contact with COVID-19 patients were tested. Disease severity was categorized as mild, moderate, or severe. RESULTS: Out of the 497 patients, 8.8% tested positive for COVID-19. These patients were predominantly male (59%), mean age 57.5 ± 17. Hospitalization was required for 45.4% of patients and 15.9% received mechanical ventilation. Symptoms such as fever, cough, dyspnea and asthenia were more frequent in the severe group. Neutrophil to lymphocyte ratio, C- reactive protein, glutamic oxalacetic transaminase and lactic dehydrogenase were significantly higher in the severe group, while hemoglobin and lymphocyte counts were significantly lower. Chest CT >50% of ground glass lesions was the risk factor associated with severe disease and need for hospitalization. The incidence of a thromboembolic event was of 22.7% in this population. The incidence, mortality, and case fatality rates were 954.4/10,000 patients, 151.8/10,000 patients, and 15.9%, respectively. CONCLUSIONS: The incidence, mortality and case fatality rates in our cohort were significantly higher than those reported for the general population. To institute appropriate control measures and early vaccination in dialysis facilities is imperative to prevent the spread of COVID-19 infection.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Aged , Brazil/epidemiology , Humans , Male , Middle Aged , Outpatients , Renal Dialysis/adverse effects
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