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1.
Transplant Direct ; 6(7): e572, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1794966

ABSTRACT

BACKGROUND: The early effects of coronavirus disease 2019 (COVID-19) on transplantation are dramatic: >75% of kidney and liver programs are either suspended or operating under major restrictions. To resume transplantation, it is important to understand the prevalence of COVID-19 among transplant recipients, donors, and healthcare workers (HCWs) and its associated mortality. METHODS: To investigate this, we studied severe acute respiratory syndrome coronavirus 2 diagnostic test results among patients with end-stage renal disease or kidney transplants from the Johns Hopkins Health System (n = 235), and screening test results from deceased donors from the Southwest Transplant Alliance Organ Procurement Organization (n = 27), and donors, candidates, and HCWs from the National Kidney Registry and Viracor-Eurofins (n = 253) between February 23 and April 15, 2020. RESULTS: We found low rates of COVID-19 among donors and HCWs (0%-1%) who were screened, higher rates of diagnostic tests among patients with end-stage renal disease or kidney transplant (17%-20%), and considerable mortality (7%-13%) among those who tested positive. CONCLUSIONS: These findings suggest the threat of COVID-19 for the transplant population is significant and ongoing data collection and reporting is critical to inform transplant practices during and after the pandemic.

2.
J Am Soc Nephrol ; 32(9): 2147-2152, 2021 09.
Article in English | MEDLINE | ID: covidwho-1708655

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a high rate of mortality in patients with ESKD, and vaccination is hoped to prevent infection. METHODS: Between January 18 and February 24, 2021, 225 kidney transplant recipients (KTRs) and 45 patients on hemodialysis (HDPs) received two injections of mRNA BNT162b2 vaccine. The postvaccinal humoral and cellular response was explored in the first 45 KTRs and ten HDPs. RESULTS: After the second dose, eight HDPs (88.9%) and eight KTRs (17.8%) developed antispike SARS-CoV-2 antibodies (P<0.001). Median titers of antibodies in responders were 1052 AU/ml (IQR, 515-2689) in HDPs and 671 AU/ml (IQR, 172-1523) in KTRs (P=0.40). Nine HDPs (100%) and 26 KTRs (57.8%) showed a specific T cell response (P=0.06) after the second injection. In responders, median numbers of spike-reactive T cells were 305 SFCs per 106 CD3+ T cells (IQR, 95-947) in HDPs and 212 SFCs per 106 CD3+ T cells (IQR, 61-330) in KTRs (P=0.40). In KTRs, the immune response to BNT162b2 seemed influenced by the immunosuppressive regimen, particularly tacrolimus or belatacept. CONCLUSION: Immunization with BNT162b2 seems more efficient in HDPs, indicating that vaccination should be highly recommended in these patients awaiting a transplant. However, the current vaccinal strategy for KTRs may not provide effective protection against COVID-19 and will likely need to be improved.


Subject(s)
Antibodies, Viral/biosynthesis , COVID-19 Vaccines/pharmacology , COVID-19/immunology , Kidney Transplantation , Renal Dialysis , SARS-CoV-2/immunology , T-Lymphocytes/immunology , Aged , COVID-19/complications , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Cohort Studies , Female , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/immunology , Kidney Failure, Chronic/therapy , Kidney Transplantation/adverse effects , Male , Middle Aged , Pandemics , RNA, Messenger/genetics , Retrospective Studies , SARS-CoV-2/genetics , Spike Glycoprotein, Coronavirus/genetics , Spike Glycoprotein, Coronavirus/immunology , Transplant Recipients
4.
Pediatr Nephrol ; 36(9): 2627-2638, 2021 09.
Article in English | MEDLINE | ID: covidwho-1520348

ABSTRACT

BACKGROUND AND OBJECTIVES: COVID-19 is responsible for the 2019 novel coronavirus disease pandemic. Despite the vast research about the adult population, there has been little data collected on acute kidney injury (AKI) epidemiology, associated risk factors, treatments, and mortality in pediatric COVID-19 patients admitted to the ICU. AKI is a severe complication of COVID-19 among children and adolescents. METHODS: A comprehensive literature search was conducted in PubMed/MEDLINE and Cochrane Center Trials to find all published literature related to AKI in COVID-19 patients, including incidence and outcomes. RESULTS: Twenty-four studies reporting the outcomes of interest were included. Across all studies, the overall sample size of COVID positive children was 1,247 and the median age of this population was 9.1 years old. Among COVID positive pediatric patients, there was an AKI incidence of 30.51%, with only 0.56% of these patients receiving KRT. The mortality was 2.55% among all COVID positive pediatric patients. The incidence of multisystem inflammatory syndrome in children (MIS-C) among COVID positive patients was 74.29%. CONCLUSION: AKI has shown to be a negative prognostic factor in adult patients with COVID-19 and now also in the pediatric cohort with high incidence and mortality rates. Additionally, our findings show a strong comparison in epidemiology between adult and pediatric COVID-19 patients; however, they need to be confirmed with additional data and studies.


Subject(s)
Acute Kidney Injury/epidemiology , COVID-19/complications , Intensive Care Units/statistics & numerical data , Renal Replacement Therapy/statistics & numerical data , Systemic Inflammatory Response Syndrome/complications , Acute Kidney Injury/immunology , Acute Kidney Injury/therapy , Acute Kidney Injury/virology , Adult , Age Factors , COVID-19/diagnosis , COVID-19/immunology , COVID-19/mortality , Child , Hospital Mortality , Humans , Incidence , Pandemics/statistics & numerical data , Risk Factors , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/immunology , Systemic Inflammatory Response Syndrome/mortality
5.
J Clin Pathol ; 74(12): 796-803, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1526518

ABSTRACT

AIMS: Hospitalised patients with COVID-19 have a variable incidence of acute kidney injury (AKI) according to studies from different nationalities. The present systematic review and meta-analysis describes the incidence of AKI, need for renal replacement therapy (RRT) and mortality among patients with COVID-19-associated AKI. METHODS: We systematically searched electronic database PubMed, SCOPUS and Web of Science to identify English articles published until 25 May 2020. In case of significant heterogeneity, the meta-analyses were conducted assuming a random-effects model. RESULTS: From 746 screened publications, we selected 21 observational studies with 15 536 patients with COVID-19 for random-effects model meta-analyses. The overall incidence of AKI was 12.3% (95% CI 7.3% to 20.0%) and 77% of patients with AKI were critically ill (95% CI 58.9% to 89.0%). The mortality among patients with AKI was 67% (95% CI 39.8% to 86.2%) and the risk of death was 13 times higher compared with patients without AKI (OR=13.3; 95% CI 6.1 to 29.2). Patients with COVID-19-associated AKI needed for RRT in 23.4% of cases (95% CI 12.6% to 39.4%) and those cases had high mortality (89%-100%). CONCLUSION: The present study evidenced an incidence of COVID-19-associated AKI higher than previous meta-analysis. The majority of patients affected by AKI were critically ill and mortality rate among AKI cases was high. Thus, it is extremely important for health systems to be aware about the impact of AKI on patients' outcomes in order to establish proper screening, prevention of additional damage to the kidneys and adequate renal support when needed.


Subject(s)
Acute Kidney Injury/epidemiology , COVID-19/epidemiology , Acute Kidney Injury/diagnosis , Acute Kidney Injury/mortality , Acute Kidney Injury/therapy , Adult , Aged , COVID-19/diagnosis , COVID-19/mortality , COVID-19/therapy , Critical Illness , Female , Humans , Incidence , Male , Middle Aged , Prognosis , Renal Replacement Therapy , Risk Assessment , Risk Factors
6.
Kidney Med ; 3(3): 426-432, 2021.
Article in English | MEDLINE | ID: covidwho-1525989

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented and historic public health crisis that continues to expand and evolve. The National Kidney Foundation held a 2-part continuing medical education live virtual symposium on July 16 and July 24, 2020, to address the multiple challenges of COVID-19 in the context of advanced chronic kidney disease. Faculty addressed the pathophysiology, impact, risks, and management of COVID-19 as it relates to advanced kidney disease. Testing, risk mitigation, and inpatient and outpatient management were also addressed. This concise review addresses major findings of the symposium along with certain updates regarding vaccinations since then. These findings include: (1) severe COVID-19 infection has been associated with acute kidney injury, (2) it is essential to prevent and actively manage acute kidney injury to decrease mortality in these critically ill patients, (3) management of patients with advanced kidney disease should be geared toward minimizing their risk for exposure while making sure they are receiving adequate treatments, and (4) patients with kidney disease, especially ones in advanced stages, should be prioritized for vaccination.

7.
Crit Care Med ; 49(10): 1739-1748, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1475872

ABSTRACT

OBJECTIVES: The coronavirus disease 2019 pandemic has overwhelmed healthcare resources even in wealthy nations, necessitating rationing of limited resources without previously established crisis standards of care protocols. In Massachusetts, triage guidelines were designed based on acute illness and chronic life-limiting conditions. In this study, we sought to retrospectively validate this protocol to cohorts of critically ill patients from our hospital. DESIGN: We applied our hospital-adopted guidelines, which defined severe and major chronic conditions as those associated with a greater than 50% likelihood of 1- and 5-year mortality, respectively, to a critically ill patient population. We investigated mortality for the same intervals. SETTING: An urban safety-net hospital ICU. PATIENTS: All adults hospitalized during April of 2015 and April 2019 identified through a clinical database search. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 365 admitted patients, 15.89% had one or more defined chronic life-limiting conditions. These patients had higher 1-year (46.55% vs 13.68%; p < 0.01) and 5-year (50.00% vs 17.22%; p < 0.01) mortality rates than those without underlying conditions. Irrespective of classification of disease severity, patients with metastatic cancer, congestive heart failure, end-stage renal disease, and neurodegenerative disease had greater than 50% 1-year mortality, whereas patients with chronic lung disease and cirrhosis had less than 50% 1-year mortality. Observed 1- and 5-year mortality for cirrhosis, heart failure, and metastatic cancer were more variable when subdivided into severe and major categories. CONCLUSIONS: Patients with major and severe chronic medical conditions overall had 46.55% and 50.00% mortality at 1 and 5 years, respectively. However, mortality varied between conditions. Our findings appear to support a crisis standards protocol which focuses on acute illness severity and only considers underlying conditions carrying a greater than 50% predicted likelihood of 1-year mortality. Modifications to the chronic lung disease, congestive heart failure, and cirrhosis criteria should be refined if they are to be included in future models.


Subject(s)
COVID-19/therapy , Crisis Intervention/standards , Resource Allocation/methods , Academic Medical Centers/organization & administration , Academic Medical Centers/statistics & numerical data , Adult , COVID-19/epidemiology , Crisis Intervention/methods , Crisis Intervention/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Male , Massachusetts , Middle Aged , Resource Allocation/statistics & numerical data , Retrospective Studies , Safety-net Providers/organization & administration , Safety-net Providers/statistics & numerical data , Standard of Care/standards , Standard of Care/statistics & numerical data , Urban Population/statistics & numerical data
8.
BMJ Open ; 10(12): e042035, 2020 12 22.
Article in English | MEDLINE | ID: covidwho-1455708

ABSTRACT

INTRODUCTION: Acute kidney injury (AKI) is common and is associated with negative long-term outcomes. Given the heterogeneity of the syndrome, the ability to predict outcomes of AKI may be beneficial towards effectively using resources and personalising AKI care. This systematic review will identify, describe and assess current models in the literature for the prediction of outcomes in hospitalised patients with AKI. METHODS AND ANALYSIS: Relevant literature from a comprehensive search across six databases will be imported into Covidence. Abstract screening and full-text review will be conducted independently by two team members, and any conflicts will be resolved by a third member. Studies to be included are cohort studies and randomised controlled trials with at least 100 subjects, adult hospitalised patients, with AKI. Only those studies evaluating multivariable predictive models reporting a statistical measure of accuracy (area under the receiver operating curve or C-statistic) and predicting resolution of AKI, progression of AKI, subsequent dialysis and mortality will be included. Data extraction will be performed independently by two team members, with a third reviewer available to resolve conflicts. Results will be reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Risk of bias will be assessed using Prediction model Risk Of Bias ASsessment Tool. ETHICS AND DISSEMINATION: We are committed to open dissemination of our results through the registration of our systematic review on PROSPERO and future publication. We hope that our review provides a platform for future work in realm of using artificial intelligence to predict outcomes of common diseases. PROSPERO REGISTRATION NUMBER: CRD42019137274.


Subject(s)
Acute Kidney Injury , Artificial Intelligence , Acute Kidney Injury/diagnosis , Acute Kidney Injury/therapy , Adult , Humans , Meta-Analysis as Topic , Renal Dialysis , Systematic Reviews as Topic
9.
Kidney Int ; 99(6): 1470-1477, 2021 06.
Article in English | MEDLINE | ID: covidwho-1386157

ABSTRACT

Patients with end stage kidney disease receiving in-center hemodialysis (ICHD) have had high rates of SARS-CoV-2 infection. Following infection, patients receiving ICHD frequently develop circulating antibodies to SARS-CoV-2, even with asymptomatic infection. Here, we investigated the durability and functionality of the immune responses to SARS-CoV-2 infection in patients receiving ICHD. Three hundred and fifty-six such patients were longitudinally screened for SARS-CoV-2 antibodies and underwent routine PCR-testing for symptomatic and asymptomatic infection. Patients were regularly screened for nucleocapsid protein (anti-NP) and receptor binding domain (anti-RBD) antibodies, and those who became seronegative at six months were screened for SARS-CoV-2 specific T-cell responses. One hundred and twenty-nine (36.2%) patients had detectable antibody to anti-NP at time zero, of whom 127 also had detectable anti-RBD. Significantly, at six months, 71/111 (64.0%) and 99/116 (85.3%) remained anti-NP and anti-RBD seropositive, respectively. For patients who retained antibody, both anti-NP and anti-RBD levels were reduced significantly after six months. Eleven patients who were anti-NP seropositive at time zero, had no detectable antibody at six months; of whom eight were found to have SARS-CoV-2 antigen specific T cell responses. Independent of antibody status at six months, patients with baseline positive SARS-CoV-2 serology were significantly less likely to have PCR confirmed infection over the following six months. Thus, patients receiving ICHD mount durable immune responses six months post SARS-CoV-2 infection, with fewer than 3% of patients showing no evidence of humoral or cellular immunity.


Subject(s)
Antibodies, Viral/analysis , COVID-19/immunology , Kidney Failure, Chronic/therapy , Renal Dialysis/adverse effects , SARS-CoV-2/immunology , COVID-19 Testing , Female , Humans , Immunity , Male , Pandemics , Polymerase Chain Reaction , Reinfection , SARS-CoV-2/isolation & purification , Serologic Tests/methods
12.
Pharmacol Res ; 161: 105107, 2020 11.
Article in English | MEDLINE | ID: covidwho-1318943

ABSTRACT

Currently, coronavirus disease 2019 (COVID-19) is spreading rapidly around the world. This study aimed to investigate whether the presence of acute kidney injury (AKI) might increase the risk of severe infection and fatality in COVID-19 patients. We searched the PubMed, Web of Science, ScienceDirect, MedRxiv and COVID-19 academic research communication platforms for studies reporting severe infection rates and case-fatality rates in COVID-19 patients with and without AKI up to June 20, 2020. The main outcomes were the comparisons of the severe infection rates and fatality rates in COVID-19 patients with and without AKI and the estimation of the odds ratio (OR) and its 95 % confidence interval (CI) for severe infection and mortality. Statistical analyses were performed with R statistical software. A total of 40 studies involving 24,527 patients with COVID-19 were included in our meta-analysis. The incidence of AKI was 10 % (95 % CI 8%-13 %) in COVID-19 patients. The patients had higher severe infection and fatality rates (55.6 % vs. 17.7 % and 63.1 % vs. 12.9 %, respectively, all P < 0.01) with COVID-19. AKI was a predictor of fatality (OR = 14.63, 95 % CI: 9.94-21.51, P < 0.00001) and severe infection (OR = 8.11, 95 % CI: 5.01-13.13, P < 0.00001) in patients with COVID-19. Higher levels of serum creatinine (Scr) and blood urea nitrogen (BUN) were associated with a significant increase in fatality [Scr: mean difference (MD): 20.19 µmol/L, 95 % CI: 14.96-25.42, P < 0.001; BUN: MD: 4.07 mmol/L, 95 % CI: 3.33-4.81, P < 0.001] and severe infection (Scr: MD: 7.78 µmol/L, 95 % CI: 4.43-11.14, P < 0.00001, BUN: MD: 2.12 mmol/L, 95 % CI: 1.74-2.50, P < 0.00001) in COVID-19 patients. In conclusion, AKI is associated with severe infection and higher fatality rates in patients with COVID-19. Clinicians should pay more attention to the monitoring and treatment of COVID-19 patients with AKI.


Subject(s)
Acute Kidney Injury/complications , Acute Kidney Injury/mortality , COVID-19/complications , COVID-19/mortality , Acute Kidney Injury/therapy , COVID-19/therapy , Humans
13.
Ther Drug Monit ; 43(4): 455-458, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1305444

ABSTRACT

ABSTRACT: In this article, we present a case of apixaban elimination prolonged by 450% in a patient with coronavirus disease 2019 because of multiple conditions, including drug-drug interaction, severe inflammation, and acute kidney injury. Therapeutic drug monitoring was used to explain unusual routine coagulation assays. This grand round highlights the importance of dialog between the clinician and a therapeutic drug monitoring consultant for optimal patient care.


Subject(s)
Acute Kidney Injury/metabolism , COVID-19/metabolism , Drug Monitoring/methods , Pyrazoles/metabolism , Pyridones/metabolism , Renal Elimination/drug effects , Teaching Rounds/methods , Acute Kidney Injury/chemically induced , Acute Kidney Injury/prevention & control , Aged, 80 and over , Antiviral Agents/adverse effects , Antiviral Agents/metabolism , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Drug Interactions/physiology , Factor Xa Inhibitors/adverse effects , Factor Xa Inhibitors/metabolism , Factor Xa Inhibitors/therapeutic use , Humans , Inflammation/chemically induced , Inflammation/metabolism , Inflammation/prevention & control , Male , Pyrazoles/adverse effects , Pyrazoles/therapeutic use , Pyridones/adverse effects , Pyridones/therapeutic use , Renal Elimination/physiology , Severity of Illness Index , Time Factors
14.
Kidney Med ; 3(3): 353-359.e1, 2021.
Article in English | MEDLINE | ID: covidwho-1291874

ABSTRACT

RATIONALE & OBJECTIVE: Since 1994, the Nephrology and Hypertension Department at the Cleveland Clinic has prepared and used bicarbonate-based solution for continuous venovenous hemodialysis (CVVHD) using a standard volumetric hemodialysis machine rather than purchasing from a commercial vendor. This report describes the process of producing Cleveland Clinic UltraPure Solution (CCUPS), quality and safety monitoring, economic costs, and clinical outcomes. STUDY DESIGN: Retrospective study. SETTING & PARTICIPANTS: CVVHD experience at Cleveland Clinic, focusing on dialysate production, institutional factors, and patients requiring continuous kidney replacement therapy. Production is shown at www.youtube.com/watch?v=WGQgephMEwA. OUTCOMES: Feasibility, safety , and cost. RESULTS: Of 6,426 patients treated between 2011 and 2019 with continuous kidney replacement therapy, 59% were men, 71% were White, 40% had diabetes mellitus, and 74% presented with acute kidney injury. 98% of patients were treated with CVVHD using CCUPS, while the remaining 2% were treated with either continuous venovenous hemofiltration or continuous venovenous hemodiafiltration using commercial solution. The prescribed and delivered effluent doses were 24.8 (IQR) versus 20.7 mL/kg/h (IQR), respectively. CCUPS was as effective in restoring electrolyte and serum bicarbonate levels and reducing phosphate, creatinine, and serum urea nitrogen levels as compared with packaged commercial solution over a 3-day period following initiation of dialysis, with a comparable effluent dose. Among those with acute kidney injury, mortality was similar to that predicted with the 60-day acute kidney injury predicted mortality score (r = 0.997; CI: 0.989-0.999). At our institution, the cost of production for 1 L of CCUPS is $0.67, which is considerably less than the cost of commercially purchased fluid. LIMITATIONS: Observational design without a rigorous control group. CONCLUSIONS: CVVHD using locally generated dialysate is safe and cost-effective.

15.
Turk J Med Sci ; 51(3): 947-961, 2021 06 28.
Article in English | MEDLINE | ID: covidwho-1289069

ABSTRACT

Background/aim: Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data investigating the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19. Materials and methods: HA-AKI development was assessed in a group of stage 3­5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared. Results: Among 621 hospitalized patients (age 60 [IQR: 47­73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4%, and stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas it developed in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1% compared to 14.3% of patients with HA-AKI but no CKD (p < 0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate to patients with CKD without AKI. Adjusted mortality risks of the AKI+non-CKD group (HR: 9.0, 95% CI: 1.9­44.2) and AKI+CKD group (HR: 7.9, 95% CI: 1.9­33.3) were significantly higher than that of the non-AKI+non-CKD group. Conclusion: AKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcomes whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients.


Subject(s)
Acute Kidney Injury/etiology , COVID-19/epidemiology , Intensive Care Units/statistics & numerical data , Renal Insufficiency, Chronic/epidemiology , SARS-CoV-2 , Acute Kidney Injury/epidemiology , Aged , COVID-19/complications , Female , Hospital Mortality/trends , Humans , Incidence , Male , Middle Aged , Pandemics , Renal Insufficiency, Chronic/complications , Retrospective Studies , Risk Factors , Survival Rate/trends
16.
Int J Infect Dis ; 106: 281-288, 2021 May.
Article in English | MEDLINE | ID: covidwho-1279602

ABSTRACT

BACKGROUND: The spatiotemporal trend of renal involvement in coronavirus disease 2019 (COVID-19) patients is still unclear. Therefore, the aim of this study was to reveal the dynamics of renal involvement superimposed COVID-19 according to time and space. METHODS: COVID-19 patients reporting renal involvement were included in this study. The following information was collected from relevant articles: first author, patient demographics, patient enrollment period, location, definition of acute kidney injury (AKI), prevalence of AKI, and use of renal replacement therapy (RRT). RESULTS: A total of 17 134 patients were finally included. The overall prevalence of AKI in COVID-19 patients was 19%, with 7% of them undergoing RRT. The overall risk of AKI in patients enrolled before March 1, 2020 (9%) was significantly lower than that after March 1, 2020 (36%) (P < 0.00001). Moreover, the overall risk of AKI outside Asia (35%) was significantly higher than that in Asia (10%) (P < 0.00001). Additionally, similar to patients requiring RRT, AKI patients were more likely to become seriously ill or even to die (P < 0.00001). CONCLUSIONS: This study found that renal involvement superimposed COVID-19, a comorbidity portending a poor prognosis, has become an increasingly serious problem over time and is more common outside Asia. Thus, more attention should be paid to the management of this specific group of patients.


Subject(s)
Acute Kidney Injury/complications , COVID-19/complications , Acute Kidney Injury/therapy , Adult , Comorbidity , Humans , Male , Middle Aged , Prevalence , Renal Replacement Therapy , Retrospective Studies , Risk Factors
17.
J Nephrol ; 34(4): 1019-1024, 2021 08.
Article in English | MEDLINE | ID: covidwho-1275023

ABSTRACT

INTRODUCTION: Acute respiratory failure (ARF) is the main clinical sign of coronavirus disease-2019 (COVID-19), but little is known about the outcome of acute kidney injury (AKI) associated with ARF. STUDY DESIGN: Retrospective cohort study on clinical features of adult patients hospitalized with COVID-19 between March 1st and April 30th, 2020 in the district of Piacenza (Italy). RESULTS: Among 1894 hospitalized patients, 1701 affected by COVID-19 underwent at least two serum creatinine evaluations. According to KDIGO definitions, 233 of 1,701 patients (13.7%) developed AKI: 159, 34, and 40 had stage 1, 2 and 3 AKI, respectively. Patients with AKI were older (mean age 73.5 ± 14 years, range 24-95) than those without AKI (72 ± 14 years, range 20-102). In-hospital mortality was high in COVID patients (567/1701 patients, 33%), which almost doubled among AKI patients (132/233 patients, 57%), compared with those without AKI (p < 0.01). Risk factors for AKI included older age, male gender, diabetes and need for ventilation. Fourteen patients with stage 3 AKI underwent renal replacement therapy (RRT). CONCLUSIONS: Hospitalized COVID-19 patients with AKI associated with ARF have poor chances of survival. Diagnosing and preventing the progression of renal damage is fundamental in order to delay initiating RRT, especially when resources are limited.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/therapy , Adult , Aged , Aged, 80 and over , Female , Hospital Mortality , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , Risk Factors , SARS-CoV-2 , Young Adult
18.
Saudi J Kidney Dis Transpl ; 32(1): 84-91, 2021.
Article in English | MEDLINE | ID: covidwho-1278586

ABSTRACT

Patients with more severe cases of coronavirus disease-19 (COVID-19) may be at greater risk for developing acute kidney injury (AKI). The aim of our study was to analyze incidence and outcomes of AKI in critically ill patients with COVID-19. Our study prospectively followed about 198 patients with COVID-19 admitted to intensive care unit (ICU), Al Adan Hospital, Kuwait, for developing AKI and outcomes. Age, gender, nationality, history of hypertension, diabetes mellitus, ischemic heart disease, congestive heart failure, bronchial asthma, and chronic obstructive pulmonary disease were analyzed. The need for mechanical ventilation (MV), extracorporeal membrane oxygenation, inotropes, and medications was recorded. Causes of AKI, indication of dialysis, dialysis modality, dialysis outcomes, and mortality were analyzed. Our study reported that61 out of 198 (30.8%) ICU patients positive for COVID-19, developed AKI according to the Kidney Disease Improving Global Outcomes definition of AKI. Forty-eight out of 61 (79%) patients need continuous renal replacement therapy using continuous venovenous hemodiafiltration. Thirty-seven (61%) out of 61 patients were with severe sepsis syndrome. The most common cause of AKI was sepsis, cytokine storm, hypovolemia, heart failure, MV, and nephrotoxic drugs. Twenty-four patients (39%) out of 61 patients died, and the most common cause of death was sepsis, cytokine storm with respiratory failure, heart failure, and AKI. The outcome of AKI was as follows: six patients (10%) had complete recovery, five patients had partial recovery (8%), and 26 (43%) patients became dialysis dependent. Incidence of AKI is high in ICU COVID-19 patients and is associated with poor outcomes and high mortality. Early detection and specific therapy of kidney changes, including adequate hemodynamic support and avoidance of nephrotoxic drugs, may help to improve critically ill patients with COVID-19.


Subject(s)
Acute Kidney Injury/epidemiology , Acute Kidney Injury/therapy , COVID-19/therapy , Acute Kidney Injury/etiology , Acute Kidney Injury/mortality , Adult , COVID-19/epidemiology , Critical Care , Critical Illness , Female , Humans , Incidence , Kuwait/epidemiology , Male , Middle Aged , Prospective Studies , Risk Factors , SARS-CoV-2 , Sepsis/complications , Survival Rate , Treatment Outcome
19.
BMC Nephrol ; 22(1): 224, 2021 06 16.
Article in English | MEDLINE | ID: covidwho-1277921

ABSTRACT

BACKGROUND: Coronavirus-19 (COVID-19) has been declared a global pandemic by the World Health Organisation. Severe disease typically presents with respiratory failure but Acute Kidney Injury (AKI) and a hypercoagulable state can also occur. Early reports suggest that thrombosis may be linked with AKI. We studied the development of AKI and outcomes of patients with COVID-19 taking chronic anticoagulation therapy. METHODS: Electronic records were reviewed for all adult patients admitted to Manchester University Foundation Trust Hospitals between March 10 and April 302,020 with a diagnosis of COVID-19. Patients with end-stage kidney disease were excluded. AKI was classified as per KDIGO criteria. RESULTS: Of the 1032 patients with COVID-19 studied,164 (15.9%) were taking anticoagulant therapy prior to admission. There were similar rates of AKI between those on anticoagulants and those not anticoagulated (23.8% versus 19.7%) with no difference in the severity of AKI or requirement of renal replacement therapy between groups (1.2% versus 3.5%). Risk factors for AKI included hypertension, pre-existing renal disease and male sex. There was a higher mortality in those taking anticoagulant therapy (40.2% versus 30%). Patients taking anticoagulants were less likely to be admitted to the Intensive Care Unit (8.5% versus 17.4%) and to receive mechanical ventilation (42.9% versus 78.1%). CONCLUSION: Patients on chronic anticoagulant therapy did not have a reduced incidence or severity of AKI suggesting that AKI is unlikely to be thrombotic in nature. Therapeutic anticoagulation is currently still under investigation in randomised controlled studies to determine whether it has a potential role in COVID-19 treatment.


Subject(s)
Acute Kidney Injury , Anticoagulants/therapeutic use , COVID-19 , Intensive Care Units/statistics & numerical data , Thrombophilia , Thrombosis/prevention & control , Acute Kidney Injury/complications , Acute Kidney Injury/diagnosis , Acute Kidney Injury/prevention & control , Acute Kidney Injury/virology , Aged , COVID-19/blood , COVID-19/epidemiology , COVID-19/therapy , Female , Hospital Mortality , Humans , Male , Preexisting Condition Coverage/statistics & numerical data , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Thrombophilia/diagnosis , Thrombophilia/prevention & control , Thrombophilia/virology , Thrombosis/blood , Thrombosis/etiology , United Kingdom/epidemiology
20.
Front Cell Dev Biol ; 9: 664868, 2021.
Article in English | MEDLINE | ID: covidwho-1273326

ABSTRACT

Acute kidney injury (AKI) is one of the most prevalent complications among hospitalized coronavirus disease 2019 (COVID-19) patients. Here, we aim to investigate the causes, risk factors, and outcomes of AKI in COVID-19 patients. We found that angiotensin-converting enzyme II (ACE2) and transmembrane protease serine 2 (TMPRSS2) were mainly expressed by different cell types in the human kidney. However, in autopsy kidney samples, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleoprotein was detected in ACE2+ or TMPRSS2+ renal tubular cells, whereas the RNAscope® Assay targeting the SARS-CoV-2 Spike gene was positive mainly in the distal tubular cells and seldom in the proximal tubular cells. In addition, the TMPRSS2 and kidney injury marker protein levels were significantly higher in the SARS-CoV-2-infected renal distal tubular cells, indicating that SARS-CoV-2-mediated AKI mainly occurred in the renal distal tubular cells. Subsequently, a cohort analysis of 722 patients with COVID-19 demonstrated that AKI was significantly related to more serious disease stages and poor prognosis of COVID-19 patients. The progressive increase of blood urea nitrogen (BUN) level during the course of COVID-19 suggests that the patient's condition is aggravated. These results will greatly increase the current understanding of SARS-CoV-2 infection.

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