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2.
Iran J Kidney Dis ; 14(5): 389-398, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-777137

RESUMEN

INTRODUCTION: Seven months after the emergence of SARS-COV-2 virus, there is paucity of data regarding the epidemiology of the virus in hemodialysis patients. We aim to present the results of the screening program implied after outbreak of COVID-19 in a referral hemodialysis ward. METHODS: We started clinical screening and obligatory mask wearing for dialysis patients and personnel on 20-Feb-2020. However 11 symptomatic COVID-19 patients emerged till day +36. On days +39 and +40 a screening program was implied including measurement of SARS-COV-2 PCR and immunoglobulin G and M (IgG/IgM) and chest computerized tomography (CCT) scan. The results of CCT scan, classified according to the coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) classification; as with very low (grade 1-normal), low, indeterminate, high, and very high likelihood of COVID-19 (grades 2, 3, 4, and 5; respectively), were used for compartmentalization of patients. RESULTS: Among 178 patients (68.2% male, mean age = 58.7 ± 16.6 years), 11 got COVID-19 before screening, two of whom died. CCT scans were normal in 71.3% and grade 2, 3, 4, and 5 in 7.9%, 4.5%, 5.6%, and 10.7%; respectively. PCR and IgG and/or IgM were positive in 27 and 32 patients. Eighty-three patients had evidence of COVID-19 infection, who were significantly older (62.2 ± 16.6 vs. 56.1 ± 16.02, P < .05). There was no difference in the rate of infection considering gender, diabetes mellitus, hypertension and different blood groups. CONCLUSION: Asymptomatic SARS- COV 2 infection may affect a large number of dialysis patients. We highly recommend a screening strategy whenever the number of patients is increasing.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Personal de Salud , Unidades de Hemodiálisis en Hospital , Fallo Renal Crónico/terapia , Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/inmunología , Betacoronavirus/genética , Betacoronavirus/inmunología , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/inmunología , Femenino , Humanos , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Incidencia , Irán/epidemiología , Fallo Renal Crónico/complicaciones , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/inmunología , Diálisis Renal , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Tomografía Computarizada por Rayos X , Adulto Joven
3.
Am J Transplant ; 20(9): 2599-2601, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-760102

RESUMEN

The COVID-19 pandemic is spreading worldwide and the impact of the disease in transplant patients is evolving. In this case report, we presented a 63-year-old female kidney transplant recipient who presented with dyspnea and cough and was diagnosed with COVID-19 pneumonia. On the fourth day of admission, the patient's condition worsened. Therefore, the immunosuppressive medications were discontinued, and hydrocortisone was started. The patient died on the fifth day.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Rechazo de Injerto/prevención & control , Fallo Renal Crónico/complicaciones , Trasplante de Riñón/métodos , Neumonía Viral/complicaciones , Receptores de Trasplantes , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Inmunosupresión/métodos , Fallo Renal Crónico/cirugía , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología
5.
J Bras Nefrol ; 42(2 suppl 1): 18-21, 2020 Aug 26.
Artículo en Inglés, Portugués | MEDLINE | ID: covidwho-740461

RESUMEN

Considering the new coronavirus epidemic (Covid-19), the Brazilian Society of Nephrology, represented by the Peritoneal Steering Committee, in agreement with the and the Dialysis Department, developed a series of recommendations for good clinical practices for peritoneal dialysis (PD) clinics, to be considered during the period of the Covid-19 epidemic. We aim to minimize the disease spread, protecting patients and staff, and ensuring the quality of the treatment provided and adequate follow-up for PD patients. The recommendations suggested at this moment must be adapted to each clinic's reality and the conditions of the structural and human resources, dependent on the adequate financial provision of the public health system for its full implementation.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Fallo Renal Crónico/terapia , Pandemias/prevención & control , Diálisis Peritoneal/normas , Neumonía Viral/prevención & control , Brasil , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Desinfección/métodos , Desinfección/normas , Humanos , Fallo Renal Crónico/complicaciones , Máscaras , Nefrología/normas , Enfermedades Profesionales/prevención & control , Grupo de Atención al Paciente , Educación del Paciente como Asunto , Aislamiento de Pacientes/métodos , Aislamiento de Pacientes/normas , Diálisis Peritoneal/instrumentación , Diálisis Peritoneal/métodos , Equipo de Protección Personal , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Sociedades Médicas , Telemedicina/legislación & jurisprudencia , Telemedicina/métodos , Telemedicina/normas , Servicio de Urología en Hospital/organización & administración , Servicio de Urología en Hospital/normas
6.
J Am Soc Nephrol ; 31(8): 1815-1823, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: covidwho-729585

RESUMEN

BACKGROUND: During the coronavirus disease 2019 (COVID-19) epidemic, many countries have instituted population-wide measures for social distancing. The requirement of patients on dialysis for regular treatment in settings typically not conducive to social distancing may increase their vulnerability to COVID-19. METHODS: Over a 6-week period, we recorded new COVID-19 infections and outcomes for all adult patients receiving dialysis in a large dialysis center. Rapidly introduced control measures included a two-stage routine screening process at dialysis entry (temperature and symptom check, with possible cases segregated within the unit and tested for SARS-CoV-2), isolated dialysis in a separate unit for patients with infection, and universal precautions that included masks for dialysis nursing staff. RESULTS: Of 1530 patients (median age 66 years; 58.2% men) receiving dialysis, 300 (19.6%) developed COVID-19 infection, creating a large demand for isolated outpatient dialysis and inpatient beds. An analysis that included 1219 patients attending satellite dialysis clinics found that older age was a risk factor for infection. COVID-19 infection was substantially more likely to occur among patients on in-center dialysis compared with those dialyzing at home. We observed clustering in specific units and on specific shifts, with possible implications for aspects of service design, and high rates of nursing staff illness. A predictive epidemic model estimated a reproduction number of 2.2; cumulative cases deviated favorably from the model from the fourth week, suggesting that the implemented measures controlled transmission. CONCLUSIONS: The COVID-19 epidemic affected a large proportion of patients at this dialysis center, creating service pressures exacerbated by nursing staff illness. Details of the control strategy and characteristics of this epidemic may be useful for dialysis providers and other institutions providing patient care.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Control de Infecciones/métodos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Anciano , Betacoronavirus , Registros Electrónicos de Salud , Femenino , Fiebre/complicaciones , Humanos , Londres , Masculino , Persona de Mediana Edad , Pandemias , Aislamiento de Pacientes , Modelos de Riesgos Proporcionales , Cuarentena , Diálisis Renal/efectos adversos , Factores de Riesgo , Servicios Urbanos de Salud/organización & administración
8.
Am J Nephrol ; 51(8): 669-674, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-691050

RESUMEN

BACKGROUND: The COVID-19 pandemic has affected the end-stage kidney disease (ESKD) population, with high mortality rates reported among patients on hemodialysis. However, the degree to which it has affected the peritoneal dialysis (PD) population in the United States has not yet been elucidated. In this report, we describe the clinical characteristics, presentations, clinical course, and outcomes of ESKD patients on PD hospitalized with COVID-19. METHODS: We describe the characteristics, presentation, and outcomes of adult ESKD patients on chronic PD hospitalized with CO-VID-19 in our 13 major hospitals in the NY health system using descriptive statistical analysis. RESULTS: Of 419 hospitalized patients with ESKD, 11 were on chronic PD therapy (2.6%). Among those 11, 3 patients required mechanical ventilation, 2 of whom died. Of the entire cohort, 9 of the 11 patients (82%) were discharged alive. While fever was a common presentation, more than half of our patients also presented with diarrhea. Interestingly, 3 patients were diagnosed with culture-negative peritonitis during their hospitalization. Seven patients reported positive SARS-CoV-2 exposure from a member of their household. CONCLUSION: Hospitalized patients on PD with COVID-19 had a relatively mild course, and majority of them were discharged home.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Fallo Renal Crónico/terapia , Diálisis Peritoneal/efectos adversos , Peritonitis/epidemiología , Neumonía Viral/epidemiología , Adulto , Anciano , Betacoronavirus/genética , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Registros Electrónicos de Salud/estadística & datos numéricos , Femenino , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/mortalidad , Masculino , Persona de Mediana Edad , New York/epidemiología , Pandemias , Peritonitis/diagnóstico , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/virología , ARN Viral/aislamiento & purificación
9.
Clin Nephrol ; 94(4): 207-211, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-659342

RESUMEN

BACKGROUND: In December 2019, the 2019 novel coronavirus disease (COVID-19) caused by SARS-CoV-2 emerged in China and now has spread to many countries. Limited data are available for hemodialysis patients with COVID-19. CASE PRESENTATION: We report a 66-year-old man with confirmed COVID-19 and parainfluenza virus infection in Wuhan. We describe the clinical characteristics, radiological findings, and treatment of the hemodialysis patient, including the patient's initial pneumonia at presentation with progression to acute respiratory distress syndrome (ARDS). DISCUSSION AND CONCLUSION: Our case underscores the possibility of SARS-CoV-2 co-infection with other pathogens in hemodialysis patients and the importance of early identification of COVID-19.


Asunto(s)
Betacoronavirus , Coinfección/diagnóstico , Infecciones por Coronavirus/complicaciones , Fallo Renal Crónico/virología , Infecciones por Paramyxoviridae/complicaciones , Neumonía Viral/complicaciones , Diálisis Renal , Anciano , China , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Pandemias , Infecciones por Paramyxoviridae/diagnóstico , Infecciones por Paramyxoviridae/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/terapia
10.
Am J Transplant ; 20(7): 1819-1825, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-642184

RESUMEN

There is minimal information on coronavirus disease 2019 (COVID-19) in immunocompromised individuals. We have studied 10 patients treated at 12 adult care hospitals. Ten kidney transplant recipients tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction, and 9 were admitted. The median age was 57 (interquartile range [IQR] 47-67), 60% were male, 40% Caucasian, and 30% Black/African American. Median time from transplant to COVID-19 testing was 2822 days (IQR 1272-4592). The most common symptom was fever, followed by cough, myalgia, chills, and fatigue. The most common chest X-ray and computed tomography abnormality was multifocal patchy opacities. Three patients had no abnormal findings. Leukopenia was seen in 20% of patients, and allograft function was stable in 50% of patients. Nine patients were on tacrolimus and a mycophenolic antimetabolite, and 70% were on prednisone. Hospitalized patients had their antimetabolite agent stopped. All hospitalized patients received hydroxychloroquine and azithromycin. Three patients died (30%), and 5 (50%) developed acute kidney injury. Kidney transplant recipients infected with COVID-19 should be monitored closely in the setting of lowered immunosuppression. Most individuals required hospitalization and presenting symptoms were similar to those of nontransplant individuals.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Neumonía Viral/complicaciones , Receptores de Trasplantes , Anciano , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Cuidados Críticos , Registros Electrónicos de Salud , Femenino , Hospitalización , Humanos , Huésped Inmunocomprometido , Inmunosupresión/efectos adversos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/virología , Masculino , Persona de Mediana Edad , New York/epidemiología , Pandemias , Neumonía Viral/mortalidad
12.
Ann Med ; 52(7): 345-353, 2020 11.
Artículo en Inglés | MEDLINE | ID: covidwho-640131

RESUMEN

PURPOSE: Emerging data suggest that coronavirus disease 2019 (COVID-19) has extrapulmonary manifestations but its renal manifestations are not clearly defined. We aimed to evaluate renal complications of COVID-19 and their incidence using a systematic meta-analysis. DESIGN: Observational studies reporting renal complications in COVID-19 patients were sought from MEDLINE, Embase and the Cochrane Library from 2019 to June 2020. The nine-star Newcastle-Ottawa Scale was used to evaluate methodological quality. Incidence with 95% confidence intervals (CIs) were pooled using random-effects models. RESULTS: We included 22 observational cohort studies comprising of 17,391 COVID-19 patients. Quality scores of studies ranged from 4 to 6. The pooled prevalence of pre-existing chronic kidney disease (CKD) and end-stage kidney disease was 5.2% (2.8-8.1) and 2.3% (1.8-2.8), respectively. The pooled incidence over follow-up of 2-28 days was 12.5% (10.1-15.0) for electrolyte disturbance (e.g. hyperkalaemia), 11.0% (7.4-15.1) for acute kidney injury (AKI) and 6.8% (1.0-17.0) for renal replacement therapy (RRT). In subgroup analyses, there was a higher incidence of AKI in US populations and groups with higher prevalence of pre-existing CKD. CONCLUSIONS: Frequent renal complications reported among hospitalized COVID-19 patients are electrolyte disturbance, AKI and RRT. Aggressive monitoring and management of these renal complications may help in the prediction of favourable outcomes. Systematic review registration: PROSPERO 2020: CRD42020186873 KEY MESSAGES COVID-19 affects multiple organs apart from the respiratory system; however, its renal manifestations are not clearly defined. In this systematic meta-analysis of 22 observational cohort studies, the prevalence of pre-existing chronic kidney disease (CKD) in COVID-19 patients was 5.2%. The most frequent renal complication was electrolyte disturbance (particularly hyperkalaemia) with an incidence of 12.5% followed by acute kidney injury (AKI) with an incidence of 11.0%; US populations and groups with higher prevalence of CKD had higher incidence of AKI.


Asunto(s)
Lesión Renal Aguda/epidemiología , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Desequilibrio Hidroelectrolítico/epidemiología , Lesión Renal Aguda/virología , Infecciones por Coronavirus/epidemiología , Humanos , Incidencia , Fallo Renal Crónico/complicaciones , Pandemias , Neumonía Viral/epidemiología , Prevalencia , Insuficiencia Renal Crónica/complicaciones , Desequilibrio Hidroelectrolítico/virología
13.
Kidney Int ; 98(1): 27-34, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-613191

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia emerged in Wuhan, China in December 2019. Unfortunately, there is a lack of evidence about the optimal management of novel coronavirus disease 2019 (COVID-19), and even less is available in patients on maintenance hemodialysis therapy than in the general population. In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of all maintenance hemodialysis patients hospitalized with COVID-19 from March 12th to April 10th, 2020 as confirmed by real-time polymerase chain reaction. Baseline features, clinical course, laboratory data, and different therapies were compared between survivors and nonsurvivors to identify risk factors associated with mortality. Among the 36 patients, 11 (30.5%) died, and 7 were able to be discharged within the observation period. Clinical and radiological evolution during the first week of admission were predictive of mortality. Among the 36 patients, 18 had worsening of their clinical status, as defined by severe hypoxia with oxygen therapy requirements greater than 4 L/min and radiological worsening. Significantly, 11 of those 18 patients (61.1%) died. None of the classical cardiovascular risk factors in the general population were associated with higher mortality. Compared to survivors, nonsurvivors had significantly longer dialysis vintage, increased lactate dehydrogenase (490 U/l ± 120 U/l vs. 281 U/l ± 151 U/l, P = 0.008) and C-reactive protein levels (18.3 mg/dl ± 13.7 mg/dl vs. 8.1 mg/dl ± 8.1 mg/dl, P = 0.021), and a lower lymphocyte count (0.38 ×103/µl ± 0.14 ×103/µl vs. 0.76 ×103/µl ± 0.48 ×103/µl, P = 0.04) 1 week after clinical onset. Thus, the mortality among hospitalized hemodialysis patients diagnosed with COVID-19 is high. Certain laboratory tests can be used to predict a worsening clinical course.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Fallo Renal Crónico/complicaciones , Neumonía Viral/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Antimaláricos/uso terapéutico , Azitromicina/uso terapéutico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Combinación de Medicamentos , Femenino , Mortalidad Hospitalaria , Humanos , Hidroxicloroquina/uso terapéutico , Fallo Renal Crónico/terapia , Lopinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/tratamiento farmacológico , Pronóstico , Diálisis Renal , Estudios Retrospectivos , Ritonavir/uso terapéutico , España/epidemiología
15.
J Investig Med High Impact Case Rep ; 8: 2324709620931238, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-596774

RESUMEN

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a rapidly spreading disease causing increased morbidity and mortality across the globe. There is limited available knowledge regarding the natural history of the SARS-CoV-2 infection. Other factors that are also making this infection spread like a pandemic include global travelers, lack of proven treatment, asymptomatic carriers, potential reinfection, underprepared global health care systems, and lack of public awareness and efforts to prevent further spread. It is understood that certain preexisting medical conditions increase the risk of mortality with COVID-19; however, the outcome of this disease in traditionally vulnerable chronic illnesses such as end-stage renal disease is not well documented. We present a case of a 56-year-old African American lady with end-stage renal disease on the peritoneal dialysis who presented predominantly with nausea, vomiting, and subsequently found to have COVID-19. We use this case to illustrate an atypical presentation of the COVID-19 in a vulnerable patient and discuss the literature.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Fallo Renal Crónico/complicaciones , Neumonía Viral/diagnóstico , Infecciones por Coronavirus/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Diálisis Peritoneal , Neumonía Viral/complicaciones
18.
Medicine (Baltimore) ; 99(27): e20956, 2020 Jul 02.
Artículo en Inglés | MEDLINE | ID: covidwho-619598

RESUMEN

RATIONALE: The 2019 novel coronavirus disease (COVID-19) causes a novel, atypical pneumonia that has brought huge public health challenges across the globe. There is limited data about patients with end-stage renal disease who also suffer from COVID-19. In this report, we discuss the case of a hemodialysis patient who developed COVID-19 pneumonia in the clinical course. PATIENT CONCERNS: A 79-year-old man who had end-stage renal disease (ESRD) and was taking regular hemodialysis was admitted to hospital for a fever and dry cough. The patient, who also had cardiovascular disease, had no history of contact with COVID-2019 patients. DIAGNOSIS: The patient was diagnosed with COVID-2019 by the reverse-transcriptase polymerase chain reaction (RT-PCR), and his pharyngeal swab for SARS-CoV-2 was positive. INTERVENTION: The treatment was mainly supportive and the patient was intensively monitored. He was treated with oxygen, broad-spectrum antibiotics, antiviral drugs, and methylprednisolone. The patient took continuous renal replacement therapy (CRRT) every 2 days. OUTCOMES: After 19 days, an RT-PCR assay for SARS-CoV-2 was negative, and computed tomography (CT) of the patient's thorax indicated that the pulmonary inflammatory exudation was absorbed and pulmonary infection improved significantly. He was discharged on day 29 after recovering from COVID-2019 pneumonia. LESSONS: The courses of disease and treatment options for this individual were significantly more complicated than those for ordinary patients. Therefore, it was necessary to monitor the condition of the patient closely and to protect the dialysis unit staff from being infected. Compared with other severe COVID-2019 cases, this patient recovered more quickly following treatment, which was likely due to the removal of inflammatory mediators by CRRT. This implies that blood purification might be an important option for hemodialysis patients with COVID-19.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Diálisis Renal , Anciano , Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Antivirales/uso terapéutico , Betacoronavirus , Terapia Combinada , Infecciones por Coronavirus/tratamiento farmacológico , Humanos , Masculino , Metilprednisolona/uso terapéutico , Terapia por Inhalación de Oxígeno , Pandemias
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