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Objective. To study the course of the new coronavirus infection in patients with chronic kidney disease (CKD), to identify cases of acute kidney injury (AKI) in the setting of COVID-19 infection, and to access the impact of renal function on prognosis in these categories of patients during the acute phase and after hospitalization, at 3, 6, and 12 months after recovery. Materials and methods. The ACTIV and ACTIV 2 registries included men and women older than 18 years with a diagnosis of COVID-19 based on a positive PCR test for COVID-19 and a characteristic chest X-ray or computed tomography chest scan. Results. A total of 9364 patients (4404 men, average age59 [48-69]) were included in the analysis. 716 (7.67 %) patients had CKD. 8496 (90,7 %) patients had their glomerular filtration rate (GFR) measured during hospitalization, and the values were distributed as follows: >=90 ml/min/1.73m2 - in 4289 (50,5 %) patients, 89-60 ml/min/1.73m2 - in 3150 (37,1 %) patients, 59-45 ml/min/1.73m2 - in 613 (7,22 %), 44-30 ml/min/1.73m2 - in 253 (2,98 %), 29-15 ml/min/1.73m2 - in 110 (1,29 %), <15 ml/min/1.73m2 - in 81 (0,95 %) patients. 11.6 % of the subjects (n=1068) developed AKI during hospitalization. This complication was reported more often than cytokine storm (in 7.46 % in 687 patients, p<0,001) or sepsis (in 0.17 % in 16 patients, p=620). CKD increased the risk of death by 3.94-fold in patients with COVID-19 during hospitalization compared with patients without CKD. The mortality of patients with AKI during hospitalization was 3.94 times higher than the mortality of those without AKI. CKD also affected long-term survival after hospitalization: within 3 months of follow-up, the risk of death in patients with CKD increased 4.88-fold, within 6 months - 4.24-fold, after 12 months - 8.36-fold. Conclusion. The prevalence of CKD in COVID-19 patients is similar to that in the general population. AKI developed in 11.6 % of cases with COVID-19 infection and was observed more frequently in patients with overweight and hyperglycemia. CKD and AKI increased the risk of hospital mortality in patients with COVID-19. In the group of patients with CKD, mortality increased in the post-COVID period, 3, 6 and 12 months after. The high mortality rate of patients who had AKI during the coronavirus infection was observed only in the first 3 months of follow-up in the post-COVID period.Copyright © 2023 The authors.
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The editorial touches upon the problem of the possible impact of COVID-19 on CKD patients, mediated by the forced reorganization of the health care system in a whole, the redistribution of its resources in the context of the COVID-19 pandemic. Lack of regular outpatient monitoring, delayed diagnosis and therapy in patients with kidney dysfunction are factors of adverse clinical outcomes - accelerated disease progression, ESKD development and the need for KRT, life-threatening complications, reduced quality of life and survival. The data of a pooled analysis of the impact of the pandemic on specialized renal care and its availability in a number of regions of the Northwest Federal District of Russia and the Moscow Region are presented: a fall in hospital admissions, outpatient consultations and a decrease in the use of hospital beds (on average, by 37 %, 40 % and 32 %, respectively). Principles and conditions of the functioning of health systems associated in the COVID-19 pandemic have been discussed. The main approaches to maintaining the standard level of renal patients care have been formulated, aimed at preventing an unfavorable patient-oriented CKD outcomes. © 2021 Patristica et Mediaevalia. All rights reserved.
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The agreement of experts of the Eurasian Association of Therapists (EAT) discusses pathogenesis and treatment of COVID-19. Modern data on the characteristics of cardiovascular, kidney, respiratory damage in SARS-infected CoV-2 are presented. The tactics of managing patients initially having cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, chronic kidney disease are discussed in detail. The article presents data on drug interaction of drugs.