Glomerular diseases and immunosuppression practices in Latin America during the COVID-19 pandemic: Analysis from Glomcon Latin America working group (lglomcon)

ABSTRACT

Background: As COVID-19 spreads across the world, nephrologists are facing difficult decisions regarding the management of active glomerular diseases (GD). We aimed to report how COVID-19 pandemic may have changed the use of immunotherapies among nephrologists In Latin America (LA) for the treatment of glomerulopathies. Methods: Descriptive analysis extracted from an online survey carried out among nephrologists, renal pathologists and other health workers treating kidney diseases between May 20-27, 2020 from sixteen Spanish speaking LA countries divided into 6 categories. We present the results for the GD and immunosuppression category. Results: 430 responses were obtained of which 360 (84%) were considered for analysis. The participants were mainly nephrologists 276 (86%), renal pathologists 13 (4%) and physicians in training 11 (3%). 213 (59%) of the respondents treat patients with GD. For patients at risk but without COVID-19 infection, the induction immunosuppression for GD treatment was not changed by 54.1% of the respondents while 24.2% gave only a fraction of it and 21.7% deferred the induction treatment. For maintenance immunosuppression, the same regimen was maintained by 74.2% of the respondents, 24.3% decreased it and 1.5% suspended it completely. In case of relapse or flare, 53.6% used standard increase of immunosuppression, 39.7% increased it but at lower levels than usual and 6.7% continued the maintenance regimen. For patients already on immunosuppression diagnosed with COVID-19 infection, 42% would decrease immunosuppressive regimens for mild disease, 62.3% in case of moderate disease and 70.8% would consider completely discontinuing immunosuppression in case of severe disease. Conclusions: Over 40% of the respondents in LA are already prescribing lower than recommended doses of immunosuppression for induction, relapses or flares as a preventive strategy in the context of COVID-19 pandemic. How this change in practice would affect the renal outcomes remains to be seen. The experience in the treatment of GD in patients with concurrent COVID-19 infection remains limited.