The Clinical Course and Prognostic Factors of COVID-19 in Patients with Chronic Kidney Disease, A Study in Six Centers.

INTRODUCTION: Coronavirus disease 19 (COVID-19), has recently emerged as a great health challenge. The novel corona virus may affect the kidneys mainly as acute kidney injury (AKI). Also, the outcome of COVID-19 may be different in patients with underlying kidney disease. The aim of this study was to compare the outcome of COVID-19 in patients with and without underlying kidney disease. METHODS: This was a retrospective study on 659 hospitalized COVID-19 patients in six centers of Iran. Patients were classified into kidney (chronic kidney disease (CKD), end-stage kidney disease (ESKD) or kidney transplantation) and non-kidney groups. The clinical conditions and laboratory data were extracted from the charts. Outcome was defined as death during hospitalization or within 30 days of discharge. RESULTS: Among 659 COVID-19 patients (mean age: 60.7 ± 16.4, 56% male), 208 were in the kidney group (86 ESKD, 35 kidney transplants, and 87 CKD patients). AKI occurred in 41.8%. Incidence of AKI was 34.7% in non-kidney, 74.7% in CKD, and 51.4% in kidney transplant patients (P < .001). Totally 178 patients (27%) died and mortality rate was significantly higher in CKD patients (50.6 vs. 23.4%, P < .001). AKI was associated with increased mortality rate (OR = 2.588, CI: 1.707 to 3.925). Initial glomerular filtration rate (GFR) < 44.2 mL/min and elevated lactate dehydrogenase (LDH) and C-reactive protein (CRP) had significant association with mortality. CONCLUSION: We showed a higher mortality rate in COVID-19 patients with AKI and CKD. Low initial GFR and elevated LDH and CRP were associated with high mortality in COVID-19 patients.

The effect of cytomegalovirus infection on acute rejection in kidney transplanted patients.

INTRODUCTION: It is known that cytomegalovirus (CMV) infection is a common problem among kidney transplant patients. This infection can be increased morbidity and decreased graft survival. This problem has been associated with acute rejection too. PATIENTS AND METHODS: One hundred and thirty renal transplant patients were included in a prospective, case-control study. The renal transplant patients were divided into two groups; patients group with CMV infection and control group without CMV infection. Serum CMV-IgG in all patients was positive (donor and recipients). None of patients had received anti-thymocyte-globulin and thymoglobulin. CMV infection was diagnosed by quantitative CMV-PCR (polymerase chain reaction) test (more than 500 copies/µg). Rejection episode was defined by kidney isotope scan or biopsy. RESULTS: In the group of 66 CMV infection patients (41 male [62.1%] and 25 female [37.9%]) the incidence of graft rejection was 36%, however in the group of 64 control patients the incidence of graft rejection was 9.4 % (P < 0.005). CONCLUSION: CMV infection is important predisposing factor for acute allograft rejection after kidney transplantation. The results of this study suggests that the control of CMV infection could decrease episodes of acute kidney rejection.