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Heldman MR, Kates OS. COVID-19 in Solid Organ Transplant Recipients: a Review of the Current Literature. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2021; 13:67-82. [PMID: 34220357 PMCID: PMC8238515 DOI: 10.1007/s40506-021-00249-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 02/07/2023]
Abstract
Purpose of review The approach to ongoing organ transplantation and management of COVID-19 in solid organ transplant recipients (SOTR) has evolved tremendously since the pandemic’s beginning. We summarize the current literature surrounding the virology of SARS-CoV-2, epidemiology of COVID-19 in transplant recipients, review the clinical features and complications of COVID-19 in SOTR, and discuss the safety and efficacy of current therapies and candidate vaccines in this population. Recent findings Despite initial suspensions in organ transplantation during early 2020, routine donor testing and de-crowding of hospitals have allowed transplant activity to resume at pre-pandemic rates. COVID-19-associated mortality in SOTR is similar to that of the general population, and lower than that of patients with end-organ disease awaiting transplant. The optimal approach to immunosuppression in SOTR with COVID-19 is unknown and disease severity may influence management decisions. Many vaccines in development are likely to be safe for immunocompromised hosts, though post-marketing investigations will be required to determine the efficacy in the SOTR. Summary Though there are multiple unique considerations in the care of SOTR with COVID-19, immunosuppression does not appear to have a detrimental impact on overall outcome. Organ transplantation remains a lifesaving intervention and can be safely performed despite a global pandemic.
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Affiliation(s)
- Madeleine R Heldman
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA
| | - Olivia S Kates
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA
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Nopsopon T, Kittrakulrat J, Takkavatakarn K, Eiamsitrakoon T, Kanjanabuch T, Pongpirul K. Covid-19 in end-stage renal disease patients with renal replacement therapies: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009156. [PMID: 34129609 PMCID: PMC8232454 DOI: 10.1371/journal.pntd.0009156] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/25/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background The novel coronavirus (COVID-19), caused by SARS-CoV-2, showed various prevalence and case-fatality rates (CFR) among patients with different pre-existing chronic conditions. End-stage renal disease (ESRD) patients with renal replacement therapy (RRT) might have a higher prevalence and CFR due to reduced immune function from uremia and kidney tropism of SARS-CoV-2, but there was a lack of systematic study on the infection and mortality of the SARS-CoV-2 infection in ESRD patients with various RRT. Methodology/Principal findings We searched five electronic databases and performed a systematic review and meta-analysis up to June 30, 2020, to evaluate the prevalence and case fatality rate (CFR) of the COVID-19 infection among ESRD patients with RRT. The global COVID-19 data were retrieved from the international database on June 30, 2020, for estimating the prevalence and CFR of the general population as referencing points. Of 3,272 potential studies, 34 were eligible studies consisted of 1,944 COVID-19 confirmed cases in 21,873 ESRD patients with RRT from 12 countries in four WHO regions. The overall pooled prevalence in ESRD patients with RRT was 3.10% [95% confidence interval (CI) 1.25–5.72] which was higher than referencing 0.14% global average prevalence. The overall estimated CFR of COVID-19 in ESRD patients with RRT was 18.06% (95% CI 14.09–22.32) which was higher than the global average at 4.98%. Conclusions This meta-analysis suggested high COVID-19 prevalence and CFR in ESRD patients with RRT. ESRD patients with RRT should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths. Chronic kidney disease (CKD) was associated with increasing severity and mortality of COVID-19. End-stage renal disease (ESRD) patients were at the terminal stage of CKD and had reduced immune function due to uremia. Additionally, ESRD patients with kidney transplantation had a diminished immune system from immunosuppressive agents. Kidneys might be the secondary target of SARS-CoV-2 after the respiratory tract regardless of the previous history of kidney disease, preferably the glomerulus, which was associated with the richness of some specific protein-coding genes in the kidney. The overall pooled prevalence in ESRD patients with renal replacement therapy was approximately 22 times the referencing global average prevalence. The overall estimated case fatality rate of COVID-19 in ESRD patients with renal replacement therapy was approximately 3.6 times the global average. ESRD patients with renal replacement therapy had high COVID-19 prevalence and case fatality rate. We suggested that ESRD patients with renal replacement therapy should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths.
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Affiliation(s)
- Tanawin Nopsopon
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jathurong Kittrakulrat
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanee Eiamsitrakoon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Bumrungrad International Hospital, Bangkok, Thailand
- * E-mail:
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53
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Raina R, Mahajan ZA, Vasistha P, Chakraborty R, Mukunda K, Tibrewal A, Neyra JA. Incidence and Outcomes of Acute Kidney Injury in COVID-19: A Systematic Review. Blood Purif 2021; 51:199-212. [PMID: 34130296 PMCID: PMC8339045 DOI: 10.1159/000514940] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/03/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES The recent worldwide pandemic of COVID-19 has been a serious, multidimensional problem that has left a detrimental worldwide impact on individuals of all ages and several organ systems. The typical manifestation of kidney involvement is acute kidney injury (AKI); however, there is a lack of consensus data regarding AKI epidemiology in COVID-19. This systematic literature review aims to bridge this knowledge gap. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS MEDLINE and Cochrane library were systematically searched for the literature related to AKI in COVID-19 patients of all ages. MedRxIV was searched for relevant unpublished manuscripts. Two reviewers independently assessed the literature on the incidence of AKI and mortality, extracting the need for kidney replacement therapy (KRT). RESULTS Sixty studies (n = 43,871 patients) were included in this review. The pooled incidence of AKI among COVID-19 patients was 19.45% (95% confidence intervals [95% CI]: 14.63-24.77%), while the pooled incidence of AKI COVID-19 patients requiring KRT was 39.04% (16.38-64.57%). The pooled proportion of COVID+ patients was significantly lower at 8.83% (5.64% to 12/66%). The overall mortality of COVID-19 patients was calculated to be 17.71% (95% CI: 11.49-24.93%), while the mortality among patients with AKI was higher at 54.24% (95% CI: 44.70-63.63%). CONCLUSION This comprehensive systematic review summarizes the available literature pertaining to AKI epidemiology in COVID-19 patients and highlights the incidence, associated mortality, and the need for KRT in this susceptible population.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA
- Department of Nephrology, Akron Children's Hospital, Akron, Ohio, USA
| | - Zubin A. Mahajan
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Prabhav Vasistha
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Ronith Chakraborty
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA
- Department of Nephrology, Akron Children's Hospital, Akron, Ohio, USA
| | - Krishna Mukunda
- Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Abhishek Tibrewal
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Javier A. Neyra
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, Lexington, Kentucky, USA
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54
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Pecly IMD, Azevedo RB, Muxfeldt ES, Botelho BG, Albuquerque GG, Diniz PHP, Silva R, Rodrigues CIS. A review of Covid-19 and acute kidney injury: from pathophysiology to clinical results. ACTA ACUST UNITED AC 2021; 43:551-571. [PMID: 34057983 PMCID: PMC8940122 DOI: 10.1590/2175-8239-jbn-2020-0204] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/16/2021] [Indexed: 01/08/2023]
Abstract
Acute kidney injury (AKI) in hospitalized patients with COVID-19 is associated with higher mortality and a worse prognosis. Nevertheless, most patients with COVID-19 have mild symptoms, and about 5% can develop more severe symptoms and involve hypovolemia and multiple organ dysfunction syndrome. In a pathophysiological perspective, severe SARS-CoV-2 infection is characterized by numerous dependent pathways triggered by hypercytokinemia, especially IL-6 and TNF-alpha, leading to systemic inflammation, hypercoagulability, and multiple organ dysfunction. Systemic endotheliitis and direct viral tropism to proximal renal tubular cells and podocytes are important pathophysiological mechanisms leading to kidney injury in patients with more critical infection, with a clinical presentation ranging from proteinuria and/or glomerular hematuria to fulminant AKI requiring renal replacement therapies. Glomerulonephritis, rhabdomyolysis, and nephrotoxic drugs are also associated with kidney damage in patients with COVID-19. Thus, AKI and proteinuria are independent risk factors for mortality in patients with SARS-CoV-2 infection. We provide a comprehensive review of the literature emphasizing the impact of acute kidney involvement in the evolutive prognosis and mortality of patients with COVID-19.
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Affiliation(s)
- Inah Maria D Pecly
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Rafael B Azevedo
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Elizabeth S Muxfeldt
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil.,Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, Brasil
| | - Bruna G Botelho
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | | | | | - Rodrigo Silva
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Cibele I S Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, São Paulo, SP, Brasil
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55
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Wang RR, He M, Kang Y. A risk score based on procalcitonin for predicting acute kidney injury in COVID-19 patients. J Clin Lab Anal 2021; 35:e23805. [PMID: 34032326 PMCID: PMC8183912 DOI: 10.1002/jcla.23805] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/05/2021] [Accepted: 04/13/2021] [Indexed: 02/05/2023] Open
Abstract
Background Acute kidney injury (AKI) has been reported developing commonly in coronavirus disease 2019 (COVID‐19) patients and could increase the risk of poor outcomes in these patients. We design this study to explore the value of serum procalcitonin (PCT) on predicting AKI and construct risk score for predicting AKI in COVID‐19 patients. Methods Patients diagnosed with COVID‐19 and hospitalized in Renmin Hospital of Wuhan University between January 30 and February 24, 2020, were included. The least absolute shrinkage and selection operator (LASSO) regression was performed to identify the strongest predictors of AKI. Multivariate logistic regression analysis was conducted to find independent risk factors for AKI and construct risk score using odds ratio (OR) value of those risk factors. Receiver operating characteristics (ROC) curves were plotted, and area under the ROC curve (AUC) value was calculated to evaluate the predictive value of single PCT level and the constructed risk score. Results Among 389 included COVID‐19 patients, 28 (7.2%) patients developed AKI. LASSO regression showed hypertension, saturation of arterial oxygen (SaO2), PCT, and blood urea nitrogen (BUN) were the strongest predictors for AKI. After multivariate logistic regression analysis, only SaO2 (<0.001), PCT (p = 0.004), and BUN (p = 0.005) were independently associated with development of AKI in COVID‐19 patients. The AUC of single PCT and constructed risk score was 0. 881 and 0.928, respectively. Conclusion PCT level is correlated with AKI in COVID‐19 patients. The efficient risk score consisted of SaO2, PCT, and BUN is readily accessible for physicians to evaluate the possibility of AKI in COVID‐19 patients.
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Affiliation(s)
- Ruo Ran Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.,COVID19 Medical Team (Hubei) of West China Hospital, Sichuan University, Chengdu, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.,COVID19 Medical Team (Hubei) of West China Hospital, Sichuan University, Chengdu, China
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56
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Voorend CGN, Joosten H, Berkhout-Byrne NC, Diepenbroek A, Franssen CFM, Bos WJW, Van Buren M, Mooijaart SP. Design of a consensus-based geriatric assessment tailored for older chronic kidney disease patients: results of a pragmatic approach. Eur Geriatr Med 2021; 12:931-942. [PMID: 33871790 PMCID: PMC8463384 DOI: 10.1007/s41999-021-00498-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/08/2021] [Indexed: 12/15/2022]
Abstract
Aim To propose a consensus-based geriatric assessment for optimizing both routine care and research in older patients with advanced chronic kidney disease. Findings Using a pragmatic approach, we reached consensus on a suitable nephrology-tailored geriatric assessment to routinely identify major geriatric impairments in older patients with advanced chronic kidney disease. This geriatric assessment contains instruments in functional, cognitive, psychological, somatic, patient preferences, nutritional status, and social domains, and can be administered with patient questionnaires and professional-administered instruments by nurse (practitioners) in approximately 20 and 40 minutes, respectively. Message We propose a consensus test set for standardized nephrology-tailored geriatric assessment, which is currently being implemented in multiple hospitals and studies, to benefit clinical care for older patients with advanced chronic kidney disease and enhance research comparability. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00498-0. Purpose Unidentified cognitive decline and other geriatric impairments are prevalent in older patients with advanced chronic kidney disease (CKD). Despite guideline recommendation of geriatric evaluation, routine geriatric assessment is not common in these patients. While high burden of vascular disease and existing pre-dialysis care pathways mandate a tailored geriatric assessment, no consensus exists on which instruments are most suitable in this population to identify geriatric impairments. Therefore, the aim of this study was to propose a geriatric assessment, based on multidisciplinary consensus, to routinely identify major geriatric impairments in older people with advanced CKD. Methods A pragmatic approach was chosen, which included focus groups, literature review, inventory of current practices, an expert consensus meeting, and pilot testing. In preparation of the consensus meeting, we composed a project team and an expert panel (n = 33), drafted selection criteria for the selection of instruments, and assessed potential instruments for the geriatric assessment. Results Selection criteria related to general geriatric domains, clinical relevance, feasibility, and duration of the assessment. The consensus-assessment contains instruments in functional, cognitive, psychological, somatic, patient preferences, nutritional status, and social domains. Administration of (seven) patient questionnaires and (ten) professional-administered instruments, by nurse (practitioners), takes estimated 20 and 40 min, respectively. Results are discussed in a multidisciplinary meeting including at least nephrology and geriatric expertise, informing nephrology treatment decisions, and follow-up interventions among which comprehensive geriatric assessment. Conclusion This first multidisciplinary consensus on nephrology-tailored geriatric assessment intent to benefit clinical care and enhance research comparability for older patients with advanced CKD. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00498-0.
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Affiliation(s)
- Carlijn G N Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands.
| | - Hanneke Joosten
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Noeleen C Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Adry Diepenbroek
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Casper F M Franssen
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, St. Antonius hospital, Nieuwegein, The Netherlands
| | - Marjolijn Van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Haga Hospital, The Hague, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
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57
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Xu H, Garcia-Ptacek S, Annetorp M, Bruchfeld A, Cederholm T, Johnson P, Kivipelto M, Metzner C, Religa D, Eriksdotter M. Acute kidney injury and mortality risk in older adults with COVID-19. J Nephrol 2021; 34:295-304. [PMID: 33751497 PMCID: PMC7982881 DOI: 10.1007/s40620-021-01022-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/07/2021] [Indexed: 12/15/2022]
Abstract
Background Research regarding COVID-19 and acute kidney injury (AKI) in older adults is scarce. We evaluated risk factors and outcomes of AKI in hospitalized older adults with and without COVID-19. Methods Observational study of patients admitted to two geriatric clinics in Stockholm from March 1st to June 15th, 2020. The difference in incidence, risk factors and adverse outcomes for AKI between patients with or without COVID-19 were examined. Odds ratios (OR) for the risk of AKI and in-hospital death were obtained from logistic regression. Results Three hundred-sixteen older patients were hospitalized for COVID-19 and 876 patients for non-COVID-19 diagnoses. AKI occurred in 92 (29%) patients with COVID-19 vs. 159 (18%) without COVID-19. The odds for developing AKI were higher in patients with COVID-19 (adjusted OR, 1.70; 95% confidence interval [CI] 1.04–2.76), low baseline kidney function as depicted by estimated glomerular filtration rate (eGFR) [4.19 (2.48–7.05), for eGFR 30 to < 60 mL/min, and 20.3 (9.95–41.3) for eGFR < 30 mL/min], and higher C reactive protein (CRP) (OR 1.81 (1.11–2.95) in patients with initial CRP > 10 mg/L). Compared to patients without COVID-19 and without AKI, the risk of in-hospital death was highest in patients with COVID-19 and AKI [OR 80.3, 95% CI (27.3–235.6)], followed by COVID-19 without AKI [16.3 (6.28–42.4)], and by patients without COVID-19 and with AKI [10.2 (3.66–28.2)]. Conclusions Geriatric patients hospitalized with COVID-19 had a higher incidence of AKI compared to patients hospitalized for other diagnoses. COVID-19 and reduced baseline kidney function were risk factors for developing AKI. AKI and COVID-19 were associated with in-hospital death. Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01022-0.
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Affiliation(s)
- Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, NEO, Blickagången 16, Huddinge, 141 52, Stockholm, Sweden.
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, NEO, Blickagången 16, Huddinge, 141 52, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Annetorp
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Tommy Cederholm
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Johnson
- Department of Geriatrics, Capio Geriatrik Nacka AB, Nacka, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, NEO, Blickagången 16, Huddinge, 141 52, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Carina Metzner
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Dorota Religa
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, NEO, Blickagången 16, Huddinge, 141 52, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, NEO, Blickagången 16, Huddinge, 141 52, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
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58
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Le Stang MB, Desenclos J, Flamant M, Chousterman BG, Tabibzadeh N. The Good Treatment, the Bad Virus, and the Ugly Inflammation: Pathophysiology of Kidney Involvement During COVID-19. Front Physiol 2021; 12:613019. [PMID: 33776785 PMCID: PMC7993058 DOI: 10.3389/fphys.2021.613019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/08/2021] [Indexed: 01/08/2023] Open
Abstract
Kidney involvement is a common complication during SARS-CoV-2 infection. Its association with poor outcomes, especially in critically ill patients, raises issues whether kidney involvement reflects multi-organ damage or if it is a specific feature of the infection. Based on observational studies, autopsy series, and on current understanding of the route of entry of the virus, this review will highlight the different types of kidney involvement during COVID-19 and put them in the perspective of the different pathophysiological hypotheses. Virus entry route through ACE2 ligation and TMPRSS2 coligation allows identifying potential viral targets in the kidney, including tubules, endothelial cells, and glomerulus. While reports have described damages of all these structures and virus kidney tropism has been identified in renal extracts in autopsy series, no direct viral infection has been found in the latter structures thus far on kidney biopsies. Notwithstanding the technical challenge of disclosing viral invasion within tissues and cells, viral direct cytopathogenic effect generally does not appear as the cause of the observed renal damage. Inflammation and altered hemodynamics, described as "viral sepsis," might rather be responsible for organ dysfunction, including kidneys. We shall place these various mechanisms into an integrated vision where the synergy between direct viral pathogenicity and systemic inflammation enhances renal damage. As SARS-CoV-2 inexorably continues its rampant spread, understanding the sequence of events in the kidneys might thus help inform improved therapeutic strategies, including antiviral drugs and immunomodulators.
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Affiliation(s)
| | - Jordan Desenclos
- Nephrology, Dialysis and Transplantation Department, CHU Clermont Ferrand, University Clermont Auvergne, Clermont Ferrand, France
- Department of Physiology, Hôpital Bichat, FHU APOLLO, DMU Dream, APHP.Nord, Paris, France
| | - Martin Flamant
- Université de Paris, U1149 INSERM, Paris, France
- Department of Physiology, Hôpital Bichat, FHU APOLLO, DMU Dream, APHP.Nord, Paris, France
| | - Benjamin G. Chousterman
- INSERM U942 MASCOT, Université de Paris, Paris, France
- Department of Anesthesia and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France
| | - Nahid Tabibzadeh
- Université de Paris, U1149 INSERM, Paris, France
- Department of Physiology, Hôpital Bichat, FHU APOLLO, DMU Dream, APHP.Nord, Paris, France
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59
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Baptista MC, Burton WN, Pawlecki B, Pransky G. A Physician's Guide for Workers' Return to Work During COVID-19 Pandemic. J Occup Environ Med 2021; 63:199-220. [PMID: 33350662 PMCID: PMC7934326 DOI: 10.1097/jom.0000000000002118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Higher probability of developing severe COVID-19 has been associated with health risk factors and medical conditions which are common among workers globally. For at risk workers, return to work may require additional protective policies and procedures. METHODS A review of the medical literature was conducted on health risk factors and medical conditions associated with increased COVID-19 morbidity and mortality, standardized measures for community COVID transmission, and occupation-specific risk. RESULTS The relative risk of acquiring and the severity of COVID-19 for workers is associated with three pillars: individual risk, workplace risk, and community risk. Matrices were developed to determine a worker's individual risk based on these three pillars. CONCLUSIONS A practical decision tool is proposed for physicians evaluating and managing individual worker COVID-19 risk in the context of returning to work.
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Affiliation(s)
- Marcos C Baptista
- Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil (Dr Baptista); Environmental and Occupational Sciences, University of Illinois School of Public Health, Chicago, IL (Dr Burton); The Goodyear Tire and Rubber Company, Akron, OH (Dr Pawlecki); Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (Dr Pransky)
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Abstract
The prevalence of COVID-19-associated diabetes is not the result of a single event but of a combination of disease susceptibility associated with chronic illness and COVID-19-specific mechanisms affecting metabolism. Whether a separate entity of post-COVID-19 diabetes, possibly associated with lasting β-cell damage, also exists is not yet clear.
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Affiliation(s)
- Domenico Accili
- Department of Medicine and Naomi Berrie Diabetes Center, Vagelos College of Physicians & Surgeons of Columbia University, New York, NY, USA.
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61
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Askari H, Sanadgol N, Azarnezhad A, Tajbakhsh A, Rafiei H, Safarpour AR, Gheibihayat SM, Raeis-Abdollahi E, Savardashtaki A, Ghanbariasad A, Omidifar N. Kidney diseases and COVID-19 infection: causes and effect, supportive therapeutics and nutritional perspectives. Heliyon 2021; 7:e06008. [PMID: 33495739 PMCID: PMC7817396 DOI: 10.1016/j.heliyon.2021.e06008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/23/2020] [Accepted: 01/13/2021] [Indexed: 02/07/2023] Open
Abstract
Recently, the novel coronavirus disease 2019 (COVID-19), has attracted the attention of scientists where it has a high mortality rate among older adults and individuals suffering from chronic diseases, such as chronic kidney diseases (CKD). It is important to elucidate molecular mechanisms by which COVID-19 affects the kidneys and accordingly develop proper nutritional and pharmacological strategies. Although numerous studies have recently recommended several approaches for the management of COVID-19 in CKD, its impact on patients with renal diseases remains the biggest challenge worldwide. In this paper, we review the most recent evidence regarding causality, potential nutritional supplements, therapeutic options, and management of COVID-19 infection in vulnerable individuals and patients with CKD. To date, there is no effective treatment for COVID-19-induced kidney dysfunction, and current treatments are yet limited to anti-inflammatory (e.g. ibuprofen) and anti-viral medications (e.g. Remdesivir, and Chloroquine/Hydroxychloroquine) that may increase the chance of treatment. In conclusion, the knowledge about kidney damage in COVID-19 is very limited, and this review improves our ability to introduce novel approaches for future clinical trials for this contiguous disease.
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Affiliation(s)
- Hassan Askari
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Sanadgol
- Department of Biology, Faculty of Sciences, University of Zabol, Zabol, Iran
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Asaad Azarnezhad
- Cellular and Molecular Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Amir Tajbakhsh
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Rafiei
- Terry Fox Laboratory, BC Cancer Research Centre, Vancouver, BC, Canada
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohammad Gheibihayat
- Department of Medical Biotechnology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ehsan Raeis-Abdollahi
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Savardashtaki
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ghanbariasad
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
- Department of Medical Biotechnology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Navid Omidifar
- Biotechnology Research Center, Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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62
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Maeda A, Hayase N, Doi K. Acute Kidney Injury Induces Innate Immune Response and Neutrophil Activation in the Lung. Front Med (Lausanne) 2020; 7:565010. [PMID: 33330525 PMCID: PMC7718030 DOI: 10.3389/fmed.2020.565010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/12/2020] [Indexed: 01/08/2023] Open
Abstract
Complication in acute kidney injury (AKI) is significantly associated with developing acute respiratory failure (ARF), while ARF is one of the most important risks for AKI. These data suggest AKI and ARF may synergistically worsen the outcomes of critically ill patients and these organ injuries may not occur independently. Organ crosstalk between the kidney and the lung has been investigated by using animal models so far. This review will focus on innate immune response and neutrophil activation among the mechanisms that contribute to this organ crosstalk. AKI increased the blood level of an inflammatory mediator in high-mobility group box 1, which induces an innate immune reaction via toll-like receptor 4. The remarkable infiltration of neutrophils to the lung was observed in animal AKI models. IL-6 and IL-8 have been demonstrated to contribute to pulmonary neutrophil activation in AKI. In addition, the formation of a neutrophil extracellular trap was also observed in the lung after the exposure of renal ischemia reperfusion in the animal model. Further investigation is necessary to determine whether targeting innate immune response and neutrophil activation will be useful for developing new therapeutics that could improve multiple organ failure in critically ill patients.
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Affiliation(s)
- Akinori Maeda
- Department of Acute Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoki Hayase
- Department of Acute Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo Hospital, Tokyo, Japan
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63
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Al Mutair A, Alhumaid S, Alhuqbani WN, Zaidi ARZ, Alkoraisi S, Al-Subaie MF, AlHindi AM, Abogosh AK, Alrasheed AK, Alsharafi AA, Alhuqbani MN, Alhowar NA, Salih S, Alhedaithy MA, Al-Tawfiq JA, Al-Shammari H, Abdulqawi R, Ismail AF, Hamdan N, Saad F, Olhaye FA, Eltahir TA, Rabaan AA, Al-Omari A. Clinical, epidemiological, and laboratory characteristics of mild-to-moderate COVID-19 patients in Saudi Arabia: an observational cohort study. Eur J Med Res 2020; 25:61. [PMID: 33239068 PMCID: PMC7686832 DOI: 10.1186/s40001-020-00462-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) emerged from China in December 2019 and has presented as a substantial and serious threat to global health. We aimed to describe the clinical, epidemiological, and laboratory findings of patients in Saudi Arabia infected with SARS-CoV-2 to direct us in helping prevent and treat coronavirus disease 2019 (COVID-19) across Saudi Arabia and around the world. Materials and methods Clinical, epidemiological, laboratory, and radiological characteristics, treatment, and outcomes of pediatric and adult patients in five hospitals in Riyadh, Saudi Arabia, were surveyed in this study. Results 401 patients (mean age 38.16 ± 13.43 years) were identified to be SARS-CoV-2 positive and 80% of cases were male. 160 patients had moderate severity and 241 were mild in severity. The most common signs and symptoms at presentation were cough, fever, fatigue, and shortness of breath. Neutrophil and lymphocyte counts, aspartate aminotransferase, C-reactive protein, and ferritin were higher in the COVID-19 moderate severity patient group. Mild severity patients spent a shorter duration hospitalized and had slightly higher percentages of abnormal CT scans and X-ray imaging. Conclusions This study provides an understanding of the features of non-ICU COVID-19 patients in Saudi Arabia. Further national collaborative studies are needed to streamline screening and treatment procedures for COVID-19.
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Affiliation(s)
- Abbas Al Mutair
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.,University of Wollongong, Wollongong, Australia
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Alahsa, Ministry of Health, Rashdiah Street, P. O. Box 12944, Alahsa, 31982, Saudi Arabia.
| | - Waad N Alhuqbani
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.,College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdul Rehman Z Zaidi
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Safug Alkoraisi
- Department of Critical Care, Al Hammadi Hospital, Riyadh, Saudi Arabia
| | - Maha F Al-Subaie
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Ahmed K Abogosh
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Aya A Alsharafi
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Njoud A Alhowar
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Samer Salih
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | | | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haifa Al-Shammari
- Department of Histopathology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rayid Abdulqawi
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.,University of Wollongong, Wollongong, Australia
| | - Alaa F Ismail
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Noura Hamdan
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Fares Saad
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Fahad A Olhaye
- Department of Internal Medicine, Al Hammadi Hospital, Riyadh, Saudi Arabia
| | - Tarig A Eltahir
- Department of Internal Medicine, Al Hammadi Hospital, Riyadh, Saudi Arabia
| | - Ali A Rabaan
- Molecular Diagnostics Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Awad Al-Omari
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Fernandez-Prado R, Gonzalez-Parra E, Ortiz A. Often forgotten, transport modality to dialysis may be life-saving. Clin Kidney J 2020; 13:510-512. [PMID: 32905336 PMCID: PMC7467588 DOI: 10.1093/ckj/sfaa163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Indexed: 12/12/2022] Open
Abstract
Haemodialysis patients commute to the dialysis facility thrice weekly, for a total of six trips per week. While nephrologists may think that how patients do this is up to them and their insurance companies, there is growing evidence that providing advice on how to commute to dialysis is part of an integrated care plan for dialysis patients. In this issue of Clinical Kidney Journal, two reports emphasize the importance of transport modality on dialysis patient well-being and even survival. Rincon et al. report on the epidemiology and clinical spectrum of coronavirus disease 2019 (COVID-19) in a Spanish haemodialysis unit. A key source of infection was related to access to healthcare or elderly care facilities. Indeed, healthcare transportation with future symptomatic [odds ratio (OR) = 3.33] or asymptomatic (OR = 4.73) COVID-19 patients increased the risk of infection. Working with transport providers to minimize cross-infection between patients during transport was one of the measures taken to stop disease transmission. Lessons learned from COVID-19 may also apply to influenza and other infections. In the second report, Yazawa et al. describe an association between transport modality to the dialysis facility and health-related quality of life (QOL) among haemodialysis patients in the Japanese Dialysis Outcomes and Practice Patterns study. These reports emphasize the need for nephrologists to understand how patients are transported to dialysis and how transport modality may be optimized to promote QOL and decrease potentially life-threatening complications.
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Affiliation(s)
- Raul Fernandez-Prado
- IIS-Fundación Jiménez Diaz, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain.,Red de Investigación Renal, Instituto Carlos III-FEDER, 28040 Madrid, Spain
| | - Emilio Gonzalez-Parra
- IIS-Fundación Jiménez Diaz, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain.,Red de Investigación Renal, Instituto Carlos III-FEDER, 28040 Madrid, Spain
| | - Alberto Ortiz
- IIS-Fundación Jiménez Diaz, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain.,Red de Investigación Renal, Instituto Carlos III-FEDER, 28040 Madrid, Spain
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