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Xue Y, Feng W, Shi L, Cui N, Zhang W, Dong J, Li C, Hu J, Wei J. Review of clinical characteristics and mortality outcomes in patients on maintenance hemodialysis during the Omicron surge: a single center experience. BMC Public Health 2024; 24:1481. [PMID: 38831260 PMCID: PMC11145803 DOI: 10.1186/s12889-024-18999-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND This hemodialysis center experienced the pandemic from December 2022 to January 2023. Therefore, we sought to describe the clinical characteristics and mortality outcomes in hemodialysis patients during this Omicron surge. METHODS According to whether they are infected, they are divided into two groups: SARS-CoV-2-positive and SARS-CoV-2-negative. The SARS-CoV-2-positive group was divided into a survival group and a non-survival group for comparison. RESULTS 366 of 457 hemodialysis patients were infected with SARS-CoV-2. The most common symptoms observed were fever (43.2%) and cough (29.8%), Followed by diarrhea (1.4%). Hemodialysis patients with hypertension were more susceptible to SARS-CoV-2 infection. The lymphocyte count, serum creatinine, serum potassium, and serum phosphorus in the SARS-CoV-2-positive group were significantly lower than those in the SARS-CoV-2-negative group. The all-cause mortality rate for infection with SARS-CoV-2 was 5.2%. Only 7 of 366 SARS-CoV-2-positive patients were admitted to the intensive care unit, but 6 of them died. Intensive care unit hospitalization rates were significantly higher in the non-survival group compared with the survival group. White blood cells count, neutrophil count, C-reactive protein, AST, and D-dimer in the non-survival group were higher than those in the survival group. The lymphocyte count, hemoglobin concentration, serum creatinine, serum albumin, serum phosphorus and parathyroid hormone in the non-survival group were lower than those in the survival group. Age > 65 years, elevated C-reactive protein and AST are independent risk factors for death. Finally, no significant difference in vaccination status was found between the SARS-CoV-2-positive group and the negative group. CONCLUSIONS Hemodialysis patients are at high risk for SARS-CoV-2 infection. Ensuring the adequacy of hemodialysis treatment and maintaining good physical condition of patients are the top priorities.
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Affiliation(s)
- Yiyang Xue
- Health Science Center, Ningbo University, 818 Fenghua Rd, 315211, Ningbo, Zhejiang, P. R. China
| | - Weiwei Feng
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Ling Shi
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Ning Cui
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Wei Zhang
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Junxiu Dong
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Chunying Li
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Jinjin Hu
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Junjun Wei
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China.
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Zhang Q, Lu C, Wu S, He J, Wang H, Li J, Wu Z, Ta B, Yang B, Liao S, Wang L, Chen H, Li M, He W, Wang Y, Jiang L, Zhao JH, Nie L. The outcome and related risk factors of unvaccinated patients with end-stage kidney disease during the Omicron pandemic: a multicentre retrospective study. BMJ Open 2024; 14:e084649. [PMID: 38749679 PMCID: PMC11097873 DOI: 10.1136/bmjopen-2024-084649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/26/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES The study aims to identify the outcome and the related factors of unvaccinated patients with end-stage kidney disease during the Omicron pandemic. DESIGN A multicentre retrospective study of patients with end-stage kidney disease undergone maintenance haemodialysis (HD) in China. SETTING 6 HD centres in China. PARTICIPANTS A total of 654 HD patients who tested positive for SARS-CoV-2 were ultimately included in the study. OUTCOME MEASURES The primary outcomes of interest were adverse outcomes, including hospitalisation due to COVID-19 and all-cause mortality. RESULTS The average age of the patients was 57 years, with 33.6% of them being over 65 years. Among the patients, 57.5% were male. During the follow-up period, 158 patients (24.2%) experienced adverse outcomes, and 93 patients (14.2%) died. The majority of patients (88/158) developed adverse outcomes within 30 days, and most deaths (77/93) occurred within 1 month. An advanced multivariable Cox regression analysis identified that adverse outcomes were associated with various factors while all-cause mortality was related to advanced age, male gender, high levels of C reactive protein (CRP) and low levels of prealbumin. The Kaplan-Meier curves demonstrated significantly higher all-cause mortality rates in the older, male, high CRP and low prealbumin subgroups. CONCLUSIONS Among unvaccinated HD patients with confirmed Omicron infections, various factors were found to be linked to adverse outcomes. Notably, age, sex, CRP and prealbumin had a substantial impact on the risk of all-cause mortality.
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Affiliation(s)
- Quanchao Zhang
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Caibao Lu
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shaofa Wu
- Department of Nephrology, Youyang Hospital, A Branch of the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin He
- Department of Endocrinology and Nephrology, Chonggang General Hospital, Chongqing, China
| | - Han Wang
- Department of Endocrinology and Nephrology, Chonggang General Hospital, Chongqing, China
| | - Jie Li
- Urology and Kidney Disease Center, Yongchuan People's Hospital of Chongqing, Chongqing, China
| | - Zhifen Wu
- Urology and Kidney Disease Center, Yongchuan People's Hospital of Chongqing, Chongqing, China
| | - Bingshuang Ta
- Department of Nephrology and Endocrinology, Chong Qing Bishan District Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Bingfeng Yang
- Department of Nephrology and Endocrinology, Chong Qing Bishan District Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Shengli Liao
- Hemodialysis Center, Nanchuan Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Liao Wang
- Hemodialysis Center, Nanchuan Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Hongwei Chen
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Moqi Li
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenchang He
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yiqin Wang
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lili Jiang
- Department of Nephrology, Youyang Hospital, A Branch of the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing-Hong Zhao
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ling Nie
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Rosca EC, Cornea A, Simu M. Emerging Trends in Complications Associated with SARS-CoV-2 Infection. Biomedicines 2023; 12:4. [PMID: 38275366 PMCID: PMC10813045 DOI: 10.3390/biomedicines12010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has presented a remarkable challenge to global health, sparking a surge in research aimed at understanding the multifaceted impacts of the virus [...].
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Affiliation(s)
- Elena Cecilia Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. no. 2, 300041 Timisoara, Romania; (A.C.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca no. 10, 300736 Timisoara, Romania
| | - Amalia Cornea
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. no. 2, 300041 Timisoara, Romania; (A.C.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca no. 10, 300736 Timisoara, Romania
| | - Mihaela Simu
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. no. 2, 300041 Timisoara, Romania; (A.C.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca no. 10, 300736 Timisoara, Romania
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Zhang F, Li G, Yu J, Shen Y, Yang Y, Fu S, Liu K, Liang Y, Luo X, Chen Y. Characteristics and Prognostic Factors of SARS-CoV-2 Omicron Variant Infection in Hemodialysis Patients: A Single-Center Study in China. Blood Purif 2023; 53:288-300. [PMID: 37972579 PMCID: PMC11251654 DOI: 10.1159/000535244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION This study aimed to evaluate the characteristics and prognostic factors for coronavirus disease 2019 (COVID-19) patients on maintenance hemodialysis (HD). METHODS All admitted HD patients who were infected with SARS-CoV-2 from December 1, 2022, to January 31, 2023, were included. Patients with pneumonia were further classified into the mild, moderate, severe, and critical illness. Clinical symptoms, laboratory results, radiologic findings, treatment, and clinical outcomes were collected. Independent risk factors for progression to critical disease and in-hospital mortality were determined by the multivariate regression analysis. The receiver operating characteristic analysis with the area under the curve was used to evaluate the predictive performance of developing critical status and in-hospital mortality. RESULTS A total of 182 COVID-19 patients with HD were included, with an average age of the 61.55 years. Out of the total, 84 (46.1%) patients did not have pneumonia and 98 (53.8%) patients had pneumonia. Among patients with pneumonia, 48 (49.0%) had moderate illness, 26 (26.5%) severe illness, and 24 (24.5%) critical illness, respectively. Elder age [HR (95% CI): 1.07 (1.01-1.13), p <0.01], increased levels of lactate dehydrogenase (LDH) [1.01 (1.003-1.01), p <0.01], and C-reactive protein (CRP) [1.01 (1.00-1.01), p = 0.04] were risk factors for developing critical illness. Elder age [1.11 (1.03-1.19), p = 0.01], increased procalcitonin (PCT) [1.07 (1.02-1.12), p = 0.01], and LDH level [1.004 (1-1.01), p = 0.03] were factors associated with increased risk of in-hospital mortality. CONCLUSION Age, CRP, PCT, and LDH can be used to predict negative clinical outcomes for HD patients with COVID-19 pneumonia.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Guoli Li
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jie Yu
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yiyu Shen
- Department of Skin, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yiya Yang
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Shuangshuang Fu
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Kanghan Liu
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yumei Liang
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Xun Luo
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China,
| | - Yinyin Chen
- Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
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Zhang Q, Lu C, Chen H, Li M, Bai X, Chen J, Li D, Zhang Y, Lei N, He W, Wang Y, Zhao J, Nie L. Effectiveness of vaccination in reducing hospitalization and mortality rates in dialysis patients with Omicron infection in China: A single-center study. Hum Vaccin Immunother 2023; 19:2252257. [PMID: 37665207 PMCID: PMC10478735 DOI: 10.1080/21645515.2023.2252257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/04/2023] [Accepted: 08/20/2023] [Indexed: 09/05/2023] Open
Abstract
The impact of vaccination on the outcomes of dialysis patients with Omicron infections in China remains unknown. This study aimed to examine the relationship between vaccination and hospitalization as well as all-cause mortality. We included patients who had undergone maintenance hemodialysis (HD) for at least three months at our center. The follow-up period spanned from December 2022 to February 2023. We assessed the connections between vaccination and hospitalization as well as all-cause mortality using univariable and multivariable logistic regression models. Receiver operating characteristic (ROC) curves were used to assess the diagnostic accuracy for hospitalization and all-cause mortality. Ultimately, a total of 427 HD patients with confirmed SARS-CoV-2 infections were included. The patients had a mean age of 54 years, and 59.4% of them were male. Prior to the investigation, 108 patients had received vaccinations, with 81 of them having completed or received booster vaccinations. Throughout the follow-up period, 81 patients were admitted to the hospital, and 39 patients died. Multivariable logistic regression revealed that vaccination significantly decreased all-cause mortality (OR 0.25, 95% CI 0.07-1.94, P = .04). Moreover, completed or booster vaccinations were effective in reducing the hospitalization rate (OR 0.41, 95%CI 0.17-0.99, P = .047). It is noteworthy that both unvaccinated and vaccinated individuals experienced mild symptoms, and the hospitalization rates were relatively low in both groups. Despite the reduced pathogenicity of Omicron compared to previous strains in dialysis patients, both vaccinated and unvaccinated, vaccination still provides benefits for improving the prognosis.
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Affiliation(s)
- Quanchao Zhang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Caibao Lu
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Hongwei Chen
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Moqi Li
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Xiaoxin Bai
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Jing Chen
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Danni Li
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Yuesha Zhang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Na Lei
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Wenchang He
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Yiqin Wang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Jinghong Zhao
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Ling Nie
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
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Beck NS, Song S, Park T, Hong SH, Jeong-Eun J, Kim KH, Im JI, Hong SY. Clinical features of COVID-19 among patients with end-stage renal disease on hemodialysis in the context of high vaccination coverage during the omicron surge period: a retrospective cohort study. BMC Nephrol 2023; 24:191. [PMID: 37370006 DOI: 10.1186/s12882-023-03219-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND We determined the clinical presentation and outcomes of the Omicron variant of severe acute respiratory syndrome coronavirus 2 infection in hemodialysis patients and identified the risk factors for severe coronavirus disease (COVID-19) and mortality in the context of high vaccination coverage. METHODS This was a retrospective cohort study involving hemodialysis patients who were vaccinated against COVID-19 during March-September 2022, when the Omicron variant was predominant, and the COVID-19 vaccination rate was high. The proportion of people with severe COVID-19 or mortality was evaluated using univariate logistic regression. RESULTS Eighty-three (78.3%) patients had asymptomatic/mild symptoms, 10 (9.4%) had moderate symptoms, and 13 (12.3%) had severe symptoms. Six (5.7%) patients required intensive care admission, two (1.9%) required mechanical ventilation, and one (0.9%) was kept on high-flow nasal cannula. Of the five (4.7%) mortality cases, one was directly attributed to COVID-19 and four to pre-existing comorbidities. Risk factors for both severe COVID-19 and mortality were advanced age; number of comorbidities; cardiovascular diseases; increased levels of aspartate transaminase, lactate dehydrogenase, blood urea nitrogen/creatinine ratio, brain natriuretic peptide, and red cell distribution; and decreased levels of hematocrit and albumin. Moreover, the number of COVID-19 vaccinations wasa protective factor against both severe disease and mortality. CONCLUSIONS Clinical features of hemodialysis patients during the Omicron surge with high COVID-19 vaccination coverage were significant for low mortality. The risk features for severe COVID-19 or mortality were similar to those in the pre-Omicron period in the context of low vaccination coverage.
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Affiliation(s)
- Nam-Seon Beck
- Department of Pediatrics, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Soomin Song
- Department of Statistics, Seoul National University, Seoul, South Korea
| | - Taesung Park
- Department of Statistics, Seoul National University, Seoul, South Korea
| | - So-Hyeon Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ewha Woman's University, School of Medicine, Seoul, South Korea
| | - Jang Jeong-Eun
- Department of Nursing, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Kyoung-Hwan Kim
- Department of Family Medicine, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Joung-Il Im
- Department of Orthopedic Surgery, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Sae-Yong Hong
- Department of Nephrology, Chung-angJeil General Hospital, 24 Jungang-Bukro, Jincheon County, Chungbuk, 27832, South Korea.
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COVID-19 infection in patients on long-term home parenteral nutrition for chronic intestinal failure ☆. Clin Nutr ESPEN 2023; 55:212-220. [PMID: 37202049 PMCID: PMC10060187 DOI: 10.1016/j.clnesp.2023.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 04/08/2023]
Abstract
Background and aims To investigate the incidence and the severity of COVID-19 infection in patients enrolled in the database for home parenteral nutrition (HPN) for chronic intestinal failure (CIF) of the European Society for Clinical Nutrition and Metabolism (ESPEN). Methods Period of observation: March 1st, 2020 March 1st, 2021. Inclusion criteria: patients included in the database since 2015 and still receiving HPN on March 1st, 2020 as well as new patients included in the database during the period of observation. Data related to the previous 12 months and recorded on March 1st 2021: 1) occurrence of COVID-19 infection since the beginning of the pandemic (yes, no, unknown); 2) infection severity (asymptomatic; mild, no-hospitalization; moderate, hospitalization no-ICU; severe, hospitalization in ICU); 3) vaccinated against COVID-19 (yes, no, unknown); 4) patient outcome on March 1st 2021: still on HPN, weaned off HPN, deceased, lost to follow up. Results Sixty-eight centres from 23 countries included 4680 patients. Data on COVID-19 were available for 55.1% of patients. The cumulative incidence of infection was 9.6% in the total group and ranged from 0% to 21.9% in the cohorts of individual countries. Infection severity was reported as: asymptomatic 26.7%, mild 32.0%, moderate 36.0%, severe 5.3%. Vaccination status was unknown in 62.0% of patients, non-vaccinated 25.2%, vaccinated 12.8%. Patient outcome was reported as: still on HPN 78.6%, weaned off HPN 10.6%, deceased 9.7%, lost to follow up 1.1%. A higher incidence of infection (p = 0.04), greater severity of infection (p < 0.001) and a lower vaccination percentage (p = 0.01) were observed in deceased patients. In COVID-19 infected patients, deaths due to infection accounted for 42.8% of total deaths. Conclusions In patients on HPN for CIF, the incidence of COVID-19 infection differed greatly among countries. Although the majority of cases were reported to be asymptomatic or have mild symptoms only, COVID-19 was reported to be fatal in a significant proportion of infected patients. Lack of vaccination was associated with a higher risk of death.
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Notarte KI, Catahay JA, Peligro PJ, Velasco JV, Ver AT, Guerrero JJ, Liu J, Lippi G, Benoit SW, Henry BM, Fernández-de-Las-Peñas C. Humoral Response in Hemodialysis Patients Post-SARS-CoV-2 mRNA Vaccination: A Systematic Review of Literature. Vaccines (Basel) 2023; 11:vaccines11040724. [PMID: 37112636 PMCID: PMC10142871 DOI: 10.3390/vaccines11040724] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has infected over 600 million individuals and caused nearly 7 million deaths worldwide (10 January 2023). Patients with renal disease undergoing hemodialysis are among those most adversely affected, with an increased predisposition to SARS-CoV-2 infection and death. This systematic review aimed to pool evidence assessing the humoral response of hemodialysis patients (HDP) post-mRNA SARS-CoV-2 vaccination. A systematic search of the literature was performed through MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers up to 10 January 2023. Cohort and case-control studies were included if they reported an immune response in one group of patients undergoing hemodialysis who received mRNA SARS-CoV-2 vaccination compared with another group of patients receiving the same vaccine but not on hemodialysis. The methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was not deemed appropriate due to the high heterogeneity between studies. From the 120 studies identified, nine (n = 1969 participants) met the inclusion criteria. Most studies (n = 8/9, 88%) were of high or medium methodological quality (≥6/9 stars). The results revealed that HDP developed lower antibody levels across all timepoints post-vaccination when compared with controls. Patients with chronic kidney disease elicited the highest antibody immune response, followed by HDP and, lastly, kidney transplant recipients. Overall, post-vaccination antibody titers were comparatively lower than in the healthy population. Current results imply that robust vaccination strategies are needed to address waning immune responses in vulnerable populations.
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Affiliation(s)
- Kin Israel Notarte
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jesus Alfonso Catahay
- Department of Medicine, Saint Peter's University Hospital, New Brunswick, NJ 08901, USA
| | | | | | - Abbygail Therese Ver
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila 1008, Philippines
| | - Jonathan Jaime Guerrero
- Learning Unit IV, College of Medicine, University of the Philippines Manila, Manila 1001, Philippines
| | - Jin Liu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, 37129 Verona, Italy
| | - Stefanie W Benoit
- Clinical Laboratory, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45103, USA
| | - Brandon Michael Henry
- Clinical Laboratory, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Madrid, Spain
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9
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McDonnell T, Wu HHL, Kalra PA, Chinnadurai R. COVID-19 in Elderly Patients Receiving Haemodialysis: A Current Review. Biomedicines 2023; 11:biomedicines11030926. [PMID: 36979905 PMCID: PMC10046485 DOI: 10.3390/biomedicines11030926] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
There is an increased incidence of elderly adults diagnosed with kidney failure as our global aging population continues to expand. Hence, the number of elderly adults indicated for kidney replacement therapy is also increasing simultaneously. Haemodialysis initiation is more commonly observed in comparison to kidney transplantation and peritoneal dialysis for the elderly. The onset of the coronavirus 2019 (COVID-19) pandemic brought new paradigms and insights for the care of this patient population. Elderly patients receiving haemodialysis have been identified as high-risk groups for poor COVID-19 outcomes. Age, immunosenescence, impaired response to COVID-19 vaccination, increased exposure to sources of COVID-19 infection and thrombotic risks during dialysis are key factors which demonstrated significant associations with COVID-19 incidence, severity and mortality for this patient group. Recent findings suggest that preventative measures such as regular screening and, if needed, isolation in COVID-19-positive cases, alongside the fulfillment of COVID-19 vaccination programs is an integral strategy to reduce the number of COVID-19 cases and consequential complications from COVID-19, particularly for high-risk groups such as elderly haemodialysis patients. The COVID-19 pandemic brought about the rapid development and repurposing of a number of medications to treat patients in the viral and inflammatory stages of their disease. However, elderly haemodialysis patients were grossly unrepresented in many of these trials. We review the evidence for contemporary treatments for COVID-19 in this population to provide clinicians with an up-to-date guide. We hope our article increases awareness on the associations and impact of COVID-19 for the elderly haemodialysis population, and encourage research efforts to address knowledge gaps in this topical area.
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Affiliation(s)
- Thomas McDonnell
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
| | - Henry H. L. Wu
- Renal Research Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, The University of Sydney, Sydney, NSW 2065, Australia
- Correspondence: ; Tel.: +61-9926-4751
| | - Philip A. Kalra
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M1 7HR, UK
| | - Rajkumar Chinnadurai
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M1 7HR, UK
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10
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Alfano G, Fontana F, Giovanella S, Morisi N, Amurri A, Ligabue G, Guaraldi G, Ferrari A, Cappelli G, Magistroni R, Gregorini M, Donati G. Prevalence, clinical course and outcomes of COVID-19 in peritoneal dialysis (PD) patients: a single-center experience. Clin Exp Nephrol 2023; 27:171-178. [PMID: 36326942 PMCID: PMC9631594 DOI: 10.1007/s10157-022-02283-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION There are limited data on the effects of COVID-19 on peritoneal dialysis (PD) patients. This study aimed to describe the impact of COVID-19 on the PD population. METHODS A monocentric retrospective observational study was conducted on 146 consecutive PD patients followed from January 2020 to March 2022 at the University Hospital of Modena, Italy. RESULTS Twenty-seven (18.4%) PD patients experienced 29 episodes of SARS-CoV-2 infection, corresponding to an incidence rate of 0.16 episodes/patient-year. Median age of COVID-19 patients was 60.4 (interquartile range [IQR] 50.2-66.5) years. In unvaccinated patients (n. 9), COVID-19 was always symptomatic and manifested with fever (100%) and cough (77.7%). COVID-19 caused hospital admission of three (33.3%) patients and two (22.2%) died of septic shock. COVID-19 was symptomatic in 83.3% of vaccinated subjects (n.18) and manifested with fever (61.1%) and cough (55.6%). Hospital admission occurred in 27.8% of the subjects but all were discharged home. Median SARS-CoV-2 shedding was 32 and 26 days in the unvaccinated and vaccinated groups, respectively. At the end of the follow-up, COVID-19 triggered the shift from PD to HD in two subjects without affecting the residual renal function of the remaining patients. Overall, COVID-19 caused an excess death of 22.2%. COVID-19 vaccination refusal accounted for only 1.6% in this cohort of patients. CONCLUSION COVID-19 incident rate was 0.16 episodes/patient-year in the PD population. About one-third of the patients were hospitalized for severe infection. Fatal outcome occurred in two (7.4%) unvaccinated patients. A low vaccination refusal rate was observed in this population.
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Affiliation(s)
- Gaetano Alfano
- Nephrology, Dialysis and Renal Transplant Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, via del Pozzo 71, 41124 Modena, Italy
| | - Francesco Fontana
- Nephrology, Dialysis and Renal Transplant Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, via del Pozzo 71, 41124 Modena, Italy
| | - Silvia Giovanella
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolo Morisi
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Alessio Amurri
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Ligabue
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- Infectious Diseases Unit, Azienda Ospedaliero Universitaria Di Modena, Modena, Italy
| | - Annachiara Ferrari
- Nephrology and Dialysis Unit, Azienda USL-IRCCS Arcispedale S. Maria Nuova Reggio Emilia, Reggio Emilia, Italy
| | - Gianni Cappelli
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Magistroni
- Nephrology, Dialysis and Renal Transplant Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, via del Pozzo 71, 41124 Modena, Italy ,Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Mariacristina Gregorini
- Nephrology and Dialysis Unit, Azienda USL-IRCCS Arcispedale S. Maria Nuova Reggio Emilia, Reggio Emilia, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Renal Transplant Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, via del Pozzo 71, 41124 Modena, Italy ,Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
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11
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Vigotti FN, Di Benedetto C, Fop F, Bianco S, Bilucaglia D, Cesano G. Lung ultrasonography performed by nephrologist: COVID-19 as an opportunity to reveal ultrasound's full potential and usefulness in the dialysis room. Clin Kidney J 2022; 16:541-548. [PMID: 36865007 PMCID: PMC9972800 DOI: 10.1093/ckj/sfac250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Indexed: 12/23/2022] Open
Abstract
Background Interest in point-of-care ultrasound (POCUS) and lung ultrasound (LUS) is growing in the nephrology and dialysis field, and the number of nephrologists skilled in what is proving to be the "5th pillar of bedside physical examination" is increasing. Patients on hemodialysis (HD) are at high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) and developing coronavirus disease 2019 (COVID-19) serious complications. Despite this, to our knowledge there are no studies to date that show the role of LUS in this setting, while there are many in the emergency room, where LUS proved to be an important tool, providing risk stratification and guiding management strategies and resource allocation. Therefore, it is not clear whether the usefulness and cut-offs of LUS highlighted in studies in the general population are reliable in dialysis, or whether variations, precautions and adjustments to this specific situation are necessary. Methods This was a 1-year monocentric prospective observational cohort study of 56 HD patients with COVID-19. Patients underwent a monitoring protocol that included at first evaluation bedside LUS, using a 12-scan scoring system, by the same nephrologist. All data were prospectively and systematically collected. Outcomes. hospitalization rate, combined outcome [non-invasive ventilation (NIV + death)], mortality. Descriptive variables are presented as medians (interquartile range), or percentage. Univariate and multivariate analysis, as well as Kaplan-Meier (K-M) survival curves, were carried out. P was fixed at .05. Results Median age was 78 years, 90% had at least one comorbidity (46% diabetics), 55% were hospitalized and 23% deaths. Median duration of disease was 23 days (14-34). A LUS score ≥11 represented a 13-fold risk of hospitalization, a 16.5-fold risk of combined outcome (NIV + death) vs risk factors such as age [odds ratio (OR) 1.6], diabetes (OR 1.2), male sex (OR 1.3) and obesity (OR 1.25), and a 7.7-fold risk of mortality. In the logistic regression, LUS score ≥11 is associated with the combined outcome with a hazard ratio (HR) of 6.1 vs inflammations indices such as CRP ≥9 mg/dL (HR 5.5) and interleukin-6 (IL-6) ≥62 pg/mL (HR 5.4). In K-M curves, survival drops significantly with LUS score above 11. Conclusions In our experience of COVID-19 HD patients, LUS appeared to be an effective and easy tool, predicting the need for NIV and mortality better than "classic" known COVID-19 risk factors such as age, diabetes, male sex and obesity, and even better than inflammations indices such as CRP and IL-6. These results are consistent with those of the studies in the emergency room setting, but with a lower LUS score cut-off (11 vs 16-18). This is probably due to the higher global frailty and peculiarity of HD population, and emphasizes how nephrologists should themselves use LUS and POCUS as a part of their everyday clinical practice, adapting it to the peculiarity of the HD ward.
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Affiliation(s)
| | - Carlo Di Benedetto
- University of Turin, Nephrology and Dialysis, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Fabrizio Fop
- University of Turin, Nephrology and Dialysis, Molinette Hospital, ASO Città della Salute e della Scienza, Turin, Italy
| | - Simona Bianco
- Nephrology and Dialysis, Martini Hospital, ASL Città di Torino, Turin, Italy
| | | | - Giulio Cesano
- Nephrology and Dialysis, Martini Hospital, ASL Città di Torino, Turin, Italy
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12
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Chuengsaman P, Boongird S, Dandecha P, Hemachudha T, Nopsopon T, Kanjanabuch T, Sritippayawan S, Kantachuvesiri S. Fatality rate, risk factors, and functional decline in peritoneal dialysis patients with coronavirus disease 2019: A nationwide cohort study. Front Med (Lausanne) 2022; 9:1051448. [DOI: 10.3389/fmed.2022.1051448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
BackgroundThe fatality rates and factors associated with death from coronavirus disease 2019 (COVID-19) in hemodialysis patients have been extensively investigated. However, data on peritoneal dialysis (PD) patients remain scarce.Materials and methodsIn this nationwide cohort study, we assessed the 28-day COVID-19-related fatality rate in PD patients between August 2021 and July 2022 using data from the InCov19-PD registry. Predictors associated with death were evaluated using a multivariable Cox regression model. Changes in functional status before and during COVID-19 were also examined.ResultsA total of 1,487 eligible participants were evaluated. During the study period, 196 participants died within 28 days after COVID-19 diagnosis (case fatality rate: 13%). In a multivariable Cox regression model, an increased risk of death within 28 days after COVID-19 diagnosis among PD patients was independently associated with functional impairment during COVID-19 [adjusted hazard ratio (HR) 2.46, 95% confidence interval (CI) 1.59–3.81], SARS-CoV-2 infection with the Delta variant (HR 2.23, 95% CI 1.55–3.21), and the need for respiratory support (HR 7.13, 95% CI 3.74–13.57) (p < 0.01 for all). Conversely, the number of COVID-19 vaccines administered (HR 0.69, 95% CI 0.55–0.87; p = 0.001) and receiving corticosteroid therapy during COVID-19 (HR 0.72, 95% CI 0.54–0.97; p = 0.03) were associated with a decreased risk of death within 28 days after COVID-19 diagnosis. The number of functionally independent PD patients dropped from 94% at baseline to 63% during COVID-19 (p < 0.01).ConclusionsThe COVID-19-related 28-day fatality rate was high among PD patients. The predictors of COVID-19-related death in PD patients were similar to those in hemodialysis patients. During COVID-19, PD patients commonly experienced functional deterioration.
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13
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Interleukin-6 and Outcome of Chronic Hemodialysis Patients with SARS-CoV-2 Pneumonia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111659. [PMID: 36422198 PMCID: PMC9699479 DOI: 10.3390/medicina58111659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
Background and Objectives: Chronic hemodialysis (CHD) patients are at increased risk of SARS-CoV-2 infection and the related complications and mortality of COVID-19 due to the high rate of comorbidities combined with advanced age. This observational study investigated the clinical manifestations of SARS-CoV-2 infection in CHD and the risk factors for patients′ death. Materials and Methods: The study included 26 CHD patients with SARS-CoV-2 pneumonia detected by positive RT-PCR on nasopharyngeal swabs and high-resolution computed tomography at hospital admission, aged 71 + 5.9 years, 14 of which (53.8%) were male, 20 (77%) under hemodiafiltration, and 6 (23%) on standard hemodialysis, with a median follow-up of 30 days. Results: Simple logistic regression analysis revealed that the factors associated with a higher risk of death were older age (OR: 1.133; 95%CI: 1.028−1.326, p = 0.0057), IL-6 levels at admission (OR: 1.014; 95%CI: 1.004−1.028, p = 0.0053), and C-reactive protein (OR: 1.424; 95%CI: 1.158−2.044, p < 0.0001). In the multiple logistic regression model, circulating IL-6 values at admission remained the only significant prognosticator of death. The ROC curve indicated the discriminatory cut-off value of 38.20 pg/mL of blood IL-6 for predicting death in chronic hemodialysis patients with SARS-CoV-2 pneumonia (sensitivity: 100%; specificity: 78%; AUC: 0.8750; p = 0.0027). Conclusions: This study identified a threshold of IL-6 levels at hospital admission for death risk in CHD patients with SARS-CoV-2 pneumonia. This might represent a valuable outcome predictor, feasibly better than other clinical, radiological, or laboratory parameters and preceding the IL-6 peak, which is unpredictable.
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14
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Alfano G, Scarmignan R, Amurri A, Fontana F, Giovanella S, Ligabue G, Gennari W, Pecorari M, Sarti M, Guaraldi G, Cappelli G, Gregorini M, Magistroni R, Donati G. Weekly Rapid Antigen Test Screening for COVID-19 in Patients on Hemodialysis. In Vivo 2022; 36:2823-2827. [PMID: 36309377 PMCID: PMC9677751 DOI: 10.21873/invivo.13020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND/AIM COVID-19 is a concerning issue among in-center hemodialysis (HD) patients. To prevent COVID-19 diffusion in our HD facility, weekly rapid nasal antigen test screening was performed for all asymptomatic patients on chronic HD. This study aimed to assess the performance of weekly rapid antigen test in detecting SARS-CoV-2 infection among asymptomatic patients receiving HD. PATIENTS AND METHODS A retrospective analysis was conducted in HD patients who underwent rapid antigen test screening from December 2021 to March 2022. The diagnosis of COVID-19 with rapid antigen test was always confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS During the observational period, 1,748 rapid antigen tests were performed in 220 HD patients. Mean age was 68.4±14.6 years. Fifteen (8.5%) patients resulted positive for SARS-CoV-2 infection using rapid antigen tests. The diagnosis was subsequently confirmed in 14 (93.3%) patients by RT-PCR. During the same period, 12 (5.4%) symptomatic patients, regularly screened with weekly rapid antigen test, resulted positive for SARS-CoV-2 infection using RT-PCR. Overall, weekly rapid antigen test screening identified 14 out of 26 (53.8%) COVID-19 cases and showed a positive predictive value of 93%. CONCLUSION Weekly antigen test screening of asymptomatic patients on chronic HD detected around half of the COVID-19 cases in our population.
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Affiliation(s)
- Gaetano Alfano
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy;
| | - Roberta Scarmignan
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessio Amurri
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Fontana
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Silvia Giovanella
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Ligabue
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - William Gennari
- Virology and Molecular Microbiology Unit, University Hospital of Modena, Modena, Italy
| | - Monica Pecorari
- Virology and Molecular Microbiology Unit, University Hospital of Modena, Modena, Italy
| | - Mario Sarti
- Clinical Microbiology Unit, University Hospital of Modena, Modena, Italy
| | - Giovanni Guaraldi
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Riccardo Magistroni
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
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15
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Geetha D, Kronbichler A, Rutter M, Bajpai D, Menez S, Weissenbacher A, Anand S, Lin E, Carlson N, Sozio S, Fowler K, Bignall R, Ducharlet K, Tannor EK, Wijewickrama E, Hafidz MIA, Tesar V, Hoover R, Crews D, Varnell C, Danziger-Isakov L, Jha V, Mohan S, Parikh C, Luyckx V. Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions. Nat Rev Nephrol 2022; 18:724-737. [PMID: 36002770 PMCID: PMC9400561 DOI: 10.1038/s41581-022-00618-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce.
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Affiliation(s)
- Duvuru Geetha
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | - Megan Rutter
- Department of Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Divya Bajpai
- Department of Nephrology, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, India
| | - Steven Menez
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Shuchi Anand
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Standford, California, USA
| | - Eugene Lin
- Department of Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
| | - Nicholas Carlson
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Research, The Danish Heart Foundation, Copenhagen, Denmark
| | - Stephen Sozio
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin Fowler
- Principal, Voice of the Patient Inc, St. Louis, Missouri, USA
| | - Ray Bignall
- Division of Nephrology and Hypertension, Nationwide Children's Hospital and Department of Paediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kathryn Ducharlet
- Department of Renal Medicine, Eastern Health Clinical School, Monash University, Melbourne, Australia
- Department of Nephrology and Palliative Care, St Vincent's Hospital Melbourne, Australia and Department of Medicine, University of Melbourne, Parkville, Australia
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Eranga Wijewickrama
- Consultant Nephrologist and Professor in the Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- University Medical Unit, National Hospital of Sri Lanka and National Institute of Nephrology, Dialysis & Transplantation, Colombo, Sri Lanka
| | | | - Vladimir Tesar
- Department of Nephrology, Charles University, Prague, Czech Republic
| | - Robert Hoover
- Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Deidra Crews
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charles Varnell
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Paediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Lara Danziger-Isakov
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA
| | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Chirag Parikh
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Valerie Luyckx
- Associate Scientist, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Honorary Associate Professor, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Nephrologist, University Childrens Hospital, Zurich, Switzerland
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16
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COVID-19 Rapid Antigen Test Screening in Patients on Hemodialysis. Int J Nephrol 2022; 2022:4678717. [PMID: 36160837 PMCID: PMC9492408 DOI: 10.1155/2022/4678717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Patients receiving in-center hemodialysis are extremely vulnerable to COVID-19. It is unclear if routine screening of asymptomatic hemodialysis patients is an effective strategy to prevent COVID-19 outbreaks within the dialysis unit. Methods We conducted a retrospective analysis of in-center hemodialysis patients who underwent bimonthly COVID-19 rapid antigen test screening from February 15th to December 26th, 2021. Nasal rapid antigen testing was performed in all asymptomatic patients. All rapid antigen-positive tests were confirmed by RT-PCR nasopharyngeal swab. Besides universal rapid antigen screening, RT-PCR testing was conducted in all symptomatic patients and contacts of COVID-19 subjects. Results Overall, 4079 rapid antigen tests were performed in 277 hemodialysis patients on chronic hemodialysis with a mean age of 68.4 ± 14.6 years. Thirty-eight (0.9%) rapid antigen tests resulted positive. Only five (13.8%) positive-rapid antigen tests were also positive by RT-PCR testing. During the same period, 219 patients regularly screened by rapid antigen tests bimonthly underwent 442 RT-PCR nasopharyngeal swabs for clinical reasons. RT-PCR testing yielded a positive result in 13 (5.9%) patients. The time elapsed between PCR and the negative-rapid antigen test was 7.7 ± 4.6 days (range 1.8-13.9 days). At the end of the follow-up, 6.4% of the population on in-center hemodialysis contracted COVID-19, and routine rapid antigen tests detected only 5 out of 18 (27.7%) COVID-19 cases. No outbreaks of COVID-19 were identified within the dialysis unit. Conclusion Bimonthly rapid antigen screening led to the early diagnosis of COVID-19 in less than one-third of cases. The short incubation period of the new SARS-CoV-2 variants makes bimonthly test screening inadequate for an early diagnosis of COVID-19. More frequent tests are probably necessary to improve the utility of COVID-19 nasal rapid antigen test in patients on hemodialysis.
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17
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Bouwmans P, Brandts L, Hilbrands LB, Duivenvoorden R, Vart P, Franssen CFM, Covic A, Islam M, Rabaté C, Jager KJ, Noordzij M, Gansevoort RT, Hemmelder MH. The clinical frailty scale as a triage tool for ICU admission of dialysis patients with COVID-19 - An ERACODA analysis. Nephrol Dial Transplant 2022; 37:2264-2274. [PMID: 36002034 PMCID: PMC9452166 DOI: 10.1093/ndt/gfac246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill coronavirus disease 2019 (COVID-19) patients. This study evaluates the impact of CFS on intensive care unit (ICU) admission rate and hospital and ICU mortality rates in hospitalized dialysis patients with COVID-19. Methods We analysed data of dialysis patients diagnosed with COVID-19 from the European Renal Association COVID-19 Database. The primary outcome was ICU admission rate and secondary outcomes were hospital and ICU mortality until 3 months after COVID-19 diagnosis. Cox regression analyses were performed to assess associations between CFS and outcomes. Results A total of 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. The ICU admission rate was lowest (5%) in patients >75 years of age with a CFS of 7–9 and highest (27%) in patients 65–75 years of age with a CFS of 5. A CFS of 7–9 was associated with a lower ICU admission rate than a CFS of 1–3 [relative risk 0.49 (95% confidence interval 0.27–0.87)]. Overall, mortality at 3 months was 34% in hospitalized patients, 65% in ICU-admitted patients and highest in patients >75 years of age with a CFS of 7–9 (69%). Only 9% of patients with a CFS ≥6 survived after ICU admission. After adjustment for age and sex, each CFS category ≥4 was associated with higher hospital and ICU mortality compared with a CFS of 1–3. Conclusions Frail dialysis patients with COVID-19 were less frequently admitted to the ICU. Large differences in mortality rates between fit and frail patients suggest that the CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.
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Affiliation(s)
- Pim Bouwmans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands. CARIM School for Cardiovascular Disease, University of Maastricht, Maastricht, The Netherlands
| | - Lloyd Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center. Nijmegen, The Netherlands
| | - Raphaël Duivenvoorden
- Department of Nephrology, Radboud University Medical Center. Nijmegen, The Netherlands
| | - Priya Vart
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Casper F M Franssen
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrian Covic
- Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania / Dr Ci Parhon Hospital, Iasi, Romania
| | - Mahmud Islam
- Zonguldak Ataturk state hospital, Zonguldak, Turkey
| | | | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Marlies Noordzij
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands. CARIM School for Cardiovascular Disease, University of Maastricht, Maastricht, The Netherlands
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18
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Mosconi G, Fantini M, Righini M, Flachi M, Semprini S, Hu L, Chiappo F, Veterani B, Ambri K, Ferrini F, Milanesi C, Giudicissi A, La Manna G, Rigotti A, Buscaroli A, Sambri V, Cappuccilli M. Efficacy of SARS-CoV-2 Vaccination in Dialysis Patients: Epidemiological Analysis and Evaluation of the Clinical Progress. J Clin Med 2022; 11:jcm11164723. [PMID: 36012962 PMCID: PMC9410204 DOI: 10.3390/jcm11164723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/24/2022] [Accepted: 08/01/2022] [Indexed: 12/16/2022] Open
Abstract
This study investigated the impact of the fourth COVID-19 pandemic wave on dialysis patients of Romagna territory, assessing the associations of vaccination status with infection risk, clinical severity and mortality. From November 2021 to February 2022, an epidemiological search was conducted on 829 patients under dialysis treatment for at least one month. The data were then analyzed with reference to the general population of the same area. A temporal comparison was also carried out with the previous pandemic waves (from March 2020 to October 2021). The epidemiological evolution over time in the dialysis population and in Romagna citizens replicated the global trend, as the peak of the fourth wave corresponded to the time of maximum diffusion of omicron variant (B.1.1.529). Of 771 prevalent dialysis patients at the beginning of the study, 109 (14.1%) contracted SARS-CoV-2 infection during the 4-month observation period. Vaccine adherence in the dialysis population of the reference area was above 95%. Compared to fully or partially vaccinated subjects, the unvaccinated ones showed a significantly higher proportion of infections (12.5% vs. 27.0% p = 0.0341), a more frequent need for hospitalization (22.2% vs. 50.0%) and a 3.3-fold increased mortality risk. These findings confirm the effectiveness of COVID-19 vaccines in keeping infectious risk under control and ameliorating clinical outcomes in immunocompromised patients.
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Affiliation(s)
- Giovanni Mosconi
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
- Correspondence: (G.M.); (F.C.); Tel.: +39-0543-735-312 (G.M.)
| | - Michela Fantini
- Local Healthcare Authority of Romagna (AUSL Romagna), 48121 Ravenna, RA, Italy
| | - Matteo Righini
- Nephrology and Dialysis Unit, AUSL Romagna S. Maria delle Croci Hospital, 48121 Ravenna, RA, Italy
| | - Marta Flachi
- Nephrology and Dialysis Unit, AUSL Romagna Infermi Hospital, 47923 Rimini, RN, Italy
| | - Simona Semprini
- Unit of Microbiology, AUSL Romagna Laboratory, 47023 Pievesestina, FC, Italy
| | - Lilio Hu
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Francesca Chiappo
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
- Correspondence: (G.M.); (F.C.); Tel.: +39-0543-735-312 (G.M.)
| | - Barbara Veterani
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Katia Ambri
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Franca Ferrini
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Catia Milanesi
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Antonio Giudicissi
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40138 Bologna, BO, Italy
| | - Angelo Rigotti
- Nephrology and Dialysis Unit, AUSL Romagna Infermi Hospital, 47923 Rimini, RN, Italy
| | - Andrea Buscaroli
- Nephrology and Dialysis Unit, AUSL Romagna S. Maria delle Croci Hospital, 48121 Ravenna, RA, Italy
| | - Vittorio Sambri
- Unit of Microbiology, AUSL Romagna Laboratory, 47023 Pievesestina, FC, Italy
| | - Maria Cappuccilli
- Nephrology Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40138 Bologna, BO, Italy
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19
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Torres R, Toro L, Sanhueza ME, Lorca E, Ortiz M, Pefaur J, Clavero R, Machuca E, Gonzalez F, Herrera P, Mocarquer A, Frias A, Roessler E, Muñoz C, Nuñez M, Aravena C, Quintana E, Lemus J, Lillo M, Reynolds E, Morales A, Pais E, Fiabane A, Parra-Lucares A, Garrido C, Mendez G, Villa E, Mansilla R, Sotomayor G, Gonzalez M, Miranda C, Briones E, Gomez E, Mezzano S, Bernales W, Rocca X, Espinoza O, Zuñiga E, Aragon H, Badilla M, Valenzuela M, Escobar L, Zamora D, Flores I, Tapia B, Borquez T, Herrera P. Clinical efficacy of SARS-CoV-2 vaccination in hemodialysis patients. Kidney Int Rep 2022; 7:2176-2185. [PMID: 35874643 PMCID: PMC9287586 DOI: 10.1016/j.ekir.2022.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction The COVID-19 pandemic is a global public health problem. Patients with end-stage renal disease on hemodialysis are at a higher risk of infection and mortality than the general population. Worldwide, a vaccination campaign has been developed that has been shown to reduce severe infections and deaths in the general population. However, there are currently limited data on the clinical efficacy of vaccinations in the hemodialysis population. Methods A national multicenter observational cohort was performed in Chile to evaluate the clinical efficacy of anti-SARS-CoV-2 vaccination in end-stage renal disease patients on chronic hemodialysis from February 2021 to August 2021. In addition, the BNT162b2 (Pfizer-BioNTech) and CoronaVac (Sinovac) vaccines were evaluated. The efficacy of vaccination in preventing SARS-CoV-2 infection, hospitalizations, and deaths associated with COVID-19 was determined. Results A total of 12,301 patients were evaluated; 10,615 (86.3%) received a complete vaccination (2 doses), 490 (4.0%) received incomplete vaccination, and 1196 (9.7%) were not vaccinated. During follow-up, 1362 (11.0%) patients developed COVID-19, and 150 died (case fatality rate: 11.0%). The efficacy of the complete vaccination in preventing infection was 18.1% (95% confidence interval [CI]:11.8–23.8%), and prevention of death was 66.0% (95% CI:60.6–70.7%). When comparing both vaccines, BNT162b2 and CoronaVac were effective in reducing infection and deaths associated with COVID-19. Nevertheless, the BNT162b2 vaccine had higher efficacy in preventing infection (42.6% vs. 15.0%) and deaths (90.4% vs. 64.8%) compared to CoronaVac. Conclusion The results of our study suggest that vaccination against SARS-CoV-2 in patients on chronic hemodialysis was effective in preventing infection and death associated with COVID-19.
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Affiliation(s)
- Rubén Torres
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Luis Toro
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile.,Centro de Investigación Clínica Avanzada, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - María E Sanhueza
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Eduardo Lorca
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Mireya Ortiz
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Department of Nephrology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jacqueline Pefaur
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Rene Clavero
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Dr. Gustavo Fricke, Valparaiso, Chile
| | - Eduardo Machuca
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Fresenius Medical Care Chile, Chile
| | | | - Patricia Herrera
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Alfredo Mocarquer
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Dialisis Gran Avenida, Santiago, Chile
| | - Alondra Frias
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Regional de Talca, Talca, Chile
| | - Eric Roessler
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Department of Nephrology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Muñoz
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Puerto Montt, Puerto Montt, Chile
| | - Miguel Nuñez
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Puerto Montt, Puerto Montt, Chile
| | - Cesar Aravena
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Dialisis Municipal La Granja, Santiago, Chile
| | - Enrique Quintana
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Padre Hurtado, Santiago, Chile
| | - Juan Lemus
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Dialisis Antares, Santiago, Chile
| | - Mario Lillo
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Centro Médico y de Diálisis Ltda, Santiago, Chile
| | - Enrique Reynolds
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Alvaro Morales
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Edgard Pais
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Complejo Asistencial Sótero del Río, Santiago, Chile
| | - Andrea Fiabane
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Alfredo Parra-Lucares
- Centro de Investigación Clínica Avanzada, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Cristian Garrido
- Department of Radiology, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Gabriel Mendez
- Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Eduardo Villa
- Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Rodrigo Mansilla
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Critical Care Medicine, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Germana Sotomayor
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Marcela Gonzalez
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Clínico de Magallanes, Punta Arenas, Chile
| | - Cecilia Miranda
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Militar de Santiago, Santiago, Chile
| | - Eduardo Briones
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,CID Servicio Integral de Salud S.A, Santiago, Chile
| | - Esteban Gomez
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Clinica Indisa, Santiago, Chile
| | - Sergio Mezzano
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Clinico San Borja Arriaran, Santiago, Chile
| | - Waldo Bernales
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Faculty of Medicine, Universidad Austral de Chile, Valdivia, Santiago
| | - Ximena Rocca
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Oscar Espinoza
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Eric Zuñiga
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Regional de Coyhaique, Coyhaique, Chile
| | - Henry Aragon
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Clinica Bupa Antofagasta, Antofagasta, Chile
| | - Marta Badilla
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital San José, Santiago, Chile
| | - Marcela Valenzuela
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Complejo Asistencial Sótero del Río, Santiago, Chile
| | - Luis Escobar
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Clinica Bupa Antofagasta, Antofagasta, Chile
| | - Daniela Zamora
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Ivan Flores
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital de Puerto Natales, Puerto Natales, Chile
| | - Beatriz Tapia
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Dr. Gustavo Fricke, Valparaiso, Chile
| | - Tamara Borquez
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital San Juan de Dios de Curicó, Curicó, Chile
| | - Patricio Herrera
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Clínico del Sur, Concepción, Chile
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20
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Alfano G, Fontana F, Ferrari A, Morisi N, Gregorini M, Cappelli G, Magistroni R, Guaraldi G, Donati G. Which criteria should we use to end isolation in hemodialysis patients with COVID-19? Clin Kidney J 2022; 15:1450-1454. [PMID: 36824062 PMCID: PMC9942439 DOI: 10.1093/ckj/sfac115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Indexed: 11/14/2022] Open
Abstract
Safe and timely discontinuation of quarantine of in-center hemodialysis (HD) patients with a previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a challenging issue for the nephrological community because current guidelines for ending isolation do not mention dialysis patients. To prevent potentially fatal outbreaks of coronavirus disease 2019 (COVID-19), a cautionary approach has been adopted by most dialysis units. The criteria for ending the isolation in the HD population generally coincide with those recommended for immunocompromised people. Thus, a test-based strategy relying on two consecutive negative reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swabs has been adopted to terminate quarantine. This strategy has the disadvantage of prolonging isolation as RT-PCR positivity does not equate to SARS-CoV-2 infectivity. Consequentially, prolonged positivity of SARS-CoV-2 results in excessive workload for the HD staff who must face an increasing number of COVID-19 patients requiring isolation. This condition leads also to serious implications for the patients and their households including work productivity loss, postponement of health-care appointments and an increased risk of COVID-19 reinfection. To counteract this problem, other diagnostic tests should be used to provide the best care to HD patients. Recent results seem to encourage the use of RT-PCR cycle threshold (Ct) values and rapid antigen tests given their better correlation with cell culture for SARS-CoV-2 than RT-PCR testing. Here, we provide an overview of the current scientific evidence on the tests used to verify the infectiousness of the virus in order to stimulate the nephrological community to adopt a streamlined and pragmatic procedure to end isolation in COVID-19 patients on HD.
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Affiliation(s)
| | - Francesco Fontana
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Annachiara Ferrari
- Nephrology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Niccolò Morisi
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Italy
| | - Mariacristina Gregorini
- Nephrology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Italy
| | - Riccardo Magistroni
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy,Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Italy
| | - Giovanni Guaraldi
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy,Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Italy
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21
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Malo MF, Affdal A, Blum D, Ballesteros F, Beaubien-Souligny W, Caron ML, Nadeau-Fredette AC, Vasilevsky M, Rios N, Fortin MC, Suri RS. Lived Experiences of Patients Receiving Hemodialysis during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network. KIDNEY360 2022; 3:1057-1064. [PMID: 35845331 PMCID: PMC9255873 DOI: 10.34067/kid.0000182022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/21/2022] [Indexed: 01/10/2023]
Abstract
Background Hemodialysis patients have faced unique challenges during the COVID-19 pandemic. They face high risk of death if infected and have unavoidable exposure to others when they come to hospital three times weekly for their life-saving treatments. The objective of this study was to gain a better understanding of the scope and magnitude of the effects of the pandemic on the lived experience of patients receiving in-center hemodialysis. Methods We conducted semi-structured interviews with 22 patients who were undergoing dialysis treatments in five hemodialysis centers in Montreal from November 2020 to May 2021. Interviews were transcribed and then analyzed using thematic content analysis. Results Most participants reported no negative effects of the COVID-19 pandemic on their hemodialysis care. Several patients had negative feelings related to forced changes in their dialysis schedules, and this was especially pronounced for indigenous patients in a shared living situation. Some patients were concerned about contracting COVID-19, especially during public transportation, whereas others expressed confidence that the physical distancing and screening measures implemented at the hospital would protect them and their loved ones. Some participants reported that masks negatively affected their interactions with health care workers, and for many others, the pandemic was associated with feelings of loneliness. Finally, some respondents reported some positive effects of the pandemic, including use of telemedicine and creating a sense of solidarity. Conclusions Patients undergoing hemodialysis reported no negative effects on their medical care but faced significant disruptions in their routines and social interactions due to the COVID-19 pandemic. Nevertheless, they showed great resilience in their ability to adapt to the new reality of their hemodialysis treatments. We also show that studies focused on understanding the lived experiences of indigenous patients and patients from different ethnic backgrounds are needed in order reduce inequities in care during public health emergencies.
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Affiliation(s)
- Marie-Françoise Malo
- Bioethics Program, École de santé publique de l’Université de Montréal, Montreal, Canada
| | - Aliya Affdal
- Bioethics Program, École de santé publique de l’Université de Montréal, Montreal, Canada
| | - Dan Blum
- Division of nephrology, Jewish General Hospital, Montreal, Canada
| | - Fabian Ballesteros
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - William Beaubien-Souligny
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada,Faculté de médecine de l’Université de Montréal, Montreal, Canada,Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Marie-Line Caron
- Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Annie-Claire Nadeau-Fredette
- Faculté de médecine de l’Université de Montréal, Montreal, Canada,Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | | | - Norka Rios
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada,Faculté de médecine de l’Université de Montréal, Montreal, Canada,Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Rita S. Suri
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada,Faculty of Medicine, McGill University, Montreal, Canada,Research Institute of the McGill University Health Centre, Montreal, Canada
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22
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Pessoa JLE, Donnini OA, Monteiro F. Impact of the COVID-19 Pandemic on Organ Donation and Transplantation in São Paulo, Brazil. Transplant Proc 2022; 54:1221-1223. [PMID: 35589415 PMCID: PMC9023323 DOI: 10.1016/j.transproceed.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has affected donation and transplantation activities in São Paulo, Brazil, as well as the patients receiving these organs. In this study, information from the database of the São Paulo Organ Allocation System was analyzed and compared 2 periods—before the pandemic and during the pandemic—to identify this effect. The COVID-19 pandemic interfered in the mortality rate and the time on the waiting list for heart, liver, pancreas, lung, and kidney transplants; the number of effective donors; and the use or disposal of available organs from deceased donors. It also reduced the transplant activity with living donors. Regarding the activity of eye tissue transplantation, the time on the waiting list increased and the number of transplant procedures decreased. The kidney transplant program was the most affected in our study. There was an increase in waiting time and mortality in the waiting list for this organ and also a decrease in kidney utilization rates.
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Oguz EG, Yeter HH, Akcay OF, Besli S, Selen T, Derici U, Sencan I, Ayli MD. Predictive value of neutrophil-to-lymphocyte ratio in terms of need for intensive care unit and mortality in maintenance hemodialysis patients with COVID-19. Hemodial Int 2022; 26:377-385. [PMID: 35001488 DOI: 10.1111/hdi.13001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The transmission risk of Severe Acute Respiratory Syndrome Coronavirus-2 virus infection is increased in maintenance hemodialysis (MHD) patients, and also the disease causes much higher mortality than the normal population. The aim of this study is to define the predictive value of neutrophil-to-lymphocyte ratio (NLR) in terms of worse outcomes in MHD patients. METHODS A total of 123 MHD patients who had received inpatient care due to COVID-19 infection were included in this multicentered retrospective study. Receiver operating curve analysis were plotted to illustrate C reactive protein (C-rp), systemic inflammatory index (SII) and NLR best cut-off values for estimation of need for intensive care unit (ICU) and mortality. Multivariate regression analysis and Cox proportional hazard models were constructed to determine the association between C-rp, SII and NLR and mortality. RESULTS Twenty-eight (23%) patients with MHD were dead due to COVID-19. Nonsurvivor patients was significantly older than the survivors (p < 0.001) and also had higher rates of diabetes mellitus (p = 0.01) and coronary artery disease (p = 0.02). Cox regression analysis revealed that NLR >5.17 significantly associated with mortality [HR: 6.508, p < 0.001]. Similarly, SII > 726 [HR: 3.124, p = 0.006] and C-rp > 88 [HR: 4.590, p = 0.002] were significantly associated with mortality due to COVID-19 in hospitalized MHD patients. Multivarite logistic regression analysis showed that age older than 60 years, higher ferritin, and NLR > 5.17 were independent factors associated with mortality. CONCLUSION NLR had favorable predictive value than the C-rp and SII in terms of need for ICU and mortality in MHD patients. Determining the poor prognosis with simple and easily applicable markers may reduce mortality in these patients with early supportive treatments.
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Affiliation(s)
- Ebru Gok Oguz
- Department of Nephrology, Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Haci Hasan Yeter
- Department of Nephrology, Sivas Numune State Hospital, Sivas, Turkey
| | - Omer Faruk Akcay
- Faculty of Medicine, Department of Nephrology, Gazi University, Ankara, Turkey
| | - Sevval Besli
- Department of Nephrology, Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tamer Selen
- Department of Nephrology, Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ulver Derici
- Faculty of Medicine, Department of Nephrology, Gazi University, Ankara, Turkey
| | - Irfan Sencan
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Deniz Ayli
- Department of Nephrology, Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
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24
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Alfano G, Fontana F, Mori G, Cappelli G, Magistroni R, Donati G. Ethical challenges in managing unvaccinated patients receiving chronic in-center hemodialysis. Clin Kidney J 2021; 15:615-617. [PMID: 35371469 PMCID: PMC8967673 DOI: 10.1093/ckj/sfab276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Indexed: 12/01/2022] Open
Abstract
Insufficient vaccine coverage and dominance of the more transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are the leading causes of the continued spread of coronavirus disease 2019 (COVID-19) worldwide. To curb the surge in infections, COVID-19 vaccination has been advocated as a priority measure, especially for frail populations and people at high risk of exposure. Patients on in-centre maintenance haemodialysis (HD) embody both conditions. They are at high risk of severe COVID-19 consequences due to their advanced age and weakened immune system and carry an increased risk of SARS-CoV-2 transmission within shared dialysis rooms and public vehicles. Vaccination of the entire HD population is therefore the most effective strategy to protect patients from the dire consequences of COVID-19. Unfortunately, a minority of patients still express COVID-19 vaccine hesitancy. The management of this group of patients, who have the full right to HD treatment, poses demanding problems from a patient safety perspective. The placement of unvaccinated patients within the dialysis room and the protection of all vaccinated patients are some of the most urgent problems the nephrologist faces during the COVID-19 pandemic. In light of these COVID-19-driven changes, an ethical reflection on the management of unvaccinated patients appears crucial to act responsibly and contribute to the health promotion of dialysis patients.
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Affiliation(s)
- Gaetano Alfano
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Fontana
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Giacomo Mori
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Gianni Cappelli
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Magistroni
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
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