COVID-19 and chronic kidney disease: an updated overview of reviews

A passive flow microreactor for urine creatinine test

Chronic kidney disease (CKD) significantly affects people's health and quality of life and presents a high economic burden worldwide. There are well-established biomarkers for CKD diagnosis. However, the existing routine standard tests are lab-based and governed by strict regulations. Creatinine is commonly measured as a filtration biomarker in blood to determine estimated Glomerular Filtration Rate (eGFR), as well as a normalization factor to calculate urinary Albumin-to-Creatinine Ratio (uACR) for CKD evaluation. In this study, we developed a passive flow microreactor for colorimetric urine creatinine measurement (uCR-Chip), which is highly amenable to integration with our previously developed microfluidic urine albumin assay. The combination of the 2-phase pressure compensation (2-PPC) technique and microfluidic channel network design accurately controls the fluidic mixing ratio and chemical reaction. Together with an optimized observation window (OW) design, a uniform and stable detection signal was achieved within 7 min. The color signal was measured by a simple USB microscope-based platform to quantify creatinine concentration in the sample. The combination of the custom in-house photomask production techniques and dry-film photoresist-based lithography enabled rapid iterative design optimization and precise chip fabrication. The developed assay achieved a dynamic linear detection range up to 40 mM and a lower limit of detection (LOD) of 0.521 mM, meeting the clinical precision requirements (comparable to existing point-of-care (PoC) systems). The microreactor was validated using creatinine standards spiked into commercial artificial urine that mimics physiological matrix. Our results showed acceptable recovery rate and low matrix effect, especially for the low creatinine concentration range in comparison to a commercial PoC uACR test. Altogether, the developed uCR-Chip offers a viable PoC test for CKD assessment and provides a potential platform technology to measure various disease biomarkers.

Marked Global Differences in Mortality in Male Patients with COVID-19: An Analysis of the CARDIO COVID 19-20 and WHF COVID-19 CVD Studies

Background

COVID-19 has led to nearly seven million deaths and male sex has been reported as one of the main risk factors for mortality. Few studies have analyzed cohorts of male patients, especially in underrepresented regions in the medical literature, such as low and middle-income nations. To address this gap, we conducted large-scale, male-specific, multinational analyses, to improve understanding of factors associated with mortality in this high-risk population and global variations.

Methods

This is a prospective, multicenter study that includes data from the CARDIO COVID-19-20 registry and the WHF COVID-19 CVD study. A multiple Poisson regression model was performed to evaluate differences in factors associated with in-hospital mortality among male COVID-19 patients across different regions.

Results

We analyzed 4,899 hospitalized male COVID-19 patients from 32 countries: Africa (11.2%), the Americas (44.7%), Asia (33.8%), and Europe (10.2%). Median age was 59 years (IQR: 47-69), with 50.5% aged 40-64. ICU admission was 42.4%, and mortality was 19.2%, with marked regional differences (ranging from 6% in Europe to 26.9% in the Americas). Poisson regression showed age >80 years (aRR = 4.21) and IMV (aRR = 3.80) as the strongest factors associated with mortality. Other factors included diabetes, chronic kidney disease, myocarditis, and decompensated heart failure. Mortality risk was higher in Africa (aRR = 3.86), Asia (aRR = 2.72), and the Americas (aRR = 2.23) compared to Europe (p < 0.001). Anticoagulation/Antiplatelet therapy showed a potential correlation with survival.

Conclusion

This study reflects the complexity of factors influencing COVID-19 mortality among male patients hospitalized with COVID-19, emphasizing global variability. The substantial differences in mortality noted across countries are likely due to differences in disease severity, comorbidities, clinical care, and health system factors. Age remains a primary risk factor, with older populations particularly vulnerable. Our findings underscore the need for targeted and tailored regional approaches to manage male COVID-19 patients.

Impact of Prior Chronic Kidney Disease and Newly Detected eGFR Impairment at Admission on Outcomes and Prognosis of Hospitalized COVID-19 Patients - A Single-Center Cohort Study

Background and Hypothesis

Chronic kidney disease (CKD) is a major prognostic factor in COVID-19. Little is known about the significance of newly detected renal impairment (RI) for COVID-19 patient outcomes. This study assessed the effect of prior CKD and RI at admission on in-hospital mortality in COVID-19 patients.

Methods

A total of 5191 consecutive patients with COVID-19 admitted between March 6, 2020 and May 31, 2021, to the University Hospital in Krakow were analyzed. The main outcome was in-hospital death from any cause compared between the three study groups - patients with a prior history of CKD (group A), no history of CKD and eGFR on admission <60 mL/min/1,73 m2 (group B), and no history of CKD and eGFR on admission >60 mL/min/1,73 m2 (group C).

Results

Of 5191 patients, 2348 (45.2%) were women and 2409 (46.4%) were older than 65 years (mean age of 61.98±16.66 years). There were 483 (9.3%) patients in group A, 1009 (22.2%) in group B and 3699 (68.5%) in group C. Groups A and B were older and had higher cardiometabolic burden compared to group C. Multivariable logistic regression showed that older age, higher CRP, WBC, D-dimer levels, HF, and being in groups A or B were associated with higher in-hospital mortality. Group B had the highest risk (OR 3.003, CI 2.298-3.926) compared to group A (OR 2.020, CI 1.636-2.494) and group C (reference).

Conclusion

COVID-19 patients with prior CKD and newly detected RI have higher odds of in-hospital death compared to those with normal kidney function. Special attention is needed for newly detected RI cases in COVID-19 patients.

Predictors of COVID-19 Readmission Among Patients Previously Hospitalized for SARS-CoV-2

INTRODUCTION

Predictors of coronavirus disease 2019 (COVID-19)-related rehospitalization remain underexplored. This study aims to identify the main risk factors associated with rehospitalizations due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections among residents of Lombardy, northern Italy.

METHODS

A retrospective observational study was conducted using two linked administrative databases covering demographic data, comorbidities, hospital records, and COVID-19 data of Lombardy residents. The study population included patients hospitalized for COVID-19 between February 2020 and August 2021. Rehospitalization was defined as a second COVID-19-related hospitalization occurring at least 90 days after the first admission. The Fine-Gray subdistribution hazard model was used to identify risk factors, accounting for death as a competing risk.

RESULTS

Out of 98,369 patients hospitalized for COVID-19 between February 1, 2020 and August 31, 2021, 72,593 were alive 90 days after admission and 610 of these (0.8%) were rehospitalized. A higher rehospitalization risk was observed in older male patients with multiple comorbidities. Renal failure, liver disease, and use of diuretics were significantly associated with rehospitalization risk, while female biological sex and the use of lipid-lowering drugs were associated with a lower risk.

CONCLUSIONS

This is the first study conducted on regional administrative databases to investigate COVID-19 rehospitalizations. Through the availability of a huge cohort, it provides a groundwork for optimizing care for individuals at higher risk for COVID-19-related rehospitalizations. It underlines the need for patient-management approaches that extend beyond the initial recovery. This stresses the importance of ongoing monitoring and personalized interventions for those at heightened risk not only of SARS-CoV-2 reinfection but also related rehospitalizations.

Comparative analysis of C-Reactive protein levels among Non-comorbid, Comorbid, and Multimorbid Hospitalized COVID-19 patients

BACKGROUND

C-reactive protein (CRP) is one of the most commonly monitored inflammatory markers in patients with COVID-19 to gain insight into the inflammation level in the body and to adopt effective disease management and therapeutic strategies. COVID-19 is now less prevalent, and the study of CRP as a biomarker of inflammation still needs deeper understanding, particularly in understanding its role among patients with comorbidities, which are known to influence inflammatory responses and increase the risk of severe outcomes during acute and chronic infectious diseases. The objective of this study was to evaluate the association of major comorbidities such as ischemic heart diseases, diabetes, chronic kidney disease, hypertension, and lung infections e.g. tuberculosis with serum CRP levels in hospitalized COVID-19 patients.

METHODS

This study involves a retrospective observational framework to monitor CRP levels among hospitalized COVID-19 patients after getting ethical approval and patient consent. The information on underlying health conditions or comorbidities and age was collected from the patient data files. The requirement of ventilation, ICU admission, mortality & survival, and CRP levels were monitored based on their daily updates in the data file. Furthermore, the association of CRP levels was evaluated with disease severity and mortality.

RESULTS

In this study 618 out of 750 hospitalized COVID-19 patients, of which 62.6% were male and 37.4% were female, the levels of serum CRP were significantly influenced by age and comorbidities. No case of hospitalization was observed in children (≤ 14 years) during the study period, while 38.3% of patients belonged to the old age group (≥ 65 years). Comorbidity status varied, with 36.1% of patients without having any comorbidities, 27.8% with one, 23.6% with two, and 12.5% with three or more comorbidities. Descriptive statistics revealed that the CRP levels in the study population averaged 88.92 mg/L (SD = 63.95), ranging from < 1 mg/L to 900 mg/L, with significant variations observed across different comorbidities and age groups. CRP levels, analyzed by the Kruskal-Wallis test, showed significant variations in different age groups of COVID-19 patients (χ² = 66.741, df = 3, p < 0.001). Moreover, pairwise comparisons showed considerable differences between young and middle-aged groups (Z = -2.724, p < 0.01) and young and old age groups of COVID-19 patients (Z = -3.970, p < 0.001). The most prevalent comorbidities observed in COVID-19 patients in this study were hypertension (42.1%), diabetes (33.8%), ischemic heart disease (16.5%), asthma (11.2%), chronic kidney disease (7.9%) and Tuberculosis (1.9%). The CRP levels fluctuate and also significantly differ among different comorbidities. COVID-19 patients with diabetes were observed to have higher CRP levels than non-diabetics (mean CRP: 126.96 mg/L vs. 88.92 mg/L, Z = -5.724, p < 0.001), and those with hypertension also encountered elevated CRP (mean CRP: 355.37 vs. 276.19 mg/L, Z = -5.447, p < 0.001). Similar tendencies were detected in COVID-19 patients with ischemic heart disease (mean CRP: 385.43 mg/L, Z = -4.704, p < 0.001), chronic kidney disease (mean CRP: 412.37 mg/L, Z = -4.206, p < 0.001) as well as with tuberculosis (mean CRP: 458.08 mg/L, Z = -2.914, p < 0.01). CRP levels on days 1 and 3 of hospitalization showed a decline (88.92 mg/L to 67.89 mg/L), representative of a response to treatment to reduce the inflammation in the body. Furthermore, high levels of CRP were significantly associated with a high requirement of non-invasive ventilation (mean CRP: 110.80 mg/L vs. 76.82 mg/L, p < 0.05), mechanical ventilation (mean CRP: 134.46 mg/L vs. 77.25 mg/L, p < 0.05) and ICU admission (mean CRP: 126.96 mg/L vs. 72.79 mg/L, p < 0.05). The Cox regression analysis showed that there is a considerable association of CRP level with the expected length of hospitalization, each 1-unit increase in CRP levels was associated with a 0.6% increase in extended stay risk (hazard ratio = 1.006, 95% CI: 1.004-1.008, p < 0.001). Furthermore, the logistic regression analysis performed on CRP levels that was monitored on the first day of hospitalization, revealed that there was a 2.7% increase in mortality odds with each unit increase in CRP (odds ratio = 1.027, 95% CI: 1.022-1.033, p < 0.001), which suggest CRP as a potential mortality predictor.

CONCLUSIONS

Elevated CRP levels in COVID-19 patients with comorbidities like diabetes, hypertension, ischemic heart disease, and chronic kidney disease were strongly associated with increased disease severity, including higher ventilation requirements and mortality. Patients with these comorbidities showed significantly higher CRP levels, which correlated with worse outcomes, including ICU admissions and prolonged hospital stays, emphasizing the importance of CRP as a predictor for severe complications in patients with infectious diseases along with one or more comorbidities.

Treatment pattern and clinical outcomes of remdesivir in hospitalized COVID-19 patients with severe chronic kidney disease: a database analysis of acute care hospitals in Japan

BACKGROUND

There is limited evidence on clinical outcomes and treatment pattern in Japanese patients with severe chronic kidney disease (CKD), hospitalized for coronavirus disease-2019 (COVID-19). We aimed to describe patient characteristics, treatment pattern, and clinical outcomes in Japanese patients with severe CKD, hospitalized for COVID-19 who received remdesivir (RDV).

METHODS

We used the anonymized claims database from Medical Data Vision Co., Ltd., Japan. The analysis included patients aged ≥ 18 years with severe CKD, hospitalized for moderate to severe COVID-19, and administered ≥ 1 dose of RDV between October 2021 and September 2023. All-cause inpatient mortality, disease progression, and recovery up to 56 days from hospitalization were evaluated.

RESULTS

Data of 847 patients were analyzed (mean age 73.0 ± 14.1 years). Median (Q1-Q3) time to RDV initiation was 1.0 day (1.0-2.0) from hospitalization and treatment duration was 5.0 days (3.0-5.0). At RDV initiation, 44.27% patients required non-invasive positive pressure ventilation/high or low flow oxygen; 4.25% required invasive mechanical ventilation/extracorporeal membrane oxygenation/intensive care unit hospitalization. Proportion of patients with all-cause mortality was 11.45% (stage 4, 14.89%; stage 5, 10.47%) by 28 days and 12.28% (stage 4, 16.49%; stage 5, 11.08%) by 56 days. At 28 days, 12.28% had disease progression and 72.14% recovered.

CONCLUSION

Most patients with severe CKD received RDV immediately after hospitalization. The majority of patients recovered by 28 days. The study provided insights into RDV treatment in inpatient settings, which could contribute to the discussion on standard of care in this population in Japan.

Characteristics and outcomes of in-hospital patients with Covid-19 and history of tuberculosis: a matched case-control from the Brazilian Covid-19 Registry

BACKGROUND

The Covid-19 pandemic caused a negative impact on other infectious diseases control, prevention, and treatment. Consequently, low and middle-income countries suffer from other endemic diseases, such as tuberculosis. This study was designed to compare Covid-19 manifestations and outcomes between patients with previously treated tuberculosis and controls without this condition.

METHODS

We performed a matched case-control study drawn from the Brazilian Covid-19 Registry data, including in-hospital patients aged 18 and over with laboratory-confirmed Covid-19 from March 1, 2020, to March 31, 2022. Cases were patients with a past history of tuberculosis. Controls were Covid-19 patients without a tuberculosis history. Patients were matched by hospital, sex, presence of HIV, and number of comorbidities, with a 1:4 ratio.

RESULTS

Of 13,636 patients with laboratory-confirmed diagnoses of Covid-19 enrolled in this study, 80 had a history of tuberculosis. Statistical differences in history of chronic pulmonary obstructive disease (15% vs. 3.2%), psychiatric disease (10% vs. 3.5%,), chronic kidney disease (11.2% vs. 2.8%), and solid-organ transplantation; (5% vs. 0.9%, p < 0.05 for all) were higher in patients with a past history of tuberculosis. Prior use of inhalatory medications (5% vs. 0.6%,), oral corticoids (8.8% vs. 1.9%), immunosuppressants (8.8% vs. 1.9%,) and the use of illicit drugs were more common in the case group (6.2% vs. 0.3% p < 0.05for all). There were no significant differences in in-hospital mortality, mechanical ventilation, need for dialysis, and ICU admission.

CONCLUSIONS

Patients with a history of tuberculosis infection presented a higher frequency of use of illicit drugs, chronic pulmonary obstructive disease, psychiatric disease, chronic kidney disease, solid-organ transplantation, prior use of inhalatory medications, oral corticoids, and immunosuppressants. The outcomes were similar between cases and controls.

Phenotypic switch of vascular smooth muscle cells in COVID-19: Role of cholesterol, calcium, and phosphate

Although the novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily manifests as severe respiratory distress, its impact on the cardiovascular system is also notable. Studies reveal that COVID-19 patients often suffer from certain vascular diseases, partly attributed to increased proliferation or altered phenotype of vascular smooth muscle cells (VSMCs). Although the association between COVID-19 and VSMCs is recognized, the precise mechanism underlying SARS-CoV-2's influence on VSMC phenotype remains largely under-reviewed. In this context, while there is a consistent body of literature dissecting the effect of COVID-19 on the cardiovascular system, few reports delve into the potential role of VSMC switching in the pathophysiology associated with COVID-19 and the molecular mechanisms involved therein. This review dissects and critiques the link between COVID-19 and VSMCs, with particular attention to pathways involving cholesterol, calcium, and phosphate. These pathways underpin the interaction between the virus and VSMCs. Such interaction promotes VSMC proliferation, and eventually potentiates vascular calcification as well as worsens prognosis in patients with COVID-19.

CHA2DS2-VASc Score as Predictor of New-Onset Atrial Fibrillation and Mortality in Critical COVID-19 Patients

BACKGROUND

Pre-existing and new-onset atrial fibrillation (NOAF) is a common arrhythmia in COVID-19 patients and is related to increased mortality. CHA2DS2-VASc score was initially developed to evaluate thromboembolic risk in patients with AF. Moreover, it predicted adverse outcomes in other clinical conditions, including SARS-CoV-2 infection. We aimed to evaluate the association of CHA2DS2-VASc with NOAF, ICU length of stay (LOS) and mortality in critically ill COVID-19 patients. We also examined the relationship of NOAF with mortality. We reviewed the literature to describe the link between cardiovascular risk factors and inflammatory response of severe COVID-19.

METHODS AND RESULTS

We retrospectively studied 163 COVID-19 patients admitted to a level 3 general ICU from March 2020 to April 2022. Patients were of advanced age (median 64 years, IQR 56.5-71) and the majority of them were male (67.5%). Regarding NOAF, we excluded 12 patients with AF history. In this group, CHA2DS2VASc score was significantly elevated (3 IQR (1-4) versus 1 IQR (1-2.75), p = 0.003). Specifically, three components of CHA2DS2VASc were notably increased: age (p < 0.001), arterial hypertension (p = 0.042) and stroke (p = 0.047). ICU mortality was raised in the NOAF group [75.8% versus 34.8%, p < 0.001 OR 5.87, 95% CI (2.43, 14.17)]. This was significant even after adjusting for ICU clinical scores (APACHE II and SOFA). About mortality in the entire sample, survivors were younger (p = 0.001). Non-survivors had greater APACHE II (p = 0.04) and SOFA (p = 0.033) scores. CHA2DS2VASc score was positively associated with mortality [p = 0.031, OR 1.28, 95% CI (1.03, 1.6)]. ICU length of stay was associated with mortality (p = 0.016) but not with CHA2DS2VASc score (p = 0.842).

CONCLUSIONS

NOAF and CHA2DS2VASc score were associated with higher mortality in COVID-19 ICU patients. CHA2DS2VASc score was also associated with NOAF but not with ICU LOS.

Association between dried fruit intake and kidney function: research from univariate and multivariate Mendelian randomized studies

Objectives

Observational studies have identified an association between dried fruit intake and kidney function. However, these studies have limitations such as vulnerability to confounders and reverse causality bias. Therefore, this study aimed to explore the potential causal relationship between dried fruit intake and kidney function.

Methods

A two-sample Mendelian randomization (MR) study was conducted using a large-scale genome-wide association study dataset to investigate the causal relationship between dried fruit intake and kidney function markers (blood urea nitrogen (BUN), creatinine (CR), uric acid (UA), cystatin C (CyC), hematuria, microalbuminuria). The main analytical method was inverse variance weighting. In addition, we applied the MR Egger and weighted median to assess the robustness of the results. Finally, Multivariate Mendelian randomization (MVMR) was used to estimate the direct effect of dried fruit intake on kidney function markers.

Results

The univariate MR analysis showed that increased dried fruit intake was associated with lower kidney function markers, including BUN (β: -0.171, 95% confidence interval (CI): -0.239 to -0.102, p = 1.063 × 10-6), CR (β: -0.205, 95% CI: -0.311 to -0.099, p = 1.455 × 10-4), UA (β = -0.317, 95% CI: -0.384 to -0.249, p = 4.439 × 10-20), and CysC (β = -0.323, 95% CI: -0.384 to -0.249, p = 1.074 × 10-11); however, it was unrelated to hematuria and microalbuminuria. Causality persisted after performing MVMR analysis; however, with the addition of alcohol consumption and smoking as exposure factors, the causality for UA (β = -0.296, 95% CI: -0.523 to -0.068, p = 1.094 × 10-2) and CysC (β = -0.238, 95% CI: -0.465 to -0.011, p = 4.024× 10-2) weakened, while the causality for BUN (β = -0.038, 95% CI: -0.215 to 0.138, p = 6.698 × 10-1) and CR (β = -0.038, 95% CI: -0.431 to 0.046, p = 1.347 × 10-1) disappeared.

Conclusion

Increased dried fruit intake was associated with lower kidney function markers (BUN, CR, UA, and CysC) in the absence of smoking and alcohol consumption; however, the causal relationship between dried fruit intake and BUN and CR disappeared in the presence of smoking and alcohol consumption. These results provide a promising avenue for delaying the course of chronic kidney disease.

COVID-19 increases mortality in hemodialysis patients: exploring links with inflammation and telomere attrition

BACKGROUND AND OBJECTIVE

An increased risk of mortality and hospitalization was consistently demonstrated in hemodialysis (HD) patients affected by pandemic coronavirus infection (COVID-19). In this study, we analyzed parameters that may impact mortality in COVID-19 HD patients, including neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH), C-reactive protein (CRP), COVID-19 disease status and telomere length in peripheral blood cells (TL).

MATERIALS AND METHODS

A total of 130 chronic hemodialysis patients were enrolled and followed up for 18 months. Patients were categorized into groups based on their COVID-19 disease history and subsequent data about their survival status at the end of the study. Routine laboratory parameters were assessed using standard automated methods and TL was determined using the modified Cawthon method. Survival predictors were analyzed using Kaplan-Meier analysis.

RESULTS

Deceased patients (30%) were older with higher body mass index (BMI), higher levels of LDH, NLR index, CRP and lower TL and lymphocytes count compared to survivors. Kaplan-Meier survival analysis showed six parameters were significant mortality predictors in the following order of significance: COVID-19 history, 2-years cardiovascular mortality risk score, NLR, TL, CRP, LDH. Using binary logistic regression analysis Summary risk score, a combination of these six parameters revealed as the best predictor of patient's survival in this group of parameters (log rank 25.4, p < 0.001).

CONCLUSION

Compared to the general population, the mortality rate among HD patients persists at a higher level despite advancements in HD technology and patient care. The situation has been exacerbated by COVID-19, by significant increase in mortality rate among these patients.

Comparison of fatalities due to COVID-19 and other nonexternal causes during the first five pandemic waves : Results from multiple cause of death statistics in Bavaria

BACKGROUND

Older age is a risk factor for a fatal course of SARS-CoV‑2 infection, possibly due to comorbidities whose exact role in this context, however, is not yet well understood. In this paper, the characteristics and comorbidities of persons who had died of COVID-19 in Bavaria by July 2022 are shown and compared with the characteristics of other fatalities during the pandemic.

METHODS

Based on data from multiple cause of death statistics, odds ratios for dying from COVID-19 (compared to dying from other nonexternal causes of death) were calculated by using logistic regression models, stratified by age, sex, and pandemic waves.

RESULTS

In Bavaria, a total of 24,479 persons (6.5% of all deaths) officially died from COVID-19 between March 2020 and July 2022. In addition to increasing age and male sex, preexisting diseases and comorbidities such as obesity, degenerative diseases of the nervous system, dementia, renal insufficiency, chronic lower respiratory diseases, and diabetes mellitus were significantly associated with COVID-19-related deaths. Dementia was mainly associated with increased COVID-19 mortality during the first and second waves, while obesity was strongly associated during the fourth wave.

DISCUSSION

The frequency of specific comorbidities in COVID-19 deaths varied over the course of the pandemic. This suggests that wave-specific results also need to be interpreted against the background of circulating virus variants, changing immunisation levels, and nonpharmaceutical interventions in place at the time.

Long-Term Interplay Between SARS-CoV-2 and Renal Impairment

Introduction The SARS-CoV-2 virus causes the highly contagious coronavirus disease 2019 (COVID-19), which most commonly manifests as severe acute respiratory syndrome. The virus is part of the Coronaroviridae family, a group of viruses that can cause various diseases, such as the common cold, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). The World Health Organization (WHO) declared the outbreak of COVID-19 as a pandemic on March 11, 2020. On February 26, 2020, Romania confirmed the first case of COVID-19, initiating a series of challenges that negatively impacted the lives of thousands of people. The COVID-19 pandemic has had a disproportionate effect on patients at risk of kidney damage. Patients with chronic kidney disease (CKD) are at high risk of SARS-CoV-2 infection and mortality associated with COVID-19. CKD is associated with pronounced immunodeficiency and represents a risk factor for contracting the infection, but also increases the risk of hospitalization, oxygen therapy, and prolonged treatments. The evidence regarding the management of patients with CKD undergoing renal replacement therapy (RRT) infected with SARS-CoV-2 is still misleading. While these are high-risk patients due to the presence of multiple comorbidities, especially cardiovascular, e.g., hypertension, left ventricular hypertrophy, but also diabetes, the question remains whether RRT itself is associated with a worse prognosis in patients infected with SARS-CoV-2, although infections generally induce severe complications in patients with CKD and RRT. Methods This retrospective study aims to analyze the evolution of COVID-19 disease in patients with CKD, focusing on the association with some common comorbidities such as ischemic coronary disease (ICD), obesity, and diabetes. The study included 72 hemodialyzed patients; they were hospitalized between November 2020 and February 2021 at "Sf. Ioan" Clinical Emergency Hospital, Nephrology and Dialysis Clinic; peritoneal dialysis patients were excluded. Results Older age was found to be an important risk factor for death in hemodialyzed patients admitted with COVID-19 infection. Obese patients were found to be at greater risk of mortality. Discussion This study showed that there is a complex relationship between COVID-19 infection and increased mortality in patients with CKD associating ischemic coronary disease, obesity, and diabetes.

COVID-19 infection and severe clinical outcomes in patients with kidney disease by vaccination status: a nationwide cohort study in Korea

OBJECTIVES

Patients with kidney disease have been prioritized for coronavirus disease 2019 (COVID-19) vaccination due to their susceptibility to COVID-19 infection. However, little evidence exists regarding these patients' vulnerability to COVID-19 post-vaccination. Thus, we evaluated the risk of COVID-19 in patients with kidney disease compared to individuals without kidney disease according to vaccination status.

METHODS

A retrospective cohort study was conducted using the Korean nationwide COVID-19 registry linked with National Health Insurance Service claims data (2018-2021). Among individuals aged 12 years or older, 2 separate cohorts were constructed: a COVID-19-vaccinated cohort and an unvaccinated cohort. Within each cohort, the risk of COVID-19 infection and all-cause mortality, hospitalization, and emergency room visits within 30 days of COVID-19 infection were compared between patients with and without kidney disease. To adjust for potential confounding, we used propensity score matching. Hazard ratios (HRs) for each outcome were estimated using a Cox proportional hazard model.

RESULTS

We identified 785,390 and 836,490 individuals in the vaccinated and unvaccinated cohorts, respectively. Compared to patients without kidney disease, patients with kidney disease were at a higher risk of COVID-19 infection in both the vaccinated cohort (HR, 1.08; 95% confidence interval [CI], 1.02 to 1.16) and the unvaccinated cohort (HR, 1.09; 95% CI, 0.99 to 1.20). Likewise, patients with kidney disease generally were at higher risk for severe clinical outcomes within 30 days of COVID-19 infection. Subgroup and sensitivity analyses showed generally consistent results.

CONCLUSIONS

Our study observed excess risk of COVID-19 in patients with kidney disease, highlighting the importance of ongoing attention to these patients even post-vaccination.

Evaluation of Clinical Characteristics of Critically Ill COVID-19 Patients With Renal Failure

INTRODUCTION

This study aimed to investigate the clinical characteristics and prognostic factors of critically ill COVID-19 patients with renal failure admitted to the ICU.

METHODS

We analyzed 300 adult patients with SARS-CoV-2 infection admitted to the ICU between November 1, 2020, and June 1, 2022. Demographic data, renal function parameters, and outcomes were collected and analyzed.

RESULTS

The median age was 72 years, and 54.3% were men. Mechanical ventilation was required for 86.3% of patients, with 71.0% needing invasive ventilation. Renal failure was present in 43.3% of patients at ICU admission, significantly associated with older age, higher mechanical and invasive ventilation needs, and increased ICU mortality (76.9% vs. 51.8%, p<0.001). Patients with renal failure had elevated levels of urea, creatinine, C-reactive protein (CRP), D-dimer, white blood cell (WBC), neutrophil (Neu), and procalcitonin (PCT) (p<0.001 for all). Among patients with acute kidney injury (AKI), those with AKI had significantly higher median age (75 vs. 66 years, p<0.001), mechanical ventilation requirement (93.6% vs. 74.3%, p<0.001) and ICU mortality (79.1% vs. 35.4%, p<0.001). Elevated levels of urea (76 vs. 44 mg/dL, p<0.001) and creatinine (1.4 vs. 0.8 mg/dL, p<0.001), as well as inflammatory markers CRP and D-dimer (p=0.001), were observed in AKI patients. Survivors had lower median age (66.0 vs. 74.0 years, p<0.001) and lower prevalence of chronic kidney disease (CKD) (4.5% vs. 12.8, p=0.019) and AKI (34.8% vs. 78.7%, p<0.001). Non-survivors exhibited higher levels of urea, creatinine, lactate dehydrogenase (LDH), CRP, ferritin, and D-dimer (p<0.001 for all).

CONCLUSION

Renal failure and AKI are prevalent in critically ill COVID-19 patients and are associated with worse outcomes. Elevated creatinine and urea levels at ICU admission are significant predictors of ICU mortality, underscoring the importance of early recognition and management of renal impairment in these patients.

Prognostic significance of chronic kidney disease and impaired renal function in Japanese patients with COVID-19

BACKGROUND

Renal impairment is a predictor of coronavirus disease (COVID-19) severity. No studies have compared COVID-19 outcomes in patients with chronic kidney disease (CKD) and patients with impaired renal function without a prior diagnosis of CKD. This study aimed to identify the impact of pre-existing impaired renal function without CKD on COVID-19 outcomes.

METHODS

This retrospective study included 3,637 patients with COVID-19 classified into three groups by CKD history and estimated glomerular filtration rate (eGFR) on referral: Group 1 (n = 2,460), normal renal function without a CKD history; Group 2 (n = 905), impaired renal function without a CKD history; and Group 3 (n = 272), history of CKD. We compared the clinical characteristics of these groups and assessed the effect of CKD and impaired renal function on critical outcomes (requirement for respiratory support with high-flow oxygen devices, invasive mechanical ventilation, or extracorporeal membrane oxygen, and death during hospitalization) using multivariable logistic regression.

RESULTS

The prevalence of comorbidities (hypertension, diabetes, and cardiovascular disease) and incidence of inflammatory responses (white blood counts, and C-reactive protein, procalcitonin, and D-dimer levels) and complications (bacterial infection and heart failure) were higher in Groups 2 and 3 than that in Group 1. The incidence of critical outcomes was 10.8%, 17.7%, and 26.8% in Groups 1, 2, and 3, respectively. The mortality rate and the rate of requiring IMV support was lowest in Group 1 and highest in Group 3. Compared with Group 1, the risk of critical outcomes was higher in Group 2 (adjusted odds ratio [aOR]: 1.32, 95% confidence interval [CI]: 1.03-1.70, P = 0.030) and Group 3 (aOR: 1.94, 95% CI: 1.36-2.78, P < 0.001). Additionally, the eGFR was significantly associated with critical outcomes in Groups 2 (odds ratio [OR]: 2.89, 95% CI: 1.64-4.98, P < 0.001) and 3 (OR: 1.87, 95% CI: 1.08-3.23, P = 0.025) only.

CONCLUSIONS

Clinicians should consider pre-existing CKD and impaired renal function at the time of COVID-19 diagnosis for the management of COVID-19.

Role and Mechanism of Growth Differentiation Factor 15 in Chronic Kidney Disease

GDF-15 is an essential member of the transforming growth factor-beta superfamily. Its functions mainly involve in tissue injury, inflammation, fibrosis, regulation of appetite and weight, development of tumor, and cardiovascular disease. GDF-15 is involved in various signaling pathways, such as MAPK pathway, PI3K/AKT pathway, STAT3 pathway, RET pathway, and SMAD pathway. In addition, several factors such as p53, ROS, and TNF-α participate the regulation of GDF-15. However, the specific mechanism of these factors regulating GDF-15 is still unclear and more research is needed to explore them. GDF-15 mainly improves the function of kidneys in CKD and plays an important role in the prediction of CKD progression and cardiovascular complications. In addition, the role of GDF-15 in the kidney may be related to the SMAD and MAPK pathways. However, the specific mechanism of these pathways remains unclear. Accordingly, more research on the specific mechanism of GDF-15 affecting kidney disease is needed in the future. In conclusion, GDF-15 may be a therapeutic target for kidney disease.

Oxidative stress in patients with coronavirus disease and end-stage renal disease: a pilot study

BACKGROUND

Oxidative stress, an imbalance between reactive oxygen species production and antioxidant capacity, increases in patients with coronavirus disease (COVID-19) or renal impairment. We investigated whether combined COVID-19 and end-stage renal disease (ESRD) would increase oxidative stress levels compared to each disease alone.

METHODS

Oxidative stress was compared among three groups. Two groups comprised patients with COVID-19 referred to the hospital with or without renal impairment (COVID-ESRD group [n = 18]; COVID group [n = 17]). The third group (ESRD group [n = 18]) comprised patients without COVID-19 on maintenance hemodialysis at a hospital.

RESULTS

The total oxidative stress in the COVID-ESRD group was lower than in the COVID group (p = 0.047). The total antioxidant status was higher in the COVID-ESRD group than in the ESRD (p < 0.001) and COVID (p < 0.001) groups after controlling for covariates. The oxidative stress index was lower in the COVID-ESRD group than in the ESRD (p = 0.001) and COVID (p < 0.001) groups. However, the three oxidative parameters did not differ significantly between the COVID and COVID-ESRD groups.

CONCLUSIONS

The role of reactive oxygen species in the pathophysiology of COVID-19 among patients withESRD appears to be non-critical. Therefore, the provision of supplemental antioxidants may not confer a therapeutic advantage, particularly in cases of mild COVID-19 in ESRD patients receiving hemodialysis. Nonetheless, this area merits further research.

Risk factors for severe COVID-19 infection and the impact of COVID-19 infection on disease progression among patients with AAV

To identify risk factors for COVID-19 infection and investigate the impact of COVID-19 infection on chronic kidney disease (CKD) progression and vasculitis flare in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This cohort study retrospectively analyzed the prevalence and severity of COVID-19 infection in 276 patients with AAV who were followed up. Logistic regression was employed to estimate the risk of COVID-19 infection as well as CKD progression and vasculitis flare upon COVID-19 infection. During the 6-month observation period, 213 (77.2%) of 276 patients were diagnosed with COVID-19 infection. Of these 213 patients, 49 (23.0%) had a COVID-19-related inpatient admission, including 17 patients who died of COVID-19 infection. AAV patients with severe COVID-19 infection were more likely to be male (OR 1.921 [95% CI 1.020-3.619], P = 0.043), suffered from worse kidney function (serum creatinine [Scr], OR 1.901 [95% CI 1.345-2.687], P < 0.001), had higher C-reactive protein (CRP) (OR 1.054 [95% CI 1.010-1.101], P = 0.017) and less likely to have evidence of initial vaccination (OR 0.469 [95% CI 0.231-0.951], P = 0.036), and Scr and COVID-19 vaccination were proven to be significantly associated with severe COVID-19 infection even after multivariable adjustment. Severe COVID-19 infection was significantly associated with subsequent CKD progression (OR 7.929 [95% CI 2.030-30.961], P = 0.003) and vasculitis flare (OR 11.842 [95% CI 1.048-133.835], P = 0.046) among patients with AAV. AAV patients who were male, and with worse kidney function were more susceptible to severe COVID-19 infection, which subsequently increased the risk of CKD progression and vasculitis flare.

Kidney Function Tests and Continuous eGFR Decrease at Six Months after SARS-CoV-2 Infection in Patients Clinically Diagnosed with Post-COVID Syndrome

The long-term sequelae of SARS-CoV-2 infection are still under research, since extensive studies showed plenty of systemic effects of the viral infection, extending even after the acute phase of the infection. This study evaluated kidney function tests six months after SARS-CoV-2 infection in patients clinically diagnosed with Post-COVID Syndrome, hypothesizing persistent renal dysfunction evidenced by altered kidney function tests compared to baseline levels. Continuous eGFR decrease <30 at six months post-infection was considered the main study outcome. Conducted at the "Victor Babes" Hospital, this retrospective observational study involved adults with laboratory-confirmed SARS-CoV-2 infection and clinically-diagnosed Post-COVID Syndrome, excluding those with prior chronic kidney disease or significant renal impairment. Kidney function tests, including serum creatinine, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), alongside markers of kidney damage such as proteinuria and hematuria, were analyzed. Among 206 participants, significant differences were observed between the control (n = 114) and the Post-COVID group (n = 92). The Post-COVID group exhibited higher serum creatinine (109.7 μmol/L vs. 84.5 μmol/L, p < 0.001), lower eGFR (65.3mL/min/1.73 m2 vs. 91.2 mL/min/1.73 m2, p < 0.001), and elevated BUN levels (23.7 mg/dL vs. 15.2 mg/dL, p < 0.001) compared to the control group. Regression analysis highlighted significant predictors of continuous eGFR decrease <30 at six months post-infection. The development of acute kidney injury (AKI) during the initial COVID-19 illness emerged as a strong predictor of reduced eGFR (β = 3.47, p < 0.001). Additional factors, including a creatinine increase (23 μmol/L above the normal range) and an elevated Albumin to Creatinine Ratio (ACR) (>11 mg/g above the normal range), were significantly associated with eGFR reduction. Patients with Post-COVID Syndrome demonstrate significant renal impairment six months post-SARS-CoV-2 infection. The study's findings stress the need for ongoing monitoring and intervention strategies for renal health in affected individuals, underscoring the persistent impact of COVID-19 on renal function.

Global trends in chronic kidney disease-related mortality: a systematic review protocol

INTRODUCTION

In recent decades, all-cause mortality has increased among individuals with chronic kidney disease (CKD), influenced by factors such as aetiology, standards of care and access to kidney replacement therapies (dialysis and transplantation). The recent COVID-19 pandemic also affected mortality over the past few years. Here, we outline the protocol for a systematic review to investigate global temporal trends in all-cause mortality among patients with CKD at any stage from 1990 to current. We also aim to assess temporal trends in the mortality rate associated with the COVID-19 pandemic.

METHODS AND ANALYSIS

We will conduct a systematic review of studies reporting mortality for patients with CKD following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will search electronic databases, national and multiregional kidney registries and grey literature to identify observational studies that reported on mortality associated with any cause for patients with CKD of all ages with any stage of the disease. We will collect data between April and August 2023 to include all studies published from 1990 to August 2023. There will be no language restriction, and clinical trials will be excluded. Primary outcome will be temporal trends in CKD-related mortality. Secondary outcomes include assessing mortality differences before and during the COVID-19 pandemic, exploring causes of death and examining trends across CKD stages, country classifications, income levels and demographics.

ETHICS AND DISSEMINATION

A systematic review will analyse existing data from previously published studies and have no direct involvement with patient data. Thus, ethical approval is not required. Our findings will be published in an open-access peer-reviewed journal and presented at scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42023416084.

Vaccine Effectiveness of BNT162b2 and CoronaVac against SARS-CoV-2 Omicron BA.2 in CKD

BACKGROUND

The ongoing coronavirus disease 2019 (COVID-19) pandemic has posed increased risks of hospitalization and mortality in patients with underlying CKD. Current data on vaccine effectiveness of COVID-19 vaccines are limited to patients with CKD on dialysis and seroconversion in the non-dialysis population.

METHODS

A case-control study was conducted of adults with CKD using data extracted from the electronic health record database in Hong Kong. Adults with CKD and COVID-19 confirmed by PCR were included in the study. Each case was matched with up to ten controls attending Hospital Authority services without a diagnosis of COVID-19 on the basis of age, sex, and index date (within three calendar days). The vaccine effectiveness of BNT162b2 and CoronaVac in preventing COVID-19 infection, hospitalizations, and all-cause mortality was estimated using conditional logistic regression adjusted by patients' comorbidities and medication history during the outbreak from January to March 2022.

RESULTS

A total of 20,570 COVID-19 cases, 6604 COVID-19-related hospitalizations, and 2267 all-cause mortality were matched to 81,092, 62,803, and 21,348 controls, respectively. Compared with the unvaccinated group, three doses of BNT162b2 or CoronaVac were associated with a reduced risk of infection (BNT162b2: 64% [95% confidence interval (CI), 60 to 67], CoronaVac: 42% [95% CI, 38 to 47]), hospitalization (BNT162b2: 82% [95% CI, 77 to 85], CoronaVac: 80% [95% CI, 76 to 84]), and mortality (BNT162b2: 94% [95% CI, 88 to 97], CoronaVac: 93% [95% CI, 88 to 96]). Vaccines were less effective in preventing infection and hospitalization in the eGFR <15 and 15-29 ml/min per 1.73 m 2 subgroups as compared with higher GFR subgroups. However, receipt of vaccine, even for one dose, was effective in preventing all-cause mortality, with estimates similar to the higher eGFR subgroups, as compared with unvaccinated.

CONCLUSIONS

A dose-response relationship was observed between the number of BNT162b2 or CoronaVac doses and the effectiveness against COVID-19 infection and related comorbidity in the CKD population.

Deliverables from Metabolomics in Kidney Disease: Adenine, New Insights, and Implication for Clinical Decision-Making

BACKGROUND

Chronic kidney disease (CKD) presents a persistent global health challenge, characterized by complex pathophysiology and diverse progression patterns. Metabolomics has emerged as a valuable tool in unraveling the intricate molecular mechanisms driving CKD progression.

SUMMARY

This comprehensive review provides a summary of recent progress in the field of metabolomics in kidney disease with a focus on spatial metabolomics to shed important insights to enhancing our understanding of CKD progression, emphasizing its transformative potential in early disease detection, refined risk assessment, and the development of targeted interventions to improve patient outcomes.

KEY MESSAGE

Through an extensive analysis of metabolic pathways and small-molecule fluctuations, bulk and spatial metabolomics offers unique insights spanning the entire spectrum of CKD, from early stages to advanced disease states. Recent advances in metabolomics technology have enabled spatial identification of biomarkers to provide breakthrough discoveries in predicting CKD trajectory and enabling personalized risk assessment. Furthermore, metabolomics can help decipher the complex molecular intricacies associated with kidney diseases for exciting novel therapeutic approaches. A recent example is the identification of adenine as a key marker of kidney fibrosis for diabetic kidney disease using both untargeted and targeted bulk and spatial metabolomics. The metabolomics studies were critical to identify a new biomarker for kidney failure and to guide new therapeutics for diabetic kidney disease. Similar approaches are being pursued for acute kidney injury and other kidney diseases to enhance precision medicine decision-making.

Gastrointestinal symptoms in COVID-19 and disease severity: a Japanese registry-based retrospective cohort study

BACKGROUND

Research on whether gastrointestinal symptoms correlate with the severity of Coronavirus Disease 2019 (COVID-19) has been inconclusive. This study aimed to clarify any associations between gastrointestinal symptoms and the prognosis of COVID-19.

METHODS

We collected data from the Japanese nationwide registry for COVID-19 to conduct a retrospective cohort study. Data from 3498 Japanese COVID-19 patients, diagnosed at 74 facilities between February 2020 and August 2022, were analyzed in this study. Hospitalized patients were followed up until discharge or transfer to another hospital. Outpatients were observed until the end of treatment. Associations between gastrointestinal symptoms and clinical outcomes were investigated using multivariable-adjusted logistic regression models.

RESULTS

The prevalence of diarrhea, nausea/vomiting, abdominal pain, and melena were 16.6% (581/3498), 8.9% (311/3498), 3.5% (121/3498), and 0.7% (23/3498), respectively. In the univariable analysis, admission to intensive care unit (ICU) and requirement for mechanical ventilation were less common in patients with diarrhea than those without (ICU, 15.7% vs. 20.6% (p = 0.006); mechanical ventilation, 7.9% vs. 11.4% (p = 0.013)). In the multivariable-adjusted analysis, diarrhea was associated with lower likelihood of ICU admission (adjusted odds ratio (aOR), 0.70; 95% confidence interval (CI), 0.53-0.92) and mechanical ventilation (aOR, 0.61; 95% CI, 0.42-0.89). Similar results were obtained in a sensitivity analysis with another logistic regression model that adjusted for 14 possible covariates with diarrhea (ICU; aOR, 0.70; 95% CI, 0.53-0.93; mechanical ventilation; aOR 0.62; 95% CI, 0.42-0.92).

CONCLUSIONS

Diarrhea was associated with better clinical outcomes in COVID-19 patients.

Impact of preexisting interstitial lung disease on mortality in COVID-19 patients from the early pandemic to the delta variant epidemic: a nationwide population-based study

BACKGROUND

COVID-19 patients with preexisting interstitial lung disease (ILD) were reported to have a high mortality rate; however, this was based on data from the early stages of the pandemic. It is uncertain how their mortality rates have changed with the emergence of new variants of concern as well as the development of COVID-19 vaccines and treatments. It is also unclear whether having ILD still poses a risk factor for mortality. As COVID-19 continues to be a major concern, further research on COVID-19 patients with preexisting ILD is necessary.

METHODS

We extracted data on COVID-19 patients between January 2020-August 2021 from a Japanese nationwide insurance claims database and divided them into those with and without preexisting ILD. We investigated all-cause mortality of COVID-19 patients with preexisting ILD in wild-type-, alpha-, and delta-predominant waves, to determine whether preexisting ILD was associated with increased mortality.

RESULTS

Of the 937,758 adult COVID-19 patients, 7,333 (0.8%) had preexisting ILD. The proportion of all COVID-19 patients who had preexisting ILD in the wild-type-, alpha-, and delta-predominant waves was 1.2%, 0.8%, and 0.3%, respectively, and their 60-day mortality was 16.0%, 14.6%, and 7.5%, respectively. The 60-day mortality significantly decreased from the alpha-predominant to delta-predominant waves (difference - 7.1%, 95% confidence intervals (CI) - 9.3% to - 4.9%). In multivariable analysis, preexisting ILD was independently associated with increased mortality in all waves with the wild-type-predominant, odds ratio (OR) 2.10, 95% CI 1.91-2.30, the alpha-predominant wave, OR 2.14, 95% CI 1.84-2.50, and the delta-predominant wave, OR 2.10, 95%CI 1.66-2.66.

CONCLUSIONS

All-cause mortality rates for COVID-19 patients with preexisting ILD decreased from the wild-type- to the more recent delta-predominant waves. However, these patients were consistently at higher mortality risk than those without preexisting ILD. We emphasize that careful attention should be given to patients with preexisting ILD despite the change in the COVID-19 environment.

Humoral immunity trends in a hemodialysis cohort following SARS-CoV-2 mRNA booster: A cohort study

Background and Aims

Patients with end stage kidney disease on hemodialysis are vulnerable to SARS-CoV-2 infection. Current guidelines recommend boosters of SARS-CoV-2 mRNA-based vaccines. The long-term humoral response of hemodialysis patients infected with SARS-CoV-2 after receiving a booster of SARS-CoV-2 mRNA-based vaccines has been incompletely characterized. Here, we determined the long-term humoral response of hemodialysis patients to two and three doses of the Pfizer BioNTech (BNT162b2) mRNA SARS-CoV-2 vaccine and investigated the effect of postbooster SARS-CoV-2 infection on antibody levels over time.

Methods

Samples were collected on a monthly basis and tested for anti-SARS-CoV-2 antibodies against anti-spike S1 domain. Thirty-five hemodialysis patients were enrolled in the original study and 27 of these received a booster. Patients were followed up to 6 months after the first two doses and an additional 7 months after the third BNT162b2 dose. Results are presented as the internationally harmonized binding antibody units (BAU/mL).

Results

Antibody level significantly increased from prebooster to 2 weeks postbooster, with a median [25th, 75th percentile] rise from 52.72 [28.55, 184.7] to 6216 [3806, 11,730] BAU/mL in the total population. Of patients with a negative or borderline detectable antibody level 6 months after vaccination who received a third dose, 89% developed positive antibody levels 2 weeks postbooster. Postbooster antibody levels declined an average rate of 29% per month in infection-naïve patients. Antibody levels spiked in patients infected with SARS-CoV-2 after receiving a booster but declined rapidly. No patients infected postbooster required hospitalization.

Conclusions

A third dose of BNT162b2 restores antibody levels to high levels in dialysis patients but levels decline over time. A third dose did not necessarily prevent infection, but no patients suffered severe infection or required hospitalization. SARS-CoV-2 recovered patients appear to have a blunted rise in antibody levels after a third dose. Although patients infected with SARS-CoV-2 postbooster had an immediate spike in antibody levels, these declined over time.

Safety of BNT162b2 mRNA COVID-19 vaccine in children with chronic kidney disease: a national population study from South Korea

BACKGROUND

In South Korea, COVID-19 vaccination has been recommended to adolescents aged 12 - 17 since October, 2021. We aimed to assess the rate of adverse events following COVID-19 vaccination in adolescents with chronic kidney disease (CKD) in South Korea, using national cohort data.

METHODS

We retrieved the clinical information of adolescents 12 - 17 years old from the Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service (K-COV-N) database, to calculate incidence rates of purpura and other hemorrhagic conditions, Guillain-Barré syndrome (GBS), Kawasaki disease/multisystem inflammatory syndrome in children (MIS-C), myocarditis and/or pericarditis, and anaphylaxis in adolescents with CKD, after BNT162b2 vaccination.

RESULTS

Among the 2306 adolescents with CKD, 62.7% (n = 1446) had received the BNT-162b2 vaccine. GBS, Kawasaki disease/MIS-C, and anaphylaxis or anaphylactic shock did not occur during the observation period. Purpura and hemorrhagic conditions were more frequent in the unvaccinated group (7/860 vs. 1/1446), while myocarditis/pericarditis was observed only in the vaccinated group (0/860 vs. 1/1446). Adjusted odds ratio for any of the two adverse events was lower in vaccinated adolescents than in the unvaccinated group which did not reach statistical significance (adjusted odds ratio = 0.14, 95% confidence interval: 0.02, 1.16, P = 0.068).

CONCLUSIONS

In this national cohort study of adolescents with CKD in South Korea, we observed no evidence of increased risk of adverse events following BNT162b2 vaccination. Our finding offers insights into the safety of COVID-19 vaccines, empowering adolescent patients with CKD and their caregivers to make informed decisions.

Cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) +49A>G (rs231775) gene polymorphism is not associated with COVID-19 severity and mortality in an Iranian population

Introduction

Cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) regulates T cell immune responses as an immune activation inhibitor. Literature reviews suggest that COVID-19 is associated with dysregulation of the inflammatory immune response. The purpose of the present hospital-based case-control study was to evaluate the genetic association of the CTLA4 +49A > G (rs231775) Single Nucleotide Polymorphism (SNP) with COVID-19 severity and mortality among the Iranian people.

Method

Genomic DNA of peripheral blood nuclear cells was extracted from the 794 COVID-19 patients and 167 control individuals. The polymorphic site of rs231775 was genotyped using the PCR-RFLP technique. Also, to identify whether this genetic variation was related to CTLA-4 mRNA expression, total RNA was extracted from 178 COVID-19 patients and 70 controls. The mRNA levels of CTLA-4 were determined using real-time PCR.

Result

There were no statistically significant differences found in the genotype and allele frequencies among the different genetic models with regards to the severity and mortality of COVID-19. Furthermore, there was no significant association between rs231775 genotypes and CTLA-4 mRNA expression in patients.

Conclusion

Our findings demonstrated that SARS-CoV-2 infection is not associated with rs231775 in the Iranian people. More investigations are crucial to show how this genetic variation affects other ethnic groups. Given the importance of CTLA-4 in regulating immune responses, further studies are recommended to examine other CTLA-4 SNPs and the function of this gene in COVID-19 patients.

Outcomes of patients with COVID-19 and coronary artery disease and heart failure: findings from the Philippine CORONA study

BACKGROUND

Patients with coronavirus disease 2019 (COVID-19) and coronary artery disease (CAD) or heart failure (HF) are more likely to have poor outcomes. This study aimed to determine the characteristics and outcomes of COVID-19 patients with CAD/HF across various institutions in the Philippines.

METHODS

We utilized the data from the Philippine CORONA Study and compared the outcomes of admitted COVID-19 patients with CAD/HF versus those without. The Student's t test, Mann-Whitney U test, binary logistic regression and multivariate regression analysis were utilized. Odds ratios (OR) and Kaplan-Meier curves were generated.

RESULTS

We included a total of 512 patients with COVID-19 had CAD/HF and 10,369 were without. CAD/HF was significantly associated with COVID severity, all-cause mortality, death from cardiac causes, respiratory failure, and prolonged hospitalization. After adjusting for confounders, the presence of CAD/HF was still associated with death from a cardiac cause (OR 2.22, 95% CI 1.49-3.3, p < 0.01).

CONCLUSIONS

The presence of CAD or HF was significantly associated with severity of COVID disease, all-cause mortality, death from cardiac causes, respiratory failure, and prolonged hospitalization.

Clinical Characteristics and Outcomes in Hospitalized Patients with COVID-19 and Cancer History: A Multicenter Cross-Sectional Study in Southwestern Iran

Background: Cancer patients are more exposed to opportunistic infections, such as COVID-19, due to their poor health status. This study aimed to identify the clinical characteristics of cancer and non-cancer patients with COVID-19 that may lead to death, intubation, and ICU admission. Materials and Methods: A Multicenter Cross-Sectional study was conducted on confirmed COVID-19 adult patients with and without a history of cancer from March 2019 to March 2021. Demographic and clinical features, ICU admission, intubation, and discharge status have been extracted from patients' medical records. Chi-square, odds ratio, Mann-Whitney test, and logistic regression were used to analyze the data. Results: The death rate in 1332 cancer patients was 28% compared to the 91464 noncancer patients which was 9% with an odds ratio of 3.94 and p<0.001. ICU admission rates among the cancer group were 43%, while in the noncancer group, it was 17.9% (p<0.001). Moreover, intubation was done for 20.9% of cancer patients and 7.4% of non-cancer patients (p<0.001). However, no significant difference was observed between the two groups in terms of length of stay in the hospital. Multivariable logistic regression analysis showed that age, level of consciousness, SPO2, and autoimmune disorders were associated with mortality in cancer patients with COVID-19. Conclusion: This study showed that older age, loss of consciousness, low oxygen saturation, and suffering from autoimmune disorders were the predictors of death in cancer patients with COVID-19. These results can have important implications for the management and care of cancer patients with COVID-19.

COVID-19 and chronic kidney disease: a bibliometric analysis

Background

The COVID-19 pandemic has caused over 656 million confirmed cases and over 6.6 million deaths worldwide. Chronic kidney disease (CKD) is considered a high-risk factor for COVID-19; therefore, considerable research has been conducted in this field. Therefore, this study aims to conduct a bibliometric analysis of publications related to COVID-19 and CKD.

Methods

Publications were retrieved from the Web of Science Core Collection database on 16 January 2023 and screened based on inclusion criteria. Then the authors used Microsoft Excel and CiteSpace to analyze the included publications from the following seven aspects: countries/regions, institutions, journals, authors, cited references, and keywords.

Results

In total, 622 publications were included in the study. The USA has the most publications in this field, followed by China. The Icahn School of Medicine at Mount Sinai and Harvard Medical School had the highest number of publications in the field. Journal of Clinical Medicine had the largest number of publications, and Lancet was the most cited journal. Alberto Ortiz was the author with the largest number of publications, but there were no influential authors in this field. The highly cited references are mainly clinical studies on COVID-19. Research hotspots in this field include end-stage recent disease, cardiovascular disease, kidney metastasis, diabetes Mellitus, acute kidney injury, meta-analysis, and consistent plasma.

Conclusions

The USA, China, and some European countries and their institutions are major contributors to these publications. End-stage renal disease, acute kidney injury, kidney transplantation and convalescent plasma are current hot topics in the field.

Significance of Chronic Kidney Disease on Morbidity and Mortality in Hospitalized Patients With COVID-19

Background

Patients with comorbid illnesses are at risk for worse outcomes with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19). Our research examined patients with chronic kidney disease (CKD) to establish whether it remains an independent risk factor for mortality and morbidity in patients with COVID-19.

Methods

We conducted a retrospective cohort study using an electronic patient database in 2020. An observational dataset from 149 hospitals comprising a United States-based health system (HCA Healthcare) was analyzed. Hospitalized patients (N=11 086), aged 18 and above, with a COVID-19 polymerase chain reaction positive result between January 1, 2020, and September 1, 2020, were included in the initial data set.Primary outcomes were in-hospital death or discharge to hospice in patients with COVID-19. Secondary outcomes were individual components of the primary outcome including intensive care unit (ICU) admission, ventilator dependency, development of acute kidney injury (AKI), and in-hospital death. Baseline patient characteristics were recorded, including demographic variables and comorbidities.

Results

A total of 11 086 patients were included in the analysis. The study group included patients with CKD (5543 patients). Patients in the control group (5543 patients) were propensity matched for age, race, sex, and ethnicity. The primary outcome of in-hospital death or discharge to hospice was observed in 20.96% of patients with CKD compared to 11.91% of the control group with an odds ratio of 1.58 (confidence interval 1.37-1.80). ICU admission was required for 37.20% of patients in the CKD group and 21.63% of patients in the control group (P < .001). Ventilator dependency was found in 14.41% of patients in the CKD group and 8.59% of patients in the control group (P < .01). Development of AKI was seen in 5.65% of patients in the CKD group and 2.90% of patients in the control group (P < .01). A logistic regression model confirmed an independent association between underlying CKD and in-hospital death or discharge to hospice in patients with COVID-19.

Conclusion

Our study confirms an independent association between underlying CKD and poor outcomes among hospitalized patients with COVID-19, including in-hospital death or discharge to hospice.

Adverse Drug Events Associated With Remdesivir in Real-World Hospitalized Patients With COVID-19, Including Vulnerable Populations: A Retrospective Multicenter Study

BACKGROUND

Remdesivir is a US Food and Drug Administration-approved drug for coronavirus disease 2019 (COVID-19). Clinical trials were conducted under strictly controlled situations for a selected population, and their reported adverse events may not fully represent conditions in real-world patients. We aimed to estimate the incidence of adverse drug events (ADEs) associated with remdesivir in hospitalized patients with COVID-19, including vulnerable subpopulations, such as those with impaired renal or hepatic function and pregnant women.

METHODS

This retrospective observational study included hospitalized patients with confirmed COVID-19 treated with remdesivir between January and December 2021 at ten hospitals. ADEs and severe ADEs (Common Toxicity Criteria for Adverse Events grade ≥ 3) were operationally defined and analyzed through laboratory investigations. The incidence of ADEs was compared with that of each matched control in subpopulations with renal or hepatic impairment and pregnant women.

RESULTS

Among 2,140 patients, 1,416 (66.2%) and 295 (13.8%) experienced at least one ADE and severe ADE, respectively. The most frequent ADE was 'hepatic injury' (42.9%), followed by anemia (27.6%). The most common severe ADEs were 'hypokalemia' (5.3%), 'hepatic injury' (2.9%), and 'anemia' (3.6%). There was no significant difference in the incidence of ADEs in patients relative to their respective matched-control groups, including those with renal impairment (80.0% vs. control 71.8%, P = 0.063), hepatic impairment (70.4% vs. control 75.0%, P = 0.623) and pregnant women (78.6% vs. control 63.7%, P = 0.067). However, severe ADE incidence was significantly higher in patients with renal impairment (40.8% vs. 16.0%, P < 0.001). The most common severe ADEs in those were 'anemia' (15.3%), 'hypokalemia' (10.5%), and 'thrombocytopenia' (8.9%). There was no statistically significant difference in the incidence of severe ADEs in patients with hepatic impairment or in pregnancy (P = 0.230; P = 0.085).

CONCLUSION

A significant proportion of patients with COVID-19 treated with remdesivir experienced ADEs and severe ADEs. Given the high incidence of severe ADEs, caution is required in patients with renal impairment. Further studies are needed to investigate ADEs in pregnant women and patients with hepatic impairment.

Factors Associated with COVID-19 Severity Among Kidney Transplant and Non-Kidney Transplant Patients at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia

Background

The COVID-19 epidemic is a rapidly shifting situation that has resulted in significant regulatory reforms and widespread initiatives to deal with the initial crisis and its effects. The COVID-19 pandemic has had a significant impact on transplantation activities. The COVID-19 pandemic has caused various important challenges in the kidney transplant industry.

Objective

To identify the factors influencing COVID-19 severity in kidney transplant and non-kidney transplant patients at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Methods

A comparative cross-sectional study was conducted. This study included 364 patients (182 kidney transplants and 182 non-kidney transplants). A systematic random sampling was used to select the respondents. Professional nurses collected data for this study using a data extraction tools. Data were analyzed by using SPSS version 25 software. A multivariable logistic regression analysis was performed to identify the association between independent variables and COVID-19 severity with adjusted odds ratio (AOR), and 95% CI for AOR and P-value for testing significance.

Results

This study included 364 patients. Off the total, 34.1% developed severe COVID-19. In Multivariable logistic regression analysis, patients with 60 years and above age groups (AOR = 4.73; 95% CI: 1.86, 12.02), aged 40-59 years (AOR = 2.70; 95% CI: 1.17, 6.22), chest congestion (AOR = 4.49; 95% CI: 2.37, 8.50), history of muscle or body aches (AOR = 0.47; 95% CI: 0.22, 0.99) shortness of breath (AOR = 3.03; 95% CI: 1.36, 6.74), changed or lost sense of taste or smell (AOR = 2.77; 95% CI: 1.34, 5.71), and muscle pain (AOR = 3.05; 95% CI: 1.40, 6.65) were significant variables associated with COVID-19 severity after adjusting for other variables.

Conclusion

The study revealed that 34.1% of patients had severe COVID-19. The majority of these patients underwent non-kidney transplants. Age groups and symptoms, such as chest congestion, shortness of breath, changed or lost sense of taste or smell, and muscle pain, were significant predictors of COVID-19 disease severity.

Nationwide in-hospital mortality and morbidity analysis of COVID-19 in advanced chronic kidney disease, dialysis and kidney transplant recipients

Background

Patients with advanced chronic kidney disease (CKD), end-stage kidney disease (ESKD), and kidney transplants (KT) are at an elevated risk for COVID-19 infection, hospitalization, and mortality. A comprehensive comparison of morbidity and mortality between these populations with kidney disease and individuals without any kidney disease is lacking.

Methods

We analysed the 2020 Nationwide Inpatient Sample (NIS) database for non-elective adult COVID-19 hospitalizations, categorizing patients into advanced CKD, ESKD, KT, and kidney disease-free cohorts. Our analysis included a description of the distribution of comorbidities across the entire spectrum of CKD, ESKD, and KT. Additionally, we investigated in-hospital mortality, morbidity, and resource utilization, adjusting for potential confounders through multivariable regression models.

Results

The study included 1,018,915 adults hospitalized for COVID-19 in 2020. The incidence of advanced CKD, ESKD, and KT in this cohort was 5.8%, 3.8%, and 0.4%, respectively. Patients with advanced CKD, ESKD, and KT exhibited higher multimorbidity burdens, with 90.3%, 91.0%, and 75.2% of patients in each group having a Charlson comorbidity index (CCI) equal to or greater than 3. The all-cause in-hospital mortality ranged from 9.3% in kidney disease-free patients to 20.6% in advanced CKD, 19.4% in ESKD, and 12.4% in KT patients. After adjusting for potential confounders at both the patient and hospital levels, CKD stages 3-5; ESKD; and KT were found to be associated with increased odds of mortality, with adjusted odds ratios (aOR) of 1.34, 1.80, 2.66, 1.97, and 1.69, respectively.

Conclusion

Patients hospitalized for COVID-19 with advanced CKD, ESKD, or KT demonstrated a higher burden of comorbidities and increased mortality rates compared to those without kidney disease. After adjusting for confounders, CKD stages 3-5; ESKD; and KT were identified as independent risk factors for in-hospital mortality, illustrating a dose-response relationship between the odds of mortality and adverse outcomes as CKD progressed from stages 3 to 5. Our study highlights the necessity for enhanced management of comorbidities, targeted interventions, and vigorous vaccination efforts to mitigate the risk of adverse outcomes in the vulnerable populations of patients with CKD, ESKD, and KT.

Humoral and Cellular Immunogenicity of 3 Doses of BNT162b2 in Children With Kidney Diseases

Introduction

Patients with severe kidney diseases are at risk of complications from COVID-19; however, little is known about the effectiveness of COVID-19 vaccines in children and adolescents with kidney diseases.

Methods

We investigated the immunogenicity and safety of an accelerated 3-dose primary series of COVID-19 vaccination among 59 pediatric patients with chronic kidney disease (CKD) (mean age 12.9 years; 30 male) with or without immunosuppression, dialysis, or kidney transplant. Dosage was 0.1 ml BNT162b2 to those aged 5 to 11 years, and 0.3 ml BNT162b2 to those aged 11 to 18 years.

Results

Three doses of either vaccine type elicited significant antibody responses that included spike receptor-binding domain (S-RBD) IgG (90.5%-93.8% seropositive) and surrogate virus neutralization (geometric mean sVNT% level, 78.6%-79.3%). There were notable T cell responses. Weaker neutralization responses were observed among those on immunosuppression, especially those receiving higher number of immunosuppressants or on mycophenolate mofetil. Neutralization was reduced against Omicron BA.1 compared to wild type (WT, i.e., ancestral) (post-dose 3 sVNT% level; 82.7% vs. 27.4%; P < 0.0001). However, the T cell response against Omicron BA.1 was preserved, which likely confers protection against severe COVID-19. Infected patients exhibited hybrid immunity after vaccination, as evidenced by the higher Omicron BA.1 neutralization response among these infected patients who received 2 doses compared with those who were uninfected. Generally mild or moderate adverse reactions following vaccines were reported.

Conclusion

An accelerated 3-dose primary series with BNT162b2 is immunogenic and safe in young children and adolescents with kidney diseases.

COVID-19 and Nutrition: Focus on Chronic Kidney Disease

Some chronic diseases, including chronic kidney disease (CKD), may be associated with poor outcomes, including a high rate of hospitalization and death after COVID-19 infection. In addition to the vaccination program, diet intervention is essential for boosting immunity and preventing complications. A healthy diet containing bioactive compounds may help mitigate inflammatory responses and oxidative stress caused by COVID-19. In this review, we discuss dietary interventions for mitigating COVID-19 complications, including in persons with CKD, which can worsen COVID-19 symptoms and its clinical outcomes, while diet may help patients with CKD to resist the ravages of COVID-19 by improving the immune system, modulating gut dysbiosis, mitigating COVID-19 complications, and reducing hospitalization and mortality. The concept of food as medicine, also known as culinary medicine, for patients with CKD can be extrapolated to COVID-19 infection because healthy foods and nutraceuticals have the potential to exert an important antiviral, anti-inflammatory, and antioxidant role.

Successful Management of Critical Acute Respiratory Distress Syndrome following COVID-19 through Extracorporeal Membrane Oxygenation in a Patient with Concurrent Nephrotic Syndrome Relapse

A 44-year-old man with coronavirus disease 2019 (COVID-19) and nephrotic syndrome relapse was admitted to our intensive-care unit for respiratory failure. Despite receiving mechanical ventilation and immunomodulators, the patient experienced refractory hypoxemia, necessitating venovenous extracorporeal membrane oxygenation (VV-ECMO) therapy. Due to a worsening renal function, continuous hemodiafiltration was initiated. After 11 days, his respiratory status gradually improved, and VV-ECMO was withdrawn. The kidney function and proteinuria improved, and hemodialysis was subsequently discontinued. The patient was discharged 64 days after admission. This case highlights the potential benefit of early ECMO application in dramatically promoting recovery in severe COVID-19 cases.

COVID-19 and Kidney: The Importance of Follow-Up and Long-Term Screening

Renal involvement and kidney injury are common in COVID-19 patients, and the symptoms are more severe if the patient already has renal impairment. Renal involvement in COVID-19 is multifactorial, and the renal tubule is mainly affected, along with podocyte injury during SARS-CoV-2 infection. Inflammation, complement activation, hypercoagulation, and crosstalk between the kidney and lungs, brain, and heart are contributory factors. Kidney injury during the acute phase, termed acute kidney injury (AKI), may proceed to chronic kidney disease if the patient is discharged with renal impairment. Both AKI and chronic kidney disease (CKD) increase mortality in COVID-19 patients. Further, COVID-19 infection in patients suffering from CKD is more severe and increases the mortality rate. Thus, it is important to address both categories of patients, either developing AKI or CKD after COVID-19 or previously having CKD, with proper management and treatment. This review discusses the pathophysiology involved in AKI and CKD in COVID-19 infection, followed by management and treatment of AKI and CKD. This is followed by a discussion of the importance of screening and treatment of CKD patients infected with COVID-19 and future perspectives to improve treatment in such patients.

Direct impact of 2 years of COVID-19 on chronic disease patients: a population-based study in a large hard-hit Italian region

OBJECTIVES

We aimed to provide a region-wide comprehensive account of the direct effects of COVID-19 on chronic disease patients, in terms of disease incidence, severity and mortality, over a 2-year pandemic period (2020-2021).

DESIGN

Population-based retrospective study.

SETTING/PARTICIPANTS

Adult patients, affected by at least 1 of 32 prevalent chronic conditions, residing in the Emilia-Romagna Region in Italy, during the years 2020 (N=1 791 189, 47.7% of the overall adult regional population) and 2021 (N=1 801 071, 47.8%).

RESULTS

COVID-19 incidence among chronic disease patients was 4.1% (74 067 cases) in 2020 and 7.3% (126 556 cases) in 2021, varying across pathologies, with obesity and dementia showing the highest incidence. Hospitalisation rate for pneumonia or acute respiratory distress syndrome among SARS-CoV-2-positive patients was 15.4%. COVID-19-related excess mortality, that is, deaths from COVID-19 as either main or contributing (1.5% of the total) cause of death, was observed during the three pandemic waves, with observed/expected death ratios ranging from +38% (March 2020) to +11% (December 2021). Increased risks of both COVID-19-related hospitalisation and death were associated with male gender, elderly age and many pre-existing pathologies, including cardiovascular, cerebrovascular and respiratory diseases, neurological and psychiatric disorders, and metabolic dysfunctions. The higher the number of concomitant pathologies, the greater the risk of COVID-19-related adverse outcomes: the likelihood of hospitalisation and death more than doubled for people with more than two comorbidities, compared with those with one underlying condition.

CONCLUSIONS

This study presents a thorough and up-to-date quantification of the direct impact of COVID-19 on chronic disease patients. The results obtained are particularly relevant considering that people with pre-existing chronic conditions accounted for almost all cases of COVID-19-related hospitalisation (82.6%) and death (91.5%) in a vast region of Italy, among the hardest hit by the pandemic.

Assessments of and Attitudes towards Specialist Teleconsultations among Nephrology and Posttransplant Outpatients during the COVID-19 Pandemic

In Poland, teleconsultations (TCs) were not legally regulated or even conducted until the COVID-19 pandemic, which necessitated their abrupt implementation and posed a challenge to patients and doctors. The aim of this study was to assess the quality of TCs and the satisfaction with this mode of consultation among nephrology and kidney transplant outpatients with a high risk of severe courses of SARS-CoV-2 infection. A self-designed questionnaire regarding patients' demographics; digital fluency; and participation in, satisfaction with, and attitude towards TCs was distributed among patients in the nephrology and posttransplant outpatient clinics at two hospitals in central Poland. The questionnaires were completed by 294 adult patients, of whom 72.1% (n = 212) had participated in TCs at one of the abovementioned clinics. Almost all (96.7%) of the TCs were conducted via phone, and in 94.8% of cases, they fulfilled the purpose of the consultation. The most commonly reported advantages were not having to leave home and the reduced risk of infection. Only a few patients felt that TCs offer no advantages. The patients' profiles and demographic data had no significant effect on their assessments of teleconsultations. Despite the overall positive rating given to TCs, patients unhesitatingly indicated that a face-to-face visit would be a preferable way to contact a specialist.

Prime time for chronic kidney disease

Chronic kidney disease (CKD) represents a public health burden worldwide and is associated with significant morbidity and mortality. Most patients with CKD are managed by primary care practitioners and this educational series hope to improve knowledge and delivery of care to this high-risk patient population with CKD.

Association between number of vasopressors and mortality in COVID-19 patients

Study objective

Study the clinical outcomes associated with the number of concomitant vasopressors used in critically ill COVID-19 patients.

Design

A single-center retrospective cohort study was conducted on patients admitted with COVID-19 to the intensive care unit (ICU) between March and October 2020.

Setting

Rush University Medical Center, United States.

Participants

Adult patients at least 18 years old with COVID-19 with continuous infusion of any vasopressors were included.

Main outcome measures

60-day mortality in COVID-19 patients by the number of concurrent vasopressors received.

Results

A total of 637 patients met our inclusion criteria, of whom 338 (53.1 %) required the support of at least one vasopressor. When compared to patients with no vasopressor requirement, those who required 1 vasopressor (V1) (adjusted odds ratio [aOR] 3.27, 95 % confidence interval (CI) 1.86-5.79, p < 0.01) (n = 137), 2 vasopressors (V2) (aOR 4.71, 95 % CI 2.54-8.77, p < 0.01) (n = 86), 3 vasopressors (V3) (aOR 26.2, 95 % CI 13.35-53.74 p < 0.01) (n = 74), and 4 or 5 vasopressors(V4-5) (aOR 106.38, 95 % CI 39.17-349.93, p < 0.01) (n = 41) were at increased risk of 60-day mortality. In-hospital mortality for patients who received no vasopressors was 6.7 %, 22.6 % for V1, 27.9 % for V2, 62.2 % for V3, and 78 % for V4-V5.

Conclusion

Critically ill patients with COVID-19 requiring vasopressors were associated with significantly higher 60-day mortality.

Disasters and kidney care: pitfalls and solutions

Patients with kidney disease, especially those with kidney failure, are particularly susceptible to the adverse effects of disasters because their survival depends on functional infrastructure, advanced technology, the availability of specific drugs and well-trained medical personnel. The risk of poor outcomes across the entire spectrum of patients with kidney diseases (acute kidney injury, chronic kidney disease and kidney failure on dialysis or with a functioning transplant) increases as a result of disaster-related logistical challenges. Patients who are displaced face even more complex problems owing to additional threats that arise during travel and after reaching their new location. Overall, risks may be mitigated by pre-disaster preparedness and training. Emergency kidney disaster responses depend on the type and severity of the disaster and include medical and/or surgical treatment of injuries, treatment of mental health conditions, appropriate diet and logistical interventions. After a disaster, patients should be evaluated for problems that were not detected during the event, including those that may have developed as a result of the disaster. A retrospective review of the disaster response is vital to prevent future mistakes. Important ethical concerns include fair distribution of limited resources and limiting harm. Patients with kidney disease, their care-givers, health-care providers and authorities should be trained to respond to the medical and logistical problems that occur during disasters to improve outcomes.

Long-Term Radiological Pulmonary Changes in Mechanically Ventilated Patients with Respiratory Failure due to SARS-CoV-2 Infection

From the first reports of SARS-CoV-2, at the end of 2019 to the present, the global mortality associated with COVID-19 has reached 6,952,522 deaths as reported by the World Health Organization (WHO). Early intubation and mechanical ventilation can increase the survival rate of critically ill patients. This prospective study was carried out on 885 patients in the ICU of Mureș County Clinical Hospital, Romania. After applying inclusion and exclusion criteria, a total of 54 patients were included. Patients were monitored during hospitalization and at 6-month follow-up. We analyzed the relationship between invasive mechanical ventilation (IMV) and non-invasive mechanical ventilation (NIMV) and radiological changes on thoracic CT scans performed at 6-month follow-up and found no significant association. Regarding paraclinical analysis, there was a statistically significant association between patients grouped by IMV and ferritin level on day 1 of admission (p = 0.034), and between patients grouped by PaO2/FiO2 ratio with metabolic syndrome (p = 0.03) and the level of procalcitonin (p = 0.01). A significant proportion of patients with COVID-19 admitted to the ICU developed pulmonary fibrosis as observed at a 6-month evaluation. Patients with oxygen supplementation or mechanical ventilation require dynamic monitoring and radiological investigations, as there is a possibility of long-term pulmonary fibrosis that requires pharmacological interventions and finding new therapeutic alternatives.

Outcomes of COVID-19 in immunocompromised patients: a single center experience

Malignancy, bone marrow and organ transplantation are associated with deficient and defective immune systems. Immunocompromised patients are at risk for severe and chronic complication of COVID-19 infection. However, the pathogenesis, diagnosis and management of this comorbidity remain to be elucidated. The purpose of the present study was to describe key aspects of COVID-19 infection in immunocompromised patients. In this retrospective, cross-sectional study, lab findings and outcomes of 418 COVID-19 patients with secondary immunodeficiency disorders admitted to Taleghani Hospital in Tehran, from March 2020 to September 2022 were investigated. Of the 418 immunocompromised patients with COVID-19, 236 (56.5%) ‌ were male and the median age of all studied patients was 56.6 ± 16.4 with range of 14 to 92 years. Totally, 198 (47.4%) of the patients died during hospitalization. Remdesivir was used for treatment of all patients. Mortality rate among patients admitted to ICU ward (86.8%) was significantly higher than non ICU admission (p < 0.001). The death rate in patients with CKD was substantially higher than other underlying disease (p < 0.001). In terms of laboratory finding, there was a significant relationship between ICU admission and worse outcome with WBC count (HR = 1.94, 95% CI = 1. 46-2.59, p < 0.001), PMN count (HR = 1.93, 95% CI = 1.452.56, p < 0.001), Hb (HR = 1.49, 95% CI = 1.042.13, p = 0.028), AST (HR = 2.55, 95% CI = 1.913.41, p < 0.001), BUN (HR = 2.56, 95% CI = 2.063.69, p < 0.001), Cr (HR = 2.63, 95% CI = 1.89-3.64, p < 0.001), Comorbidities index (HR = 1.71, 95% CI = 1.29-2.27, p < 0.001) and aging (HR = 1.91, 95% CI = 1.4-2.54, p < 0.001). Immunocompromised status increased the risk of mortality or worse outcome in patients diagnosed with COVID-19. Our finding showed outcome predicting markers in whom the waned immune system encounter new emerging disease and improved our understanding of COVID-19 virus behavior in immunocompromised individuals.

Predictors of negative outcomes in hospitalized patients with SARS‑CoV‑2 pneumonia: A retrospective study

The coronavirus disease 2019 (COVID-19) pandemic posed a serious threat to human health worldwide after the first case was identified in December 2019. Specific therapeutic options for COVID-19 are lacking; thus, the treatment of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is complex in clinical practice. Despite the development of treatment options and methods to limit the spread of SARS-CoV-2, certain patients experience critical illness and numerous deaths have occurred. Notably, treatment of this disease is complex due to the evolution of viral mutations and variants with different rates of infection. Moreover, specific patient characteristics may be associated with rapid disease progression and poor outcomes. Thus, the present study aimed to identify the specific characteristics of patients who developed poor outcomes, including clinical manifestations, blood samples (blood cell count and coagulation tests) at hospital admission and comorbidities. The present study included a total of 1,813 patients hospitalized with pneumonia and SARS-CoV-2 infection, and mortality rates associated with each patient characteristic were calculated. The characteristics associated with the highest risk of mortality were as follows: Age >90 years (OR, 105; 95% CI, 17.70-2,023.00); oxygen saturation at the time of hospital admission <89% in room air (OR, 14.3; 95% CI, 7.54-30.7), admission to the Intensive Care Unit (OR, 39.4; 95% CI, 27.7-57.0); and a neutrophil/lymphocyte ratio of 8.76-54.2 (OR, 14; 95% CI, 7.62-29.0). Treatment of patients with SARS-CoV-2 pneumonia represents a challenge for the healthcare system, but there are a number of predictors for poor patient outcomes that could be identified at the time of hospital admission.

Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups: a tree-based model analysis

AIMS OF THE STUDY

Remdesivir has shown benefits against COVID-19. However, it remains unclear whether, to what extent, and among whom remdesivir can reduce COVID-19-related mortality. We explored whether the treatment response to remdesivir differed by patient characteristics.

METHODS

We analysed data collected from a hospital surveillance study conducted in 21 referral hospitals in Switzerland between 2020 and 2022. We applied model-based recursive partitioning to group patients by the association between treatment levels and mortality. We included either treatment (levels: none, remdesivir within 7 days of symptom onset, remdesivir after 7 days, or another treatment), age and sex, or treatment only as regression variables. Candidate partitioning variables included a range of risk factors and comorbidities (and age and sex unless included in regression). We repeated the analyses using local centring to correct the results for the propensity to receive treatment.

RESULTS

Overall (n = 21,790 patients), remdesivir within 7 days was associated with increased mortality (adjusted hazard ratios 1.28-1.54 versus no treatment). The CURB-65 score caused the most instability in the regression parameters of the model. When adjusted for age and sex, patients receiving remdesivir within 7 days of onset had higher mortality than those not treated in all identified eight patient groups. When age and sex were included as partitioning variables instead, the number of groups increased to 19-20; in five to six of those branches, mortality was lower among patients who received early remdesivir. Factors determining the groups where remdesivir was potentially beneficial included the presence of oncological comorbidities, male sex, and high age.

CONCLUSIONS

Some subgroups of patients, such as individuals with oncological comorbidities or elderly males, may benefit from remdesivir.

Comorbidities associated with the severity of COVID-19, and differences across ethnic groups: a UK Biobank cohort study

BACKGROUND

Disparities in COVID-19 outcomes exist on the basis of ethnicity and comorbidities. Minority ethnic groups in the UK are known to have poorer COVID-19 outcomes, but also an increased prevelance of certain comorbidities associated with severe outcomes. Additionally, despite the prevalence of certain psychiatric disorders there is a lack of research establishing their relationship with COVID-19 outcomes.

METHODS

We used UK Biobank data, involving 472,182 participants, to test for an association between comorbidities and COVID-19 diagnosis (n = 30,901); and to test for an association between comorbidities and severe COVID-19 (n = 3182). This was done by performing univariable and multivariable logistic regression analysis, estimating odds ratios (ORs) and their 95% confidence intervals (95% CIs). The comorbidities studied were coronary heart disease (CHD), hypertension, type II diabetes mellitus (T2DM), obesity, chronic kidney disease (CKD), depression and anxiety. Multivariable models were adjusted for various socioeconomic, demographic and health-related confounders. We then performed sub-group analysis by common UK ethnic groups (White, South Asian, and Black).

RESULTS

Increased prevalence of all studied comorbidities was seen in both outcomes, compared to the rest of the cohort. All studied comorbidities were associated with an increased risk of COVID-19 infection and severity across all models. For example, the adjusted ORs (95% CI) for depression were 1.112 (1.083 - 1.161) for COVID-19 diagnosis and 2.398 (2.163 - 2.658) for severe COVID-19. Sub-group analysis revealed stronger associations of COVID-19 diagnosis and severe COVID-19 for South-Asian participants for CHD (OR 1.585 [95% CI 1.194-2.105] for COVID-19 diagnosis and 3.021 [1.683-5.390] for severe COVID-19), hypertension (1.488 [1.231-1.799]; 3.399 [1.862-6.206]) and T2DM (1.671 [1.346-2.076]; 5.412 [3.130-9.357]) compared to White participants (1.264 [1.195-1.336] and 1.627 [1.441-1.837] for CHD; 1.131 [1.097-1.116] and 2.075 [1.885-2.284] for hypertension; 1.402 [1.331-1.476] and 2.890 [2.596-3.216] for T2DM). Similar results were seen for Black participants with CKD and hypertension.

CONCLUSION

Specific comorbidities are risk factors for poorer COVID-19 outcomes, supporting targeted interventions and policy aimed at individuals with these comorbidities. Although further research is required, there's also a need for targeted policies for ethnic minorities assessing the unique reasons they are at greater risk of poor COVID-19 outcomes.

Body temperature as a predictor of mortality in COVID-19

It remains uncertain if body temperature (BT) is a useful prognostic indicator in coronavirus disease 2019 (COVID-19). We investigated the relationship between BT and mortality in COVID-19 patients. We used a de-identified database that prospectively collected information from patients screened for COVID-19 at the Mount Sinai facilities from February 28, 2020 to July 28, 2021. All patients diagnosed with COVID-19 that had BT data were included. BT at initial presentation, maximum BT during hospitalization, comorbidity, and vaccination status data were extracted. Mortality rate was assessed as a primary outcome. Among 24,293 cases, patients with initial BT below 36 °C had higher mortality than those with BT of 36-37 °C (p < 0.001, odds ratio 2.82). Initial BT > 38 °C was associated with high mortality with an incremental trend at higher BT. In 10,503 in-patient cases, a positive association was observed between mortality and maximum BT except in patients with BT < 36 °C. Multiple logistic regression analyses including the comorbidities revealed that maximum BT was an independent predictor of mortality. While vaccination did not change the distribution of maximum BT, mortality was decreased in vaccinated patients. Our retrospective cohort study suggests that high maximum BT is an independent predictor of higher mortality in COVID-19 patients.