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Veronese-Araújo A, de Lucena DD, Aguiar-Brito I, Cristelli MP, Tedesco-Silva H, Medina-Pestana JO, Rangel ÉB. Sex Differences among Overweight/Obese Kidney Transplant Recipients Requiring Oxygen Support Amid the COVID-19 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1555. [PMID: 37763674 PMCID: PMC10535294 DOI: 10.3390/medicina59091555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/19/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Overweight/obesity puts individuals at greater risk for COVID-19 progression and mortality. We aimed to evaluate the impact of overweight/obesity on oxygen (O2) requirement outcomes of male and female kidney transplant recipients (KTRs) during the COVID-19 pandemic. Materials and Methods: We conducted a retrospective analysis of a cohort of KTRs diagnosed with COVID-19. Participants were stratified based on BMI categories, and data on the need for O2 therapy outcome were collected and analyzed separately for male and female KTRs. Results: In total, 284 KTRs (97 males and 187 females) were included in the study. Overweight/obesity was observed in 60.6% of male KTRs and 71% of female KTRs. Strikingly, overweight/obese women had a significantly higher requirement for supplemental O2 (63.3% vs. 41.7%, OR = 2.45, p = 0.03), particularly among older individuals (OR = 1.05, p = 0.04), smokers (OR = 4.55, p = 0.03), those with elevated lactate dehydrogenase (LDH) levels (OR = 1.01, p = 0.006), and those with lower admission and basal estimated glomerular filtration rate (eGFR) levels. Within this cohort, the necessity for O2 supplementation was correlated with more unfavorable outcomes. These included heightened mortality rates, transfers to the intensive care unit, employment of invasive mechanical ventilation, and the emergence of acute kidney injury requiring hemodialysis. On the other hand, although overweight/obese male KTRs had a higher prevalence of hypertension and higher fasting blood glucose levels, no significant association was found with COVID-19-related outcomes when compared to lean male KTRs. Conclusions: Overweight/obesity is highly prevalent in KTRs, and overweight/obese women demonstrated a higher need for supplemental O2. Therefore, the early identification of factors that predict a worse outcome in overweight/obese female KTRs affected by COVID-19 contributes to risk stratification and guides therapeutic decisions.
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Affiliation(s)
- Alexandre Veronese-Araújo
- Nephrology Division, Department of Medicine, Federal University of São Paulo, São Paulo 04038-031, SP, Brazil; (A.V.-A.); (D.D.d.L.); (I.A.-B.); (H.T.-S.); (J.O.M.-P.)
| | - Débora D. de Lucena
- Nephrology Division, Department of Medicine, Federal University of São Paulo, São Paulo 04038-031, SP, Brazil; (A.V.-A.); (D.D.d.L.); (I.A.-B.); (H.T.-S.); (J.O.M.-P.)
- Hospital do Rim, São Paulo 04038-002, SP, Brazil;
| | - Isabella Aguiar-Brito
- Nephrology Division, Department of Medicine, Federal University of São Paulo, São Paulo 04038-031, SP, Brazil; (A.V.-A.); (D.D.d.L.); (I.A.-B.); (H.T.-S.); (J.O.M.-P.)
| | | | - Hélio Tedesco-Silva
- Nephrology Division, Department of Medicine, Federal University of São Paulo, São Paulo 04038-031, SP, Brazil; (A.V.-A.); (D.D.d.L.); (I.A.-B.); (H.T.-S.); (J.O.M.-P.)
- Hospital do Rim, São Paulo 04038-002, SP, Brazil;
| | - José O. Medina-Pestana
- Nephrology Division, Department of Medicine, Federal University of São Paulo, São Paulo 04038-031, SP, Brazil; (A.V.-A.); (D.D.d.L.); (I.A.-B.); (H.T.-S.); (J.O.M.-P.)
- Hospital do Rim, São Paulo 04038-002, SP, Brazil;
| | - Érika B. Rangel
- Nephrology Division, Department of Medicine, Federal University of São Paulo, São Paulo 04038-031, SP, Brazil; (A.V.-A.); (D.D.d.L.); (I.A.-B.); (H.T.-S.); (J.O.M.-P.)
- Hospital do Rim, São Paulo 04038-002, SP, Brazil;
- Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil
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Farmakiotis D. COVID-19 Treatments for Nonhospitalized Patients. JAMA 2022; 327:2247. [PMID: 35699710 DOI: 10.1001/jama.2022.6167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Dimitrios Farmakiotis
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Mecadon K, Hardesty A, Vieira K, Rogers R, Merhi B, Osband AJ, Bayliss Md G, Gohh R, Morrissey P, Farmakiotis D. Elevated Tacrolimus Levels at Time of Diagnosis of COVID-19 Compared to Baseline Among Hospitalized Organ Transplant Recipients. Ann Pharmacother 2022; 56:10600280221078983. [PMID: 35179073 DOI: 10.1177/10600280221078983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The effect of COVID-19 on immunosuppressant drug levels in organ transplant recipients (OTRs) has not been adequately studied. OBJECTIVE To study the effect of COVID-19 on tacrolimus trough levels (primary outcome) in OTRs and the association of the later with acute kidney injury, bacterial infection, and oxygen requirements. METHODS We studied adult (>18-year-old) hospitalized OTRs with COVID-19, who were receiving tacrolimus between 3/1 and 12/16/2020. RESULTS Among 30 OTRs, 67% were men, 90% had a kidney transplant. Median age was 60.5 (interquartile range [IQR]: 45-68) years, median time from transplant 36 (IQR: 20-84) months. Tacrolimus troughs were higher on admission for COVID-19 than baseline (average over 6 months prior) (P = .001). Eighteen patients (60%) had admission tacrolimus trough >10, 5 (17%) >20 ng/mL. Patients with diarrhea had borderline higher tacrolimus troughs, compared to those without diarrhea (P = .09). Organ transplant recipients with a tacrolimus trough >10 ng/mL were more likely to have elevated aspartate aminotransferase on admission (P = .01) and require supplemental oxygen. (P = .026). CONCLUSION AND RELEVANCE Tacrolimus trough levels were elevated in most OTRs with COVID-19 at the time of hospital admission, compared to baseline. Potential mechanisms are diarrhea and hepatic involvement in COVID-19. In OTRs with COVID-19, including outpatients, immunosuppressant drug levels should be closely followed; management of immunosuppression should be individualized.
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Affiliation(s)
- Krista Mecadon
- Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
| | - Anna Hardesty
- Department of Internal Medicine, Residency, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kendra Vieira
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ralph Rogers
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Basma Merhi
- Division of Nephrology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Adena J Osband
- Department of Surgery (Transplantation), The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - George Bayliss Md
- Division of Nephrology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Reginald Gohh
- Division of Nephrology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Paul Morrissey
- Department of Surgery (Transplantation), The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Dimitrios Farmakiotis
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Masset C, Gautier-Vargas G, Cantarovich D, Ville S, Dantal J, Delbos F, Walencik A, Kerleau C, Hourmant M, Garandeau C, Meurette A, Giral M, Benotmane I, Caillard S, Blancho G. Occurrence of de novo Donor Specific Antibodies after Covid-19 in kidney transplant recipients is low despite immunosuppression modulation. Kidney Int Rep 2022; 7:983-992. [PMID: 35155848 PMCID: PMC8818557 DOI: 10.1016/j.ekir.2022.01.1072] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/30/2021] [Accepted: 01/31/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction Methods Results Conclusion
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Affiliation(s)
- Christophe Masset
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
- Correspondence: Christophe Masset, Service de Néphrologie et Immunologie Clinique, 30 bd Jean Monnet, 44093 Nantes Cedex 01, France.
| | - Gabriela Gautier-Vargas
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Strasbourg, France
| | - Diego Cantarovich
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Simon Ville
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| | - Jacques Dantal
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| | | | | | - Clarisse Kerleau
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Maryvonne Hourmant
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| | - Claire Garandeau
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Aurélie Meurette
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Magali Giral
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| | - Ilies Benotmane
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Strasbourg, France
| | - Sophie Caillard
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Strasbourg, France
| | - Gilles Blancho
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
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