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Luyckx VA. Health inequality and inequity during the COVID-19 pandemic. Nephrol Dial Transplant 2023; 38:2417-2419. [PMID: 37309023 DOI: 10.1093/ndt/gfad119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Indexed: 06/14/2023] Open
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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2
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Koraishy FM, Mallipattu SK. Dialysis resource allocation in critical care: the impact of the COVID-19 pandemic and the promise of big data analytics. FRONTIERS IN NEPHROLOGY 2023; 3:1266967. [PMID: 37965069 PMCID: PMC10641281 DOI: 10.3389/fneph.2023.1266967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023]
Abstract
The COVID-19 pandemic resulted in an unprecedented burden on intensive care units (ICUs). With increased demands and limited supply, critical care resources, including dialysis machines, became scarce, leading to the undertaking of value-based cost-effectiveness analyses and the rationing of resources to deliver patient care of the highest quality. A high proportion of COVID-19 patients admitted to the ICU required dialysis, resulting in a major burden on resources such as dialysis machines, nursing staff, technicians, and consumables such as dialysis filters and solutions and anticoagulation medications. Artificial intelligence (AI)-based big data analytics are now being utilized in multiple data-driven healthcare services, including the optimization of healthcare system utilization. Numerous factors can impact dialysis resource allocation to critically ill patients, especially during public health emergencies, but currently, resource allocation is determined using a small number of traditional factors. Smart analytics that take into account all the relevant healthcare information in the hospital system and patient outcomes can lead to improved resource allocation, cost-effectiveness, and quality of care. In this review, we discuss dialysis resource utilization in critical care, the impact of the COVID-19 pandemic, and how AI can improve resource utilization in future public health emergencies. Research in this area should be an important priority.
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Affiliation(s)
- Farrukh M. Koraishy
- Division of Nephrology, Department of Medicine, Stony Brook University Hospital, , Stony Brook, NY, United States
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3
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Lin Y, Shao Y, Liu Y, Yang R, Liao S, Yang S, Xu M, He J. Efficacy and safety of nafamostat mesilate anticoagulation in blood purification treatment of critically ill patients: a systematic review and meta-analysis. Ren Fail 2022; 44:1263-1279. [PMID: 35930302 PMCID: PMC9359194 DOI: 10.1080/0886022x.2022.2105233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Nafamostat mesilate (NM), a broad-spectrum and potent serine protease inhibitor, can be used as an anticoagulant during extracorporeal circulation, as well as a promising drug effective against coronavirus disease 2019 (COVID-19). We conducted a systematic meta-analysis to evaluate the safety and efficacy of NM administration in critically ill patients who underwent blood purification therapy (BPT). Methods The Cochrane Library, Web of Science and PubMed were comprehensively searched from inception to August 20, 2021, for potential studies. Results Four randomized controlled trials (RCTs) and seven observational studies with 2723 patients met the inclusion criteria. The meta-analysis demonstrated that conventional therapy (CT) significantly increased hospital mortality compared with NM administration (RR = 1.25, p = 0.0007). In subgroup analyses, the in-hospital mortality of the NM group was significantly lower than that of the anticoagulant-free (NA) group (RR = 1.31, p = 0.002). The CT interventions markedly elevated the risk ratio of bleeding complications by 45% (RR = 1.45, p = 0.010) compared with NM interventions. In another subgroup analysis, NM used exhibited a significantly lower risk of bleeding complications than those of the low-molecular-weight heparin (LMWH) used (RR = 4.58, p = 0.020). The filter lifespan was decreased significantly (MD = −10.59, p < 0.0001) in the NA groups compared with the NM groups. Due to the poor quality of the included RCTs, these results should be interpreted with caution. Conclusion Given the better survival outcomes, lower risk of bleeding, NM anticoagulation seems to be a safe and efficient approach for BPT patients and could yield a favorable filter lifespan. More multi-center RCTs with large samples are required for further validation of this study.
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Affiliation(s)
- Yao Lin
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Yiming Shao
- The Intensive Care Unit, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuchun Liu
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Ruoxuan Yang
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Shuanglin Liao
- The Intensive Care Unit, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Shuai Yang
- The Intensive Care Unit, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Mingwei Xu
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Junbing He
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
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4
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Arnold F, Wobser R, Kalbhenn J, Westermann L. Integration of sustained low-efficiency dialysis into extracorporeal membrane oxygenation circuit in critically ill COVID-19 patients - a feasibility study. Artif Organs 2022; 46:1847-1855. [PMID: 35490349 PMCID: PMC9347788 DOI: 10.1111/aor.14277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
Background Severe COVID‐19 can necessitate multiple organ support including veno‐venous extracorporeal membrane oxygenation (vvECMO) and renal replacement therapy. The therapy can be complicated by venous thromboembolism due to COVID‐19‐related hypercoagulability, thus restricting vascular access beyond the vvECMO cannula. Although continuous renal replacement therapy can be performed via a vvECMO circuit, studies addressing sustained low‐efficiency dialysis (SLED) integration into vvECMO circuits are scarce. Here we address the lack of evidence by evaluating feasibility of SLED integration into vvECMO circuits. Methods Retrospective cohort study on nine critically ill COVID‐19 patients, treated with integrated ECMO‐SLED on a single intensive care unit at a tertiary healthcare facility between December 2020 and November 2021. The SLED circuits were established between the accessory arterial oxygenator outlets of a double‐oxygenator vvECMO setup. Data on filter survival, quality of dialysis, and volume management were collected and compared with an internal control group receiving single SLED. Results This study demonstrates general feasibility of SLED integration into existing vvECMO circuits. Filter lifespans of ECMO‐SLED compared with single SLED are significantly prolonged (median 18.3 h vs. 10.3 h, p < 0.01). ECMO‐SLED treatment is furthermore able to sufficiently normalize creatinine, blood urea nitrogen, and serum sodium, and allows for adequate ultrafiltration rates. Conclusions We can show that ECMO‐SLED is practical, safe, results in adequate dialysis quality and enables sufficient electrolyte and volume management. Our data indicate that SLED devices can serve as potential alternative to continuous‐veno‐venous‐hemodialysis for integration in vvECMO circuits.
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Affiliation(s)
- Frederic Arnold
- Department of Medicine IV, Medical Center, Faculty of Medicine University of Freiburg, Freiburg, Germany.,Institute for Microbiology and Hygiene, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Germany
| | - Rika Wobser
- Department of Medicine IV, Medical Center, Faculty of Medicine University of Freiburg, Freiburg, Germany
| | - Johannes Kalbhenn
- Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Westermann
- Department of Medicine IV, Medical Center, Faculty of Medicine University of Freiburg, Freiburg, Germany
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5
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Efficacy and complications of regional citrate anticoagulation during continuous renal replacement therapy in critically ill patients with COVID-19. J Crit Care 2021; 67:126-131. [PMID: 34768173 PMCID: PMC8576341 DOI: 10.1016/j.jcrc.2021.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/23/2021] [Accepted: 10/16/2021] [Indexed: 12/23/2022]
Abstract
Background We compared filter survival and citrate-induced complications during continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA) in COVID-19 and Non-COVID-19 patients. Methods In this retrospective study we included all consecutive adult patients (n = 97) treated with RCA-CRRT. Efficacy and complications of RCA-CRRT were compared between COVID-19 and Non-COVID-19 patients. Results Mean filter run-time was significantly higher in COVID-19 patients compared to Non-COVID-19 patients (68.4 (95%CI 67.0–69.9) vs. 65.2 (95%CI 63.2–67.2) hours, respectively; log-rank 0.014). COVID-19 patients showed significantly higher activated partial thromboplastin time (aPTT) throughout the CRRT due to intensified systemic anticoagulation compared to Non-COVID-19 patients (54 (IQR 45–61) vs. 47 (IQR 41–58) seconds, respectively; p < 0.001). A significantly higher incidence of metabolic alkalosis, hypercalcemia and hypernatremia, consistent with reduced filter patency and citrate overload, was observed in COVID-19 patients compared to Non-COVID-19 patients (19.1% vs. 12.7%, respectively; p = 0.04). These metabolic disarrangements were resistant to per-protocol adjustments and disappeared after replacement of the CRRT-filter. Conclusions RCA-CRRT in COVID-19 patients with intensified systemic anticoagulation provides an adequate filter lifespan. However, close monitoring of the acid-base balance appears warranted, as these patients tend to develop reduced filter patency leading to a higher incidence of citrate overload and metabolic disturbances. Trial registration (local authority) EA1/285/20 (Ethikkommission der Charité - Universitätsmedizin Berlin); date of registration 08.10.2020.
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6
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Garg S, Patel K, Pham H, Whitaker M, O'Halloran A, Milucky J, Anglin O, Kirley PD, Reingold A, Kawasaki B, Herlihy R, Yousey-Hindes K, Maslar A, Anderson EJ, Openo KP, Weigel A, Teno K, Ryan PA, Monroe ML, Reeg L, Kim S, Como-Sabetti K, Bye E, Shrum Davis S, Eisenberg N, Muse A, Barney G, Bennett NM, Felsen CB, Billing L, Shiltz J, Sutton M, Abdullah N, Talbot HK, Schaffner W, Hill M, Chatelain R, Wortham J, Taylor C, Hall A, Fry AM, Kim L, Havers FP. Clinical Trends Among U.S. Adults Hospitalized With COVID-19, March to December 2020 : A Cross-Sectional Study. Ann Intern Med 2021; 174:1409-1419. [PMID: 34370517 PMCID: PMC8381761 DOI: 10.7326/m21-1991] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused substantial morbidity and mortality. OBJECTIVE To describe monthly clinical trends among adults hospitalized with COVID-19. DESIGN Pooled cross-sectional study. SETTING 99 counties in 14 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET). PATIENTS U.S. adults (aged ≥18 years) hospitalized with laboratory-confirmed COVID-19 during 1 March to 31 December 2020. MEASUREMENTS Monthly hospitalizations, intensive care unit (ICU) admissions, and in-hospital death rates per 100 000 persons in the population; monthly trends in weighted percentages of interventions, including ICU admission, mechanical ventilation, and vasopressor use, among an age- and site-stratified random sample of hospitalized case patients. RESULTS Among 116 743 hospitalized adults with COVID-19, the median age was 62 years, 50.7% were male, and 40.8% were non-Hispanic White. Monthly rates of hospitalization (105.3 per 100 000 persons), ICU admission (20.2 per 100 000 persons), and death (11.7 per 100 000 persons) peaked during December 2020. Rates of all 3 outcomes were highest among adults aged 65 years or older, males, and Hispanic or non-Hispanic Black persons. Among 18 508 sampled hospitalized adults, use of remdesivir and systemic corticosteroids increased from 1.7% and 18.9%, respectively, in March to 53.8% and 74.2%, respectively, in December. Frequency of ICU admission, mechanical ventilation, and vasopressor use decreased from March (37.8%, 27.8%, and 22.7%, respectively) to December (20.5%, 12.3%, and 12.8%, respectively); use of noninvasive respiratory support increased from March to December. LIMITATION COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country. CONCLUSION Rates of COVID-19-associated hospitalization, ICU admission, and death were highest in December 2020, corresponding with the third peak of the U.S. pandemic. The frequency of intensive interventions for management of hospitalized patients decreased over time. These data provide a longitudinal assessment of clinical trends among adults hospitalized with COVID-19 before widespread implementation of COVID-19 vaccines. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Shikha Garg
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Kadam Patel
- Centers for Disease Control and Prevention and General Dynamics Information Technology, Atlanta, Georgia (K.P., O.A.)
| | - Huong Pham
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Michael Whitaker
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Alissa O'Halloran
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Jennifer Milucky
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Onika Anglin
- Centers for Disease Control and Prevention and General Dynamics Information Technology, Atlanta, Georgia (K.P., O.A.)
| | - Pam D Kirley
- California Emerging Infections Program, Oakland, California (P.D.K., A.R.)
| | - Arthur Reingold
- California Emerging Infections Program, Oakland, California (P.D.K., A.R.)
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, Colorado (B.K., R.H.)
| | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver, Colorado (B.K., R.H.)
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y., A.M.)
| | - Amber Maslar
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y., A.M.)
| | - Evan J Anderson
- Emory University School of Medicine and Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia (E.J.A.)
| | - Kyle P Openo
- Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia (K.P.O.)
| | - Andrew Weigel
- Iowa Department of Public Health, Des Moines, Iowa (A.W., K.T.)
| | - Kenzie Teno
- Iowa Department of Public Health, Des Moines, Iowa (A.W., K.T.)
| | - Patricia A Ryan
- Maryland Department of Health, Baltimore, Maryland (P.A.R., M.L.M.)
| | - Maya L Monroe
- Maryland Department of Health, Baltimore, Maryland (P.A.R., M.L.M.)
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, Michigan (L.R., S.K.)
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan (L.R., S.K.)
| | | | - Erica Bye
- Minnesota Department of Health, St. Paul, Minnesota (K.C., E.B.)
| | - Sarah Shrum Davis
- New Mexico Department of Health, Santa Fe, New Mexico (S.S.D., N.E.)
| | - Nancy Eisenberg
- New Mexico Department of Health, Santa Fe, New Mexico (S.S.D., N.E.)
| | - Alison Muse
- New York State Department of Health, Albany, New York (A.M., G.B.)
| | - Grant Barney
- New York State Department of Health, Albany, New York (A.M., G.B.)
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B., C.B.F.)
| | - Christina B Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B., C.B.F.)
| | | | - Jess Shiltz
- Ohio Department of Health, Columbus, Ohio (L.B., J.S.)
| | | | | | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - Mary Hill
- Salt Lake County Health Department, Salt Lake City, Utah (M.H., R.C.)
| | - Ryan Chatelain
- Salt Lake County Health Department, Salt Lake City, Utah (M.H., R.C.)
| | - Jonathan Wortham
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Christopher Taylor
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Aron Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Lindsay Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Fiona P Havers
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
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7
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Vaid A, Chan L, Chaudhary K, Jaladanki SK, Paranjpe I, Russak A, Kia A, Timsina P, Levin MA, He JC, Böttinger EP, Charney AW, Fayad ZA, Coca SG, Glicksberg BS, Nadkarni GN. Predictive Approaches for Acute Dialysis Requirement and Death in COVID-19. Clin J Am Soc Nephrol 2021; 16:1158-1168. [PMID: 34031183 PMCID: PMC8455052 DOI: 10.2215/cjn.17311120] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/28/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES AKI treated with dialysis initiation is a common complication of coronavirus disease 2019 (COVID-19) among hospitalized patients. However, dialysis supplies and personnel are often limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using data from adult patients hospitalized with COVID-19 from five hospitals from the Mount Sinai Health System who were admitted between March 10 and December 26, 2020, we developed and validated several models (logistic regression, Least Absolute Shrinkage and Selection Operator (LASSO), random forest, and eXtreme GradientBoosting [XGBoost; with and without imputation]) for predicting treatment with dialysis or death at various time horizons (1, 3, 5, and 7 days) after hospital admission. Patients admitted to the Mount Sinai Hospital were used for internal validation, whereas the other hospitals formed part of the external validation cohort. Features included demographics, comorbidities, and laboratory and vital signs within 12 hours of hospital admission. RESULTS A total of 6093 patients (2442 in training and 3651 in external validation) were included in the final cohort. Of the different modeling approaches used, XGBoost without imputation had the highest area under the receiver operating characteristic (AUROC) curve on internal validation (range of 0.93-0.98) and area under the precision-recall curve (AUPRC; range of 0.78-0.82) for all time points. XGBoost without imputation also had the highest test parameters on external validation (AUROC range of 0.85-0.87, and AUPRC range of 0.27-0.54) across all time windows. XGBoost without imputation outperformed all models with higher precision and recall (mean difference in AUROC of 0.04; mean difference in AUPRC of 0.15). Features of creatinine, BUN, and red cell distribution width were major drivers of the model's prediction. CONCLUSIONS An XGBoost model without imputation for prediction of a composite outcome of either death or dialysis in patients positive for COVID-19 had the best performance, as compared with standard and other machine learning models. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_07_09_CJN17311120.mp3.
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Affiliation(s)
- Akhil Vaid
- The Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York,The Hasso Plattner Institute of Digital Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lili Chan
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York,The Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kumardeep Chaudhary
- The Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York,The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Suraj K. Jaladanki
- The Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ishan Paranjpe
- The Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adam Russak
- The Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arash Kia
- The Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Prem Timsina
- The Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthew A. Levin
- The Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Cijiang He
- The Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erwin P. Böttinger
- The Hasso Plattner Institute of Digital Health, Icahn School of Medicine at Mount Sinai, New York, New York,Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Alexander W. Charney
- The Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York,The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York,The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zahi A. Fayad
- The Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York,BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, BioMedical Engineering and Imaging Institute, Icahn School
| | - Steven G. Coca
- The Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin S. Glicksberg
- The Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York,The Hasso Plattner Institute of Digital Health, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Girish N. Nadkarni
- The Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York,The Hasso Plattner Institute of Digital Health, Icahn School of Medicine at Mount Sinai, New York, New York,The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York,The Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Smarz-Widelska I, Grywalska E, Morawska I, Forma A, Michalski A, Mertowski S, Hrynkiewicz R, Niedźwiedzka-Rystwej P, Korona-Glowniak I, Parczewski M, Załuska W. Pathophysiology and Clinical Manifestations of COVID-19-Related Acute Kidney Injury-The Current State of Knowledge and Future Perspectives. Int J Mol Sci 2021; 22:7082. [PMID: 34209289 PMCID: PMC8268979 DOI: 10.3390/ijms22137082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023] Open
Abstract
The continually evolving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in a vast number of either acute or chronic medical impairments of a pathophysiology that is not yet fully understood. SARS-CoV-2 tropism for the organs is associated with bilateral organ cross-talks as well as targeted dysfunctions, among which acute kidney injury (AKI) seems to be highly prevalent in infected patients. The need for efficient management of COVID-related AKI patients is an aspect that is still being investigated by nephrologists; however, another reason for concern is a disturbingly high proportion of various types of kidney dysfunctions in patients who have recovered from COVID-19. Even though the clinical picture of AKI and COVID-related AKI seems to be quite similar, it must be considered that regarding the latter, little is known about both the optimal management and long-term consequences. These discrepancies raise an urgent need for further research aimed at evaluating the molecular mechanisms associated with SARS-CoV-2-induced kidney damage as well as standardized management of COVID-related AKI patients. The following review presents a comprehensive and most-recent insight into the pathophysiology, clinical manifestations, recommended patient management, treatment strategies, and post-mortem findings in patients with COVID-related AKI.
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Affiliation(s)
- Iwona Smarz-Widelska
- Department of Nephrology, Cardinal Stefan Wyszynski Provincial Hospital in Lublin, 20-718 Lublin, Poland;
| | - Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (A.M.); (S.M.)
| | - Izabela Morawska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (A.M.); (S.M.)
| | - Alicja Forma
- Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Adam Michalski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (A.M.); (S.M.)
| | - Sebastian Mertowski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (A.M.); (S.M.)
| | - Rafał Hrynkiewicz
- Institute of Biology, University of Szczecin, 71-412 Szczecin, Poland;
| | | | - Izabela Korona-Glowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, Chodźki 1, 20-093 Lublin, Poland;
| | - Miłosz Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, 71-455 Szczecin, Poland;
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 20-954 Lublin, Poland;
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9
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Raina R, Mahajan ZA, Vasistha P, Chakraborty R, Mukunda K, Tibrewal A, Neyra JA. Incidence and Outcomes of Acute Kidney Injury in COVID-19: A Systematic Review. Blood Purif 2021; 51:199-212. [PMID: 34130296 PMCID: PMC8339045 DOI: 10.1159/000514940] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/03/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES The recent worldwide pandemic of COVID-19 has been a serious, multidimensional problem that has left a detrimental worldwide impact on individuals of all ages and several organ systems. The typical manifestation of kidney involvement is acute kidney injury (AKI); however, there is a lack of consensus data regarding AKI epidemiology in COVID-19. This systematic literature review aims to bridge this knowledge gap. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS MEDLINE and Cochrane library were systematically searched for the literature related to AKI in COVID-19 patients of all ages. MedRxIV was searched for relevant unpublished manuscripts. Two reviewers independently assessed the literature on the incidence of AKI and mortality, extracting the need for kidney replacement therapy (KRT). RESULTS Sixty studies (n = 43,871 patients) were included in this review. The pooled incidence of AKI among COVID-19 patients was 19.45% (95% confidence intervals [95% CI]: 14.63-24.77%), while the pooled incidence of AKI COVID-19 patients requiring KRT was 39.04% (16.38-64.57%). The pooled proportion of COVID+ patients was significantly lower at 8.83% (5.64% to 12/66%). The overall mortality of COVID-19 patients was calculated to be 17.71% (95% CI: 11.49-24.93%), while the mortality among patients with AKI was higher at 54.24% (95% CI: 44.70-63.63%). CONCLUSION This comprehensive systematic review summarizes the available literature pertaining to AKI epidemiology in COVID-19 patients and highlights the incidence, associated mortality, and the need for KRT in this susceptible population.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA
- Department of Nephrology, Akron Children's Hospital, Akron, Ohio, USA
| | - Zubin A. Mahajan
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Prabhav Vasistha
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Ronith Chakraborty
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA
- Department of Nephrology, Akron Children's Hospital, Akron, Ohio, USA
| | - Krishna Mukunda
- Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Abhishek Tibrewal
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Javier A. Neyra
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, Lexington, Kentucky, USA
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10
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Moledina DG, Simonov M, Yamamoto Y, Alausa J, Arora T, Biswas A, Cantley LG, Ghazi L, Greenberg JH, Hinchcliff M, Huang C, Mansour SG, Martin M, Peixoto A, Schulz W, Subair L, Testani JM, Ugwuowo U, Young P, Wilson FP. The Association of COVID-19 With Acute Kidney Injury Independent of Severity of Illness: A Multicenter Cohort Study. Am J Kidney Dis 2021; 77:490-499.e1. [PMID: 33422598 PMCID: PMC7791318 DOI: 10.1053/j.ajkd.2020.12.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE & OBJECTIVE Although coronavirus disease 2019 (COVID-19) has been associated with acute kidney injury (AKI), it is unclear whether this association is independent of traditional risk factors such as hypotension, nephrotoxin exposure, and inflammation. We tested the independent association of COVID-19 with AKI. STUDY DESIGN Multicenter, observational, cohort study. SETTING & PARTICIPANTS Patients admitted to 1 of 6 hospitals within the Yale New Haven Health System between March 10, 2020, and August 31, 2020, with results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing via polymerase chain reaction of a nasopharyngeal sample. EXPOSURE Positive test for SARS-CoV-2. OUTCOME AKI by KDIGO (Kidney Disease: Improving Global Outcomes) criteria. ANALYTICAL APPROACH Evaluated the association of COVID-19 with AKI after controlling for time-invariant factors at admission (eg, demographic characteristics, comorbidities) and time-varying factors updated continuously during hospitalization (eg, vital signs, medications, laboratory results, respiratory failure) using time-updated Cox proportional hazard models. RESULTS Of the 22,122 patients hospitalized, 2,600 tested positive and 19,522 tested negative for SARS-CoV-2. Compared with patients who tested negative, patients with COVID-19 had more AKI (30.6% vs 18.2%; absolute risk difference, 12.5% [95% CI, 10.6%-14.3%]) and dialysis-requiring AKI (8.5% vs 3.6%) and lower rates of recovery from AKI (58% vs 69.8%). Compared with patients without COVID-19, patients with COVID-19 had higher inflammatory marker levels (C-reactive protein, ferritin) and greater use of vasopressors and diuretic agents. Compared with patients without COVID-19, patients with COVID-19 had a higher rate of AKI in univariable analysis (hazard ratio, 1.84 [95% CI, 1.73-1.95]). In a fully adjusted model controlling for demographic variables, comorbidities, vital signs, medications, and laboratory results, COVID-19 remained associated with a high rate of AKI (adjusted hazard ratio, 1.40 [95% CI, 1.29-1.53]). LIMITATIONS Possibility of residual confounding. CONCLUSIONS COVID-19 is associated with high rates of AKI not fully explained by adjustment for known risk factors. This suggests the presence of mechanisms of AKI not accounted for in this analysis, which may include a direct effect of COVID-19 on the kidney or other unmeasured mediators. Future studies should evaluate the possible unique pathways by which COVID-19 may cause AKI.
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Affiliation(s)
- Dennis G Moledina
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Michael Simonov
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Yu Yamamoto
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Jameel Alausa
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Tanima Arora
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Aditya Biswas
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Lloyd G Cantley
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Lama Ghazi
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Jason H Greenberg
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Section of Pediatric Nephrology, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Monique Hinchcliff
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Section of Rheumatology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Chenxi Huang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - Sherry G Mansour
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Melissa Martin
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Aldo Peixoto
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Wade Schulz
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - Labeebah Subair
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Jeffrey M Testani
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Ugochukwu Ugwuowo
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Patrick Young
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - F Perry Wilson
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
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11
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Stevens JS, Velez JCQ, Mohan S. Continuous renal replacement therapy and the COVID pandemic. Semin Dial 2021; 34:561-566. [PMID: 33705575 PMCID: PMC8242500 DOI: 10.1111/sdi.12962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 01/08/2023]
Abstract
Severe COVID‐19 illness and the consequent cytokine storm and vasodilatory shock commonly lead to ischemic acute kidney injury (AKI). The need for renal replacement therapies (RRTs) in those with the most severe forms of AKI is considerable and risks overwhelming health‐care systems at the peak of a surge. We detail the challenges and considerations involved in the preparation of a disaster response plan in situations such as the COVID‐19 pandemic, which dramatically increase demand for nephrology services. Taking careful inventory of all aspects of an RRT program (personnel, consumables, and machines) before a surge in RRT arises and developing disaster contingency protocol anticoagulation and for shared RRT models when absolutely necessary are paramount to a successful response to such a disaster.
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Affiliation(s)
- Jacob S Stevens
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Renal Epidemiology Group, Columbia University, New York, NY, USA
| | - Juan Carlos Q Velez
- Department of Nephrology, Ochsner Health System, New Orleans, LA, USA.,Ochsner Clinical School, The University of Queensland (Brisbane, New Orleans, LA, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Renal Epidemiology Group, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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12
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Nugent J, Aklilu A, Yamamoto Y, Simonov M, Li F, Biswas A, Ghazi L, Greenberg J, Mansour S, Moledina D, Wilson FP. Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19. JAMA Netw Open 2021; 4:e211095. [PMID: 33688965 PMCID: PMC7948062 DOI: 10.1001/jamanetworkopen.2021.1095] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Acute kidney injury (AKI) occurs in up to half of patients hospitalized with coronavirus disease 2019 (COVID-19). The longitudinal effects of COVID-19-associated AKI on kidney function remain unknown. Objective To compare the rate of change in estimated glomerular filtration rate (eGFR) after hospital discharge between patients with and without COVID-19 who experienced in-hospital AKI. Design, Setting, and Participants A retrospective cohort study was conducted at 5 hospitals in Connecticut and Rhode Island from March 10 to August 31, 2020. Patients who were tested for COVID-19 and developed AKI were screened, and those who survived past discharge, did not require dialysis within 3 days of discharge, and had at least 1 outpatient creatinine level measurement following discharge were included. Exposures Diagnosis of COVID-19. Main Outcomes and Measures Mixed-effects models were used to assess the association between COVID-19-associated AKI and eGFR slope after discharge. The secondary outcome was the time to AKI recovery for the subgroup of patients whose kidney function had not returned to the baseline level by discharge. Results A total of 182 patients with COVID-19-associated AKI and 1430 patients with AKI not associated with COVID-19 were included. The population included 813 women (50.4%); median age was 69.7 years (interquartile range, 58.9-78.9 years). Patients with COVID-19-associated AKI were more likely to be Black (73 [40.1%] vs 225 [15.7%]) or Hispanic (40 [22%] vs 126 [8.8%]) and had fewer comorbidities than those without COVID-19 but similar rates of preexisting chronic kidney disease and hypertension. Patients with COVID-19-associated AKI had a greater decrease in eGFR in the unadjusted model (-11.3; 95% CI, -22.1 to -0.4 mL/min/1.73 m2/y; P = .04) and after adjusting for baseline comorbidities (-12.4; 95% CI, -23.7 to -1.2 mL/min/1.73 m2/y; P = .03). In the fully adjusted model controlling for comorbidities, peak creatinine level, and in-hospital dialysis requirement, the eGFR slope difference persisted (-14.0; 95% CI, -25.1 to -2.9 mL/min/1.73 m2/y; P = .01). In the subgroup of patients who had not achieved AKI recovery by discharge (n = 319), COVID-19-associated AKI was associated with decreased kidney recovery during outpatient follow-up (adjusted hazard ratio, 0.57; 95% CI, 0.35-0.92). Conclusions and Relevance In this cohort study of US patients who experienced in-hospital AKI, COVID-19-associated AKI was associated with a greater rate of eGFR decrease after discharge compared with AKI in patients without COVID-19, independent of underlying comorbidities or AKI severity. This eGFR trajectory may reinforce the importance of monitoring kidney function after AKI and studying interventions to limit kidney disease after COVID-19-associated AKI.
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Affiliation(s)
- James Nugent
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Abinet Aklilu
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Yu Yamamoto
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Michael Simonov
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Fan Li
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Aditya Biswas
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lama Ghazi
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jason Greenberg
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Sherry Mansour
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Dennis Moledina
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - F. Perry Wilson
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
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13
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Anger MS, Mullon C, Ficociello LH, Thompson D, Kraus MA, Newcomb P, Kossmann RJ. Meeting the Demand for Renal Replacement Therapy during the COVID-19 Pandemic: A Manufacturer's Perspective. KIDNEY360 2021; 2:350-354. [PMID: 35373015 PMCID: PMC8740997 DOI: 10.34067/kid.0006192020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/29/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Michael S. Anger
- Renal Therapies Group, Medical Department, Fresenius Medical Care, Waltham, Massachusetts
| | - Claudy Mullon
- Renal Therapies Group, Medical Department, Fresenius Medical Care, Waltham, Massachusetts
| | - Linda H. Ficociello
- Renal Therapies Group, Medical Department, Fresenius Medical Care, Waltham, Massachusetts
| | - David Thompson
- Renal Therapies Group, Medical Department, Fresenius Medical Care, Waltham, Massachusetts
| | - Michael A. Kraus
- Fresenius Kidney Care, Medical Office, Fresenius Medical Care North America, Waltham, Massachusetts
| | - Pete Newcomb
- NxStage, Critical Care, Fresenius Medical Care, Lawrence, Massachusetts
| | - Robert J. Kossmann
- Renal Therapies Group, Medical Department, Fresenius Medical Care, Waltham, Massachusetts
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14
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Chan L, Hindi J, Nadkarni GN. COVID-19: The Kidneys Tell a Tale. Am J Kidney Dis 2021; 77:175-177. [PMID: 33342610 PMCID: PMC7834848 DOI: 10.1053/j.ajkd.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Lili Chan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Judy Hindi
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, NY; The Mount Sinai Clinical Intelligence Center, New York, NY.
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15
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Portales-Castillo I, Allegretti AS. Dialysis Filter Life in COVID-19: Early Lessons from the Pandemic. KIDNEY360 2020; 1:1334-1336. [PMID: 35372899 PMCID: PMC8815521 DOI: 10.34067/kid.0006212020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/28/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Ignacio Portales-Castillo
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew S. Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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16
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McAdams M, Ostrosky-Frid M, Rajora N, Hedayati S. Effect of COVID-19 on Kidney Disease Incidence and Management. KIDNEY360 2020; 2:141-153. [PMID: 35368812 PMCID: PMC8785734 DOI: 10.34067/kid.0006362020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/24/2020] [Indexed: 02/04/2023]
Abstract
The COVID-19 outbreak has had substantial effects on the incidence and management of kidney diseases, including AKI, ESKD, GN, and kidney transplantation. Initial reports from China suggested a lower AKI incidence in patients with COVID-19, but more recent studies from North America reveal a much higher incidence, likely due to the higher prevalence of comorbid conditions, such as hypertension, diabetes, and CKD. AKI in this setting is associated with worse outcomes, including the requirement for vasopressors or mechanical ventilation and death. Performing RRT in those with AKI poses challenges, such as limiting exposure of staff, preserving PPE, coagulopathy, and hypoxemia due to acute respiratory distress syndrome. Continuous RRT is the preferred modality, with sustained low-efficiency dialysis also an option, both managed without 1:1 hemodialysis nursing support. Regional citrate is the preferred anticoagulation, but systemic unfractionated heparin may be used in patients with coagulopathy. The ultrafiltration rate has to be set carefully, taking into consideration hypotension, hypoxemia, and responsiveness to presser and ventilatory support. The chance of transmission puts in-center chronic hemodialysis and other immunosuppressed patients at particularly increased risk. Limited data show that patients with CKD are also at increased risk for more severe disease, if infected. Little is known about the virus's effects on immunocompromised patients with glomerular diseases and kidney transplants, which introduces challenges for management of immunosuppressant regimens. Although there are no standardized guidelines regarding the management of immunosuppression, several groups recommend stopping the antimetabolite in hospitalized transplant patients and continuing a reduced dose of calcineurin inhibitors. This comprehensive review critically appraises the best available evidence regarding the effect of COVID-19 on the incidence and management of kidney diseases. Where evidence is lacking, current expert opinion and clinical guidelines are reviewed, and knowledge gaps worth investigation are identified.
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Affiliation(s)
- Meredith McAdams
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Nilum Rajora
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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17
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Kant S, Menez SP, Hanouneh M, Fine DM, Crews DC, Brennan DC, Sperati CJ, Jaar BG. The COVID-19 nephrology compendium: AKI, CKD, ESKD and transplantation. BMC Nephrol 2020; 21:449. [PMID: 33109103 PMCID: PMC7590240 DOI: 10.1186/s12882-020-02112-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023] Open
Abstract
The pandemic of coronavirus disease 2019 (CoVID-19) has been an unprecedented period. The disease afflicts multiple organ systems, with acute kidney injury (AKI) a major complication in seriously ill patients. The incidence of AKI in patients with CoVID-19 is variable across numerous international studies, but the high incidence of AKI and its associated worse outcomes in the critical care setting are a consistent finding. A multitude of patterns and mechanisms of AKI have been elucidated, and novel strategies to address shortage of renal replacement therapy equipment have been implemented. The disease also has had consequences on longitudinal management of patients with chronic kidney disease and end stage kidney disease. Kidney transplant recipients may be especially susceptible to CoVID-19 as a result of immunosuppression, with preliminary studies demonstrating high mortality rates. Increased surveillance of disease with low threshold for testing and adjustment of immunosuppression regimen during acute periods of illness have been recommended.
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Affiliation(s)
- Sam Kant
- Department of Medicine, Johns Hopkins School of Medicine, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, 21205, USA
| | - Steven P Menez
- Department of Medicine, Johns Hopkins School of Medicine, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, 21205, USA
| | - Mohamed Hanouneh
- Department of Medicine, Johns Hopkins School of Medicine, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, 21205, USA
- Nephrology Center of Maryland, Baltimore, MD, USA
| | - Derek M Fine
- Department of Medicine, Johns Hopkins School of Medicine, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, 21205, USA
| | - Deidra C Crews
- Department of Medicine, Johns Hopkins School of Medicine, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, 21205, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel C Brennan
- Department of Medicine, Johns Hopkins School of Medicine, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, 21205, USA
| | - C John Sperati
- Department of Medicine, Johns Hopkins School of Medicine, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, 21205, USA
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins School of Medicine, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, 21205, USA.
- Nephrology Center of Maryland, Baltimore, MD, USA.
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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