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Chang HY, Hsu CC, Hu LF, Chou CY, Chang YL, Lu CC, Chang LJ. Safety and effectiveness of remdesivir in hospitalized patients with COVID-19 and severe renal impairment: experience at a large medical center. Ann Med 2024; 56:2361843. [PMID: 38830017 PMCID: PMC11149583 DOI: 10.1080/07853890.2024.2361843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/23/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Literature on the safety of remdesivir in hospitalized COVID-19 patients with severe renal impairment is limited. We aimed to investigate the safety and effectiveness of remdesivir in this population. METHODS We conducted a retrospective cohort study of adult hospitalized COVID-19 patients who received remdesivir between April 2022 and October 2022. Outcomes were compared between estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 and ≥30 mL/min/1.73 m2 groups. The primary safety outcomes were acute kidney injury (AKI) and bradycardia, while the primary effectiveness outcomes included mortality in COVID-19-dedicated wards and hospital mortality. Secondary outcomes included laboratory changes, disease progression, and recovery time. RESULTS A total of 1,343 patients were recruited, with 307 (22.9%) in the eGFR <30 group and 1,036 (77.1%) in the eGFR ≥30 group. Patients with an eGFR <30 had higher risks of AKI (adjusted hazard ratio [aHR] 2.92, 95% CI 1.93-4.44) and hospital mortality (aHR 1.47, 95% CI 1.06-2.05) but had comparable risks of bradycardia (aHR 1.15, 95% CI 0.85-1.56) and mortality in dedicated wards (aHR 1.43, 95% CI 0.90-2.28) than patients with an eGFR ≥30. Risk of disease progression was higher in the eGFR <30 group (adjusted odds ratio 1.62, 95% CI 1.16-2.26). No difference between the two groups in laboratory changes and recovery time. CONCLUSIONS Hospitalized COVID-19 patients receiving remdesivir with severe renal impairment had an increased risk of AKI, hospital mortality, and COVID-19 disease progression compared to patients without severe renal impairment.
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Affiliation(s)
- Hsuan-Yu Chang
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Chen Hsu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Fang Hu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chian-Ying Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuh-Lih Chang
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chia Lu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Jen Chang
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
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Yuan L, Mehmood A, Meng L. A meta-analysis of risk factors for acute kidney injury in pneumonia: Effectiveness of nursing interventions. Ther Apher Dial 2024; 28:518-533. [PMID: 38545743 DOI: 10.1111/1744-9987.14124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/10/2024] [Accepted: 03/01/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION The spread of coronavirus disease 2019 (COVID-19) worldwide since November 2019 is of interest to understand its impact on various organs. COVID-19 patients experience a higher incidence of acute kidney injury (AKI) compared with non-COVID-19 patients. METHODS A systematic literature search was conducted that covered the period from November 1, 2019 to February 28, 2021. RESULTS The analysis incorporated a comprehensive review of 19 studies of 21 362 patients. The older age (mean difference [MDs] = 5.11), cardiovascular disease (CVD) (odds ratio [OR] = 1.94), male sex (OR = 1.55), chronic kidney disease (CKD) (OR = 3.82), hypertension (OR = 2.15), diabetes (OR = 1.71), cancer (OR = 1.16), and chronic obstructive pulmonary disease (COPD) (OR = 1.40), mechanical ventilation (OR = 8.66), and vasopressor (OR = 6.30), were significantly associated with risk factor for AKI (P < 0.05). CONCLUSION The analysis revealed independent risk factors for AKI.
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Affiliation(s)
- Liangjuan Yuan
- Department of Respiratory, Shandong Provincial Third Hospital, Jinan, China
| | - Arshad Mehmood
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Meng
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
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Hu R, Yin J, He T, Zhu Y, Li Y, Gao J, Ye X, Hu L, Li Y. Impact of COVID-19 Vaccination on Mortality and Clinical Outcomes in Hemodialysis Patients. Vaccines (Basel) 2024; 12:799. [PMID: 39066437 PMCID: PMC11281375 DOI: 10.3390/vaccines12070799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/09/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
This study analyzed 550 hemodialysis patients, 469 unvaccinated and 81 vaccinated against COVID-19, to assess the impact on infection rates, mortality, and clinical/laboratory parameters. Gender distribution was similar (p = 0.209), but the vaccinated group's median age was significantly lower (p = 0.005). Hospitalization rates showed no significant difference (p = 0.987), while mortality was lower in the vaccinated group (p = 0.041). Only uric acid levels were significantly higher in the vaccinated group (p = 0.009); other parameters, including creatinine and B-type natriuretic peptide, showed no significant differences. Age was an independent predictor of mortality (HR = 1.07, p < 0.001). Peak mortality occurred in December 2022 and January 2023, predominantly among unvaccinated patients. Although vaccination lowered mortality, it did not significantly affect long-term survival rates (p = 0.308). Logistic regression identified age and dialysis duration as significant mortality factors. Monthly death counts indicated higher mortality among unvaccinated patients during peak pandemic months, suggesting that vaccination provides some protection, though no significant long-term survival benefit was found.
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Affiliation(s)
- Rihong Hu
- Key Laboratory of Kidney Disease Prevention and Control Technology, Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, 453 Tiyu Road, Xihu District, Hangzhou 310012, China; (R.H.); (X.Y.)
- Hemodialysis Unit, Hangzhou Hospital of Traditional Chinese Medicine, 453 Tiyu Road, Xihu District, Hangzhou 310012, China
| | - Jiazhen Yin
- Hangzhou Clinical College, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou 310053, China; (J.Y.); (T.H.); (Y.Z.); (Y.L.); (J.G.)
| | - Tingfei He
- Hangzhou Clinical College, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou 310053, China; (J.Y.); (T.H.); (Y.Z.); (Y.L.); (J.G.)
| | - Yuxuan Zhu
- Hangzhou Clinical College, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou 310053, China; (J.Y.); (T.H.); (Y.Z.); (Y.L.); (J.G.)
| | - Ye Li
- Hangzhou Clinical College, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou 310053, China; (J.Y.); (T.H.); (Y.Z.); (Y.L.); (J.G.)
| | - Jinchi Gao
- Hangzhou Clinical College, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou 310053, China; (J.Y.); (T.H.); (Y.Z.); (Y.L.); (J.G.)
| | - Xiaomin Ye
- Key Laboratory of Kidney Disease Prevention and Control Technology, Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, 453 Tiyu Road, Xihu District, Hangzhou 310012, China; (R.H.); (X.Y.)
- Hemodialysis Unit, Hangzhou Hospital of Traditional Chinese Medicine, 453 Tiyu Road, Xihu District, Hangzhou 310012, China
| | - Lidan Hu
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Binjiang District, Hangzhou 310003, China
| | - Yayu Li
- Key Laboratory of Kidney Disease Prevention and Control Technology, Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, 453 Tiyu Road, Xihu District, Hangzhou 310012, China; (R.H.); (X.Y.)
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Chesnaye NC, Ortiz A, Zoccali C, Stel VS, Jager KJ. The impact of population ageing on the burden of chronic kidney disease. Nat Rev Nephrol 2024:10.1038/s41581-024-00863-9. [PMID: 39025992 DOI: 10.1038/s41581-024-00863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/20/2024]
Abstract
The burden of chronic kidney disease (CKD) and its risk factors are projected to rise in parallel with the rapidly ageing global population. By 2050, the prevalence of CKD category G3-G5 may exceed 10% in some regions, resulting in substantial health and economic burdens that will disproportionately affect lower-income countries. The extent to which the CKD epidemic can be mitigated depends largely on the uptake of prevention efforts to address modifiable risk factors, the implementation of cost-effective screening programmes for early detection of CKD in high-risk individuals and widespread access and affordability of new-generation kidney-protective drugs to prevent the development and delay the progression of CKD. Older patients require a multidisciplinary integrated approach to manage their multimorbidity, polypharmacy, high rates of adverse outcomes, mental health, fatigue and other age-related symptoms. In those who progress to kidney failure, comprehensive conservative management should be offered as a viable option during the shared decision-making process to collaboratively determine a treatment approach that respects the values and wishes of the patient. Interventions that maintain or improve quality of life, including pain management and palliative care services when appropriate, should also be made available.
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Affiliation(s)
- Nicholas C Chesnaye
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
| | - Carmine Zoccali
- Associazione Ipertensione Nefrologia Trapianto Renale (IPNET), c/o Nefrologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy
- Institute of Molecular Biology and Genetics (Biogem), Ariano Irpino, Italy
- Renal Research Institute, New York, NY, USA
| | - Vianda S Stel
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
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Toapanta N, Sánchez-Gavilan E, Guirao C, Leon Román J, Ramos N, Vergara A, Azancot M, Agraz I, Bermejo S, Montiel E, Molina C, Ribó M, Soler MJ. Pilot monitoring study in patients with diabetic kidney disease using NORA application. Nefrologia 2024:S2013-2514(24)00132-9. [PMID: 39013756 DOI: 10.1016/j.nefroe.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Diabetic Kidney Disease (DKD) is the most common cause of end-stage chronic kidney disease (CKD), conditioning these patients to a worse renal prognosis and higher cardiovascular mortality and/or requirement for renal replacement therapy. The use of novel information and communication technologies (ICTs) focused on the field of health, may facilitates a better quality of life and disease control in these patients. Our objective is to evaluate the effect of monitoring DKD patients using NORA-app. MATERIAL AND METHODS Prospective feasibility/validation study of NORA-app in patients with DKD stage G3bA3 or higher, followed in outpatient clinics of a tertiary care hospital. NORA-app is an application for smartphones designed to control risk factors, share educational medical information, communicate via chat with health professionals, increase treatment compliance (Morisky-Green), and collect patient reported outcomes such as anxiety and depression using HADs scale. Clinical-laboratory variables were collected at 3 months and compared to control patients who declined using NORA-app. RESULTS From 01/01/2021 to 03/03/2022 the use of NORA-app was offered to 118 patients, 82 accepted and 36 declined (controls). After a mean follow-up period of 6,04 months and at the time of data extraction 71 (86.6%) NORA-app patients remain active users, 2 have completed the follow-up at one year and 9 are inactive (3 due to death and 6 due to non-locatable). There were no differences in baseline characteristics including Creatinine [2.1 (1.6-2.4) vs. 1.9 (1.5-2.5)] mg/dL and alb/creat [962 (475-1784) vs. 1036 (560-2183)] mg/gr between Nora and control patients respectively. The therapeutic compliance rate in the NORA-app group was 77%, improving at 90 days to 91%. Patients in the NORA-group showed significantly lower levels of alb/creat than controls (768(411-1971) mg/g Vs 2039 (974-3214) p = 0.047) at 90-day follow-up. CONCLUSIONS In patients with DKD the use of NORA-app was maintained in the long-term, leading to high levels of treatment compliance, and achieving a better disease control. Our study suggests that the generalized use of ICTs may help in the personalized monitoring of these patients to delay the progression of kidney disease.
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Affiliation(s)
- Néstor Toapanta
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | | | - Cristina Guirao
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Juan Leon Román
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Natalia Ramos
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Ander Vergara
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - María Azancot
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Irene Agraz
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Sheila Bermejo
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Estefanía Montiel
- Serivicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Carlos Molina
- Serivicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Marc Ribó
- Serivicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - María José Soler
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
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Bersano-Reyes PA, Nieto G, Cana-Poyatos A, Guerrero Sanz P, García-Maset R, García-Testal A. Nutritional status and its relationship with COVID-19 prognosis in hemodialysis patients. NUTR HOSP 2024; 41:628-635. [PMID: 38666342 DOI: 10.20960/nh.04850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Introduction Introduction: among the groups more affected by the COVID-19 pandemic were patients undergoing chronic hemodialysis (HD) treatment due to their comorbidities, advanced age, impaired innate and adaptive immune function, and increased nutritional risk due to their underlying inflammatory state. All of these factors contribute to a higher risk of severe complications and worse outcomes compared to the general population when infected with SARS-CoV-2. Objective: the objective of this study was to describe the nutritional characteristics of and their potential association with the prognosis of COVID-19 in patients undergoing chronic HD treatment. Method: a descriptive, retrospective, observational design. All cases of COVID-19 in patients undergoing chronic treatment at the Hemodialysis Unit of Hospital de Manises, Valencia, Spain, from the start of the pandemic to before vaccination were included. Results: for that, 189 patients were studied, who received chronic HD treatment in the hospital unit, 22 patients were diagnosed with COVID-19 (12 %) in that period. The mean age was 71 years, 10 were women, the Charlson index was 6.59 points, diabetes mellitus 10, vintage HD 51.6 months, 2 patients had previously received a currently non-functioning kidney transplant, 16 had arteriovenous fistula as vascular access, and 6 had central vascular access. The mean dialysis session time was 220.14 minutes and the initial value of the single dose of the Kt/V pool was 1.7. 16 patients had body composition measurement, a strong association (p < 0.05) was identified between mortality and BMI, as well as mortality and FTI. Furthermore, the differences between deceased and surviving groups in the serum levels of various variables related to nutritional status were analyzed, finding significant differences with p < 0.05 in the value of triglycerides and ferritin. Conclusions: higher body mass index and higher body fat content, along with lower baseline levels of triglycerides and ferritin, were significantly associated with higher COVID-19 mortality in patients on chronic hemodialysis. These findings suggest that the initial nutritional status of these patients can significantly influence the prognosis of SARS-CoV-2 infection.
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Affiliation(s)
| | - Gema Nieto
- Department of Food Technology, Food Science, and Nutrition. Universidad de Murcia
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Wang Y, Chen T, Li C, Qi M, Fu P, Zeng X. Research on coronavirus disease 2019 and the kidney: A bibliometric analysis. Heliyon 2024; 10:e31749. [PMID: 38845946 PMCID: PMC11154606 DOI: 10.1016/j.heliyon.2024.e31749] [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: 10/27/2023] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
Background In addition to damage to the lungs, coronavirus disease 2019 (COVID-19) can damage multiple organs, including the kidney. Our purpose was to analyze the research hotspots and trends in COVID-19 and kidney diseases using bibliometrics to help clarify the development direction of this field. Methods We selected and extracted all relevant publications related to COVID-19 and the kidney from the Web of Science from December 1, 2019, to July 24, 2022. VOSviewer, RStudio, CiteSpace, and other software were used to visualize keywords, publishing trends, authors and their countries, and institutions in this field and perform the statistical analysis. Results A total of 645 articles published in 220 journals were included in this study. The United States and China contributed the most publications and were most active in international cooperation. In addition to COVID-19 and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), acute kidney injury (AKI), kidney transplant and mortality were the three keywords with the highest frequencies. In the initial stage of the COVID-19 outbreak, research focused on the clinical symptoms of COVID-19 and other macrocharacteristics, while in a later stage, the associations between SARS-CoV-2 infection and CKD and AKI, as well as the prognosis of patients with kidney disease or those who underwent kidney transplantation, gained more attention. The immune response and vaccines were also recent research hotspots. Conclusions This bibliometric analysis provides a comprehensive overview of research on COVID-19 and kidney disease, which has received continuous, global attention. AKI, CKD, kidney transplantation, immune response and vaccines are among the hotspots in this field.
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Affiliation(s)
- Yujiao Wang
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Tingting Chen
- The Second Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Chunyang Li
- West China Biomedical Big Data Center, West China Hospital, Chengdu, China
| | - Mei Qi
- Division of Nephrology, The Second People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Ping Fu
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
- West China Biomedical Big Data Center, West China Hospital, Chengdu, China
| | - Xiaoxi Zeng
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
- West China Biomedical Big Data Center, West China Hospital, Chengdu, China
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Xue Y, Feng W, Shi L, Cui N, Zhang W, Dong J, Li C, Hu J, Wei J. Review of clinical characteristics and mortality outcomes in patients on maintenance hemodialysis during the Omicron surge: a single center experience. BMC Public Health 2024; 24:1481. [PMID: 38831260 PMCID: PMC11145803 DOI: 10.1186/s12889-024-18999-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND This hemodialysis center experienced the pandemic from December 2022 to January 2023. Therefore, we sought to describe the clinical characteristics and mortality outcomes in hemodialysis patients during this Omicron surge. METHODS According to whether they are infected, they are divided into two groups: SARS-CoV-2-positive and SARS-CoV-2-negative. The SARS-CoV-2-positive group was divided into a survival group and a non-survival group for comparison. RESULTS 366 of 457 hemodialysis patients were infected with SARS-CoV-2. The most common symptoms observed were fever (43.2%) and cough (29.8%), Followed by diarrhea (1.4%). Hemodialysis patients with hypertension were more susceptible to SARS-CoV-2 infection. The lymphocyte count, serum creatinine, serum potassium, and serum phosphorus in the SARS-CoV-2-positive group were significantly lower than those in the SARS-CoV-2-negative group. The all-cause mortality rate for infection with SARS-CoV-2 was 5.2%. Only 7 of 366 SARS-CoV-2-positive patients were admitted to the intensive care unit, but 6 of them died. Intensive care unit hospitalization rates were significantly higher in the non-survival group compared with the survival group. White blood cells count, neutrophil count, C-reactive protein, AST, and D-dimer in the non-survival group were higher than those in the survival group. The lymphocyte count, hemoglobin concentration, serum creatinine, serum albumin, serum phosphorus and parathyroid hormone in the non-survival group were lower than those in the survival group. Age > 65 years, elevated C-reactive protein and AST are independent risk factors for death. Finally, no significant difference in vaccination status was found between the SARS-CoV-2-positive group and the negative group. CONCLUSIONS Hemodialysis patients are at high risk for SARS-CoV-2 infection. Ensuring the adequacy of hemodialysis treatment and maintaining good physical condition of patients are the top priorities.
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Affiliation(s)
- Yiyang Xue
- Health Science Center, Ningbo University, 818 Fenghua Rd, 315211, Ningbo, Zhejiang, P. R. China
| | - Weiwei Feng
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Ling Shi
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Ning Cui
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Wei Zhang
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Junxiu Dong
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Chunying Li
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Jinjin Hu
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China
| | - Junjun Wei
- Blood Purification Center, Ningbo Urol & Nephrol Hospital, 998 Qianhe Rd, 315100, Ningbo, Zhejiang, P. R. China.
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Tanaka H, Chubachi S, Asakura T, Namkoong H, Azekawa S, Otake S, Nakagawara K, Fukushima T, Lee H, Watase M, Sakurai K, Kusumoto T, Masaki K, Kamata H, Ishii M, Hasegawa N, Okada Y, Koike R, Kitagawa Y, Kimura A, Imoto S, Miyano S, Ogawa S, Kanai T, Fukunaga K. Prognostic significance of chronic kidney disease and impaired renal function in Japanese patients with COVID-19. BMC Infect Dis 2024; 24:527. [PMID: 38796423 PMCID: PMC11128123 DOI: 10.1186/s12879-024-09414-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 05/17/2024] [Indexed: 05/28/2024] Open
Abstract
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.
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Affiliation(s)
- Hiromu Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
- Department of Clinical Medicine (Laboratory of Bioregulatory Medicine), Kitasato University School of Pharmacy, Tokyo, Japan.
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan.
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Shuhei Azekawa
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Shiro Otake
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Takahiro Fukushima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Ho Lee
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Mayuko Watase
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kaori Sakurai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Tatsuya Kusumoto
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Genome Informatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Ryuji Koike
- Health Science Research and Development Center (HeRD), Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akinori Kimura
- Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | - Satoru Miyano
- M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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10
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Li K, Xia Y, Ye H, Sun X, Shi B, Wu J. Effectiveness and safety of immune response to SARS‑CoV‑2 vaccine in patients with chronic kidney disease and dialysis: A systematic review and meta‑analysis. Biomed Rep 2024; 20:78. [PMID: 38590946 PMCID: PMC10999903 DOI: 10.3892/br.2024.1766] [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: 10/18/2023] [Accepted: 02/02/2024] [Indexed: 04/10/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) vaccination is the most effective way to prevent COVID-19. However, for chronic kidney disease patients on long-term dialysis, there is a lack of evidence regarding the efficacy and safety of the immune response to the vaccine. The present meta-analysis explores the efficacy and safety of COVID-19 vaccine in the immune response of patients with chronic kidney disease (CKD) undergoing dialysis. PubMed, Web of Science, Science Direct, and Cochrane Library databases were systematically searched from January 1, 2020, to December 31, 2022. Data analysis was performed using REVMAN 5.1s and Stata14 software. Baseline data and endpoint events were extracted, mainly including age, sex, dialysis vintage, body mass index (BMI), vaccine type and dose, history of COVID-19 infection, seropositivity rate, antibody titer, pain at injection site, headache and other safety events. The meta-analysis included 33 trials involving 81,348 patients. The immune efficacy of patients with CKD and dialysis was 80% (95 CI, 73-87%). The seropositivity rate of individuals without COVID-19 infection was 76.48% (3,824/5,000), while the seropositivity rate of individuals with COVID-19 infection was 80.82% (1,858/2,299). The standard mean difference of antibody titers in CKD and dialysis patients with or without COVID-19 infection was 27.73 (95% CI, -19.58-75.04). A total of nine studies reported the most common adverse events: Pain at the injection site, accounting for 18% (95 CI, 6-29%), followed by fatigue and headache, accounting for 8 (95 CI, 4-13%) and 6% (95 CI, 2-9%), respectively. COVID-19 vaccine benefitted patients with CKD undergoing dialysis with seropositivity rate ≥80%. Adverse events such as fatigue, headache, and pain at the injection site may occur after COVID-19 vaccination but the incidence is low.
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Affiliation(s)
- Kejia Li
- Department of Nephrology, The First People's Hospital of Jiashan, Jiaxing, Zhejiang 314100, P.R. China
| | - Yang Xia
- Department of Nephrology, The First People's Hospital of Jiashan, Jiaxing, Zhejiang 314100, P.R. China
| | - Hua Ye
- Department of Nephrology, The First People's Hospital of Jiashan, Jiaxing, Zhejiang 314100, P.R. China
| | - Xian Sun
- Department of Nephrology, The First People's Hospital of Jiashan, Jiaxing, Zhejiang 314100, P.R. China
| | - Bairu Shi
- Department of Nephrology, The First People's Hospital of Jiashan, Jiaxing, Zhejiang 314100, P.R. China
| | - Jiajun Wu
- Department of Nephrology, The First People's Hospital of Jiashan, Jiaxing, Zhejiang 314100, P.R. China
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11
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Benny D, Giacobini M, Costa G, Gnavi R, Ricceri F. Multimorbidity in middle-aged women and COVID-19: binary data clustering for unsupervised binning of rare multimorbidity features and predictive modeling. BMC Med Res Methodol 2024; 24:95. [PMID: 38658821 PMCID: PMC11040796 DOI: 10.1186/s12874-024-02200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Multimorbidity is typically associated with deficient health-related quality of life in mid-life, and the likelihood of developing multimorbidity in women is elevated. We address the issue of data sparsity in non-prevalent features by clustering the binary data of various rare medical conditions in a cohort of middle-aged women. This study aims to enhance understanding of how multimorbidity affects COVID-19 severity by clustering rare medical conditions and combining them with prevalent features for predictive modeling. The insights gained can guide the development of targeted interventions and improved management strategies for individuals with multiple health conditions. METHODS The study focuses on a cohort of 4477 female patients, (aged 45-60) in Piedmont, Italy, and utilizes their multimorbidity data prior to the COVID-19 pandemic from their medical history from 2015 to 2019. The COVID-19 severity is determined by the hospitalization status of the patients from February to May 2020. Each patient profile in the dataset is depicted as a binary vector, where each feature denotes the presence or absence of a specific multimorbidity condition. By clustering the sparse medical data, newly engineered features are generated as a bin of features, and they are combined with the prevalent features for COVID-19 severity predictive modeling. RESULTS From sparse data consisting of 174 input features, we have created a low-dimensional feature matrix of 17 features. Machine Learning algorithms are applied to the reduced sparsity-free data to predict the Covid-19 hospital admission outcome. The performance obtained for the corresponding models are as follows: Logistic Regression (accuracy 0.72, AUC 0.77, F1-score 0.69), Linear Discriminant Analysis (accuracy 0.7, AUC 0.77, F1-score 0.67), and Ada Boost (accuracy 0.7, AUC 0.77, F1-score 0.68). CONCLUSION Mapping higher-dimensional data to a low-dimensional space can result in information loss, but reducing sparsity can be beneficial for Machine Learning modeling due to improved predictive ability. In this study, we addressed the issue of data sparsity in electronic health records and created a model that incorporates both prevalent and rare medical conditions, leading to more accurate and effective predictive modeling. The identification of complex associations between multimorbidity and the severity of COVID-19 highlights potential areas of focus for future research, including long COVID and intervention efforts.
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Affiliation(s)
- Dayana Benny
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, 10043, Piedmont, Italy.
- Modeling and Data Science, Department of Mathematics, University of Turin, Via Carlo Alberto 10, Turin, 10123, Piedmont, Italy.
| | - Mario Giacobini
- Data Analysis and Modeling Unit, Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Giuseppe Costa
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, 10043, Piedmont, Italy
- Unit of Epidemiology, Regional Health Service, Local Health Unit Torino 3, Grugliasco, Turin, Italy
| | - Roberto Gnavi
- Unit of Epidemiology, Regional Health Service, Local Health Unit Torino 3, Grugliasco, Turin, Italy
| | - Fulvio Ricceri
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, 10043, Piedmont, Italy
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12
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Enilama O, MacDonald C, Thompson P, Khan U, Allu S, Beaucage M, Yau K, Oliver MJ, Hladunewich MA, Levin A. Perceptions and Information-Seeking Behavior Regarding COVID-19 Vaccination Among Patients With Chronic Kidney Disease in 2023: A Cross-Sectional Survey. Can J Kidney Health Dis 2024; 11:20543581241242550. [PMID: 38628809 PMCID: PMC11020724 DOI: 10.1177/20543581241242550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024] Open
Abstract
Background People living with chronic kidney disease (CKD) face an increased risk of severe outcomes such as hospitalization or death from COVID-19. COVID-19 vaccination is a vital approach to mitigate the risk and severity of infection in patients with CKD. Limited information exists regarding the factors that shape COVID-19 vaccine uptake, including health information-seeking behavior and perceptions, within the CKD population. Objective The objectives were to describe among CKD patients, (1) health information-seeking behavior on COVID-19, (2) their capacity to comprehend and trust COVID-19 information from different sources, and (3) their perceptions concerning COVID-19 infection and vaccination. Design/Setting Cross-sectional web-based survey administered in British Columbia and Ontario from February 17, 2023, to April 17, 2023. Participants Chronic kidney disease G3b-5D patients and kidney transplant recipients (CKD G1T-5T) enrolled in a longitudinal COVID-19 vaccine serology study. Methods and Measurements The survey consisted of a questionnaire that included demographic and clinical data, perceived susceptibility of contracting COVID-19, the ability to collect, understand, and trust information on COVID-19, as well as perceptions regarding COVID-19 vaccination. Descriptive statistics were used to present the data with values expressed as count (%) and chi square tests were performed with a significance level set at P ≤ .05. A content analysis was performed on one open-ended response regarding respondents' questions surrounding COVID-19 infection and vaccination. Results Among the 902 patients who received the survey via email, 201 completed the survey, resulting in a response rate of 22%. The median age was 64 years old (IQR 53-74), 48% were male, 51% were university educated, 32% were on kidney replacement therapies, and 57% had received ≥5 COVID-19 vaccine doses. 65% of respondents reported that they had sought out COVID-19-related information in the last 12 months, with 91% and 84% expressing having understood and trusted the information they received, respectively. Those with a higher number of COVID-19 vaccine doses were associated with having sought out (P =.017), comprehended (P < .001), and trusted (P =. 005) COVID-19-related information. Female sex was associated with expressing more concern about contracting COVID-19 (P = .011). Most respondents strongly agreed to statements regarding the benefits of COVID-19 vaccination. Respondents' questions about COVID-19 infection and vaccination centered on 4 major themes: COVID-19 vaccination strategy, vaccine effectiveness, vaccine safety, and the impact of COVID-19 infection and vaccination on kidney health. Limitations This survey was administered within the Canadian health care context to patients with CKD who had at least 1 COVID-19 vaccine dose. Race/ethnicity of participants was not captured. Conclusions In this survey of individuals with CKD, COVID-19 information-seeking behavior was high and almost all respondents understood and trusted the information they received. Perceptions toward the COVID-19 vaccine and booster were mostly favorable.
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Affiliation(s)
- Omosomi Enilama
- Experimental Medicine, Department of Medicine, The University of British Columbia, Vancouver, Canada
- Nephrology Research Program, Providence Research, Vancouver, BC, Canada
- Can-SOLVE CKD Network, Vancouver, BC, Canada
| | | | | | - Umair Khan
- Can-SOLVE CKD Network, Vancouver, BC, Canada
| | - Selina Allu
- Can-SOLVE CKD Network, Vancouver, BC, Canada
- Faculty of Medicine, University of Calgary, AB, Canada
| | | | - Kevin Yau
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Nephrology, Department of Medicine, Unity Health Toronto, ON, Canada
| | - Matthew J. Oliver
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Ontario Renal Network, Toronto, Canada
| | - Michelle A. Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Ontario Renal Network, Toronto, Canada
| | - Adeera Levin
- Nephrology Research Program, Providence Research, Vancouver, BC, Canada
- Can-SOLVE CKD Network, Vancouver, BC, Canada
- BC Renal, Vancouver, Canada
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
- St. Paul’s Hospital, Vancouver, BC, Canada
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13
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Sakaguchi T, Mitsuke A, Osako Y, Yamada Y, Takeyama H, Ogawa R, Takahashi K, Hirohata Y, Yamamoto S, Arima J, Fukumoto W, Sugita S, Inoguchi S, Matsushita R, Yoshino H, Tatarano S, Enokida H. Assessing antiviral treatment efficacy and risk factors for severe COVID-19 in kidney transplant recipients during the Omicron subvariant-dominant period: a retrospective study. BMC Nephrol 2024; 25:124. [PMID: 38589827 PMCID: PMC11000285 DOI: 10.1186/s12882-024-03561-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Kidney transplant recipients (KTRs) are at risk of severe coronavirus disease 2019 (COVID-19), and even now that Omicron subvariants have become dominant, cases of severe disease are certain to occur. The aims of this retrospective study were to evaluate the efficacy of antiviral treatment for COVID-19 and to identify risk factors for severe disease in KTRs during Omicron subvariant-dominant periods. METHODS A total of 65 KTRs diagnosed with COVID-19 who received antiviral treatment between July 2022 and September 2023 were analyzed. Mild cases received oral molnupiravir (MP) as outpatient therapy, while moderate or worse cases received intravenous remdesivir (RDV) as inpatient therapy. In principle, mycophenolate mofetil was withdrawn and switched to everolimus. We investigated the efficacy of antiviral treatment and compared the clinical parameters of mild/moderate and severe/critical cases to identify risk factors for severe COVID-19. RESULTS Among 65 cases, 49 were mild, 6 were moderate, 9 were severe, and 1 was of critical severity. MP was administered to 57 cases; 49 (86%) improved and 8 (14%) progressed. RDV was administered to 16 cases; 14 (87%) improved and 2 (13%) progressed. Seventeen (26%) cases required hospitalization, and none died. Comparisons of the severe/critical group (n = 10) with the mild/moderate group (n = 55) demonstrated that the severe/critical group had a significantly higher median age (64 vs. 53 years, respectively; p = 0.0252), prevalence of diabetes (70% vs. 22%, respectively; p = 0.0047) and overweight/obesity (40% vs. 11%, respectively; p = 0.0393), as well as a significantly longer median time from symptom onset to initial antiviral therapy (3 days vs. 1 day, respectively; p = 0.0026). Multivariate analysis showed that a longer time from symptom onset to initial antiviral treatment was an independent risk factor for severe COVID-19 (p = 0.0196, odds ratio 1.625, 95% confidence interval 1.081-2.441). CONCLUSION These findings suggest that a longer time from symptom onset to initial antiviral treatment is associated with a higher risk of severe COVID-19 in KTRs. Initiating antiviral treatment as early as possible is crucial for preventing severe outcomes; this represents a valuable insight into COVID-19 management in KTRs.
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Affiliation(s)
- Takashi Sakaguchi
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Akihiko Mitsuke
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Yoichi Osako
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Yasutoshi Yamada
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Himawari Takeyama
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Risako Ogawa
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Katsuya Takahashi
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Yukiko Hirohata
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Sayuri Yamamoto
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Junya Arima
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Wataru Fukumoto
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Satoshi Sugita
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Satoru Inoguchi
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Ryosuke Matsushita
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Hirofumi Yoshino
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Shuichi Tatarano
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan
| | - Hideki Enokida
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan.
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14
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Vanslambrouck JM, Neil JA, Rudraraju R, Mah S, Tan KS, Groenewegen E, Forbes TA, Karavendzas K, Elliott DA, Porrello ER, Subbarao K, Little MH. Kidney organoids reveal redundancy in viral entry pathways during ACE2-dependent SARS-CoV-2 infection. J Virol 2024; 98:e0180223. [PMID: 38334329 PMCID: PMC10949421 DOI: 10.1128/jvi.01802-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
With a high incidence of acute kidney injury among hospitalized COVID-19 patients, considerable attention has been focussed on whether SARS-CoV-2 specifically targets kidney cells to directly impact renal function, or whether renal damage is primarily an indirect outcome. To date, several studies have utilized kidney organoids to understand the pathogenesis of COVID-19, revealing the ability for SARS-CoV-2 to predominantly infect cells of the proximal tubule (PT), with reduced infectivity following administration of soluble ACE2. However, the immaturity of standard human kidney organoids represents a significant hurdle, leaving the preferred SARS-CoV-2 processing pathway, existence of alternate viral receptors, and the effect of common hypertensive medications on the expression of ACE2 in the context of SARS-CoV-2 exposure incompletely understood. Utilizing a novel kidney organoid model with enhanced PT maturity, genetic- and drug-mediated inhibition of viral entry and processing factors confirmed the requirement for ACE2 for SARS-CoV-2 entry but showed that the virus can utilize dual viral spike protein processing pathways downstream of ACE2 receptor binding. These include TMPRSS- and CTSL/CTSB-mediated non-endosomal and endocytic pathways, with TMPRSS10 likely playing a more significant role in the non-endosomal pathway in renal cells than TMPRSS2. Finally, treatment with the antihypertensive ACE inhibitor, lisinopril, showed negligible impact on receptor expression or susceptibility of renal cells to infection. This study represents the first in-depth characterization of viral entry in stem cell-derived human kidney organoids with enhanced PTs, providing deeper insight into the renal implications of the ongoing COVID-19 pandemic. IMPORTANCE Utilizing a human iPSC-derived kidney organoid model with improved proximal tubule (PT) maturity, we identified the mechanism of SARS-CoV-2 entry in renal cells, confirming ACE2 as the sole receptor and revealing redundancy in downstream cell surface TMPRSS- and endocytic Cathepsin-mediated pathways. In addition, these data address the implications of SARS-CoV-2 exposure in the setting of the commonly prescribed ACE-inhibitor, lisinopril, confirming its negligible impact on infection of kidney cells. Taken together, these results provide valuable insight into the mechanism of viral infection in the human kidney.
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Affiliation(s)
- Jessica M. Vanslambrouck
- The Novo Nordisk Foundation Centre for Stem Cell Medicine (reNEW), Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jessica A. Neil
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Rajeev Rudraraju
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Sophia Mah
- The Novo Nordisk Foundation Centre for Stem Cell Medicine (reNEW), Murdoch Children’s Research Institute, Melbourne, Australia
| | - Ker Sin Tan
- The Novo Nordisk Foundation Centre for Stem Cell Medicine (reNEW), Murdoch Children’s Research Institute, Melbourne, Australia
| | - Ella Groenewegen
- The Novo Nordisk Foundation Centre for Stem Cell Medicine (reNEW), Murdoch Children’s Research Institute, Melbourne, Australia
| | - Thomas A. Forbes
- The Novo Nordisk Foundation Centre for Stem Cell Medicine (reNEW), Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Nephrology, Royal Children’s Hospital, Melbourne, Australia
| | - Katerina Karavendzas
- The Novo Nordisk Foundation Centre for Stem Cell Medicine (reNEW), Murdoch Children’s Research Institute, Melbourne, Australia
| | - David A. Elliott
- The Novo Nordisk Foundation Centre for Stem Cell Medicine (reNEW), Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Australia Regenerative Medicine Institute, Monash University, Melbourne, Victoria, Australia
| | - Enzo R. Porrello
- The Novo Nordisk Foundation Centre for Stem Cell Medicine (reNEW), Murdoch Children’s Research Institute, Melbourne, Australia
- Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, The Royal Children’s Hospital, Melbourne, Australia
- Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Melbourne, Australia
| | - Kanta Subbarao
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
- The WHO Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Melissa H. Little
- The Novo Nordisk Foundation Centre for Stem Cell Medicine (reNEW), Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Novo Nordisk Foundation Centre for Stem Cell Medicine (reNEW), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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Fukui A, Takeshita K, Nakashima A, Maruyama Y, Tsuboi N, Hoshina T, Yokoo T. The relation between proteinuria and the severity of COVID-19. Clin Exp Nephrol 2024; 28:235-244. [PMID: 37962747 PMCID: PMC10881620 DOI: 10.1007/s10157-023-02428-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The association between proteinuria, which is also an indicator of chronic kidney disease (CKD), and coronavirus disease 2019 (COVID-19) severity is unclear. METHODS We selected 342 hospitalized patients with COVID-19 diagnosed via polymerase chain reaction testing between February 2020 and October 2022 and who had at least one urinalysis 14-365 days before admission. RESULTS Proteinuria before admission was associated neither with oxygen administration nor developing pneumonia in multivariate analysis (odds ratio [OR] 1.03; 95% confidence interval (CI) 0.44-2.40, p = 0.95 and OR 1.01; 95% CI 0.47-2.17, p = 0.98, respectively). Proteinuria on admission was associated both with oxygen administration and developing pneumonia in multivariate analysis (OR 3.29; 95% CI 1.37-7.88, p < 0.01 and OR 3.81; 95% CI 1.68-8.62, p < 0.01, respectively). The percentage of patients with proteinuria on admission was significantly higher than those before admission (37.4% vs. 17.8%; p < 0.01). In the subgroup analysis, proteinuria on admission among patients with eGFR ≥ 60 mL/min/1.73 m2 was associated with both oxygen administration and developing pneumonia (OR 4.86; 95% CI 1.22-19.38, p = 0.03, OR 3.65; 95% CI 1.06-12.58, p = 0.04, respectively). In contrast, proteinuria on admission among patients with eGFR < 60 mL/min/1.73 m2 was associated with developing pneumonia (OR 6.45; 95%CI 1.78-23.35, p = 0.01), not with oxygen administration (OR 3.28; 95% CI 0.92-11.72, p = 0.07). CONCLUSIONS Although underlying proteinuria before admission was not associated with COVID-19 severity, proteinuria on admission was associated with oxygen demand and developing pneumonia.
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Affiliation(s)
- Akira Fukui
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8471, Japan.
| | - Kohei Takeshita
- Department of Innovation for Medical Information Technology, Jikei University School of Medicine, Tokyo, Japan
| | - Akio Nakashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8471, Japan
| | - Yukio Maruyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8471, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8471, Japan
| | - Tokio Hoshina
- Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8471, Japan
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16
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Bronder S, Mihm J, Urschel R, Klemis V, Schmidt T, Marx S, Abu-Omar A, Hielscher F, Guckelmus C, Widera M, Sester U, Sester M. Potent induction of humoral and cellular immunity after bivalent BA.4/5 mRNA vaccination in dialysis patients. NPJ Vaccines 2024; 9:25. [PMID: 38326340 PMCID: PMC10850212 DOI: 10.1038/s41541-024-00816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
Knowledge on immunogenicity of the bivalent Omicron BA.4/5 vaccine in dialysis patients and the effect of a previous infection is limited. Therefore, vaccine-induced humoral and cellular immunity was analyzed in dialysis patients and immunocompetent controls with and without prior infection. In an observational study, 33 dialysis patients and 58 controls matched for age, sex and prior infection status were recruited. Specific IgG, neutralizing antibody activity and cellular immunity towards the spike-antigen from parental SARS-CoV-2 and Omicron-subvariants BA.1, BA.2 and BA.4/5 were analyzed before and 13-18 days after vaccination. The bivalent vaccine led to a significant induction of IgG, neutralizing titers, and specific CD4+ and CD8+ T-cell levels. Neutralizing activity towards the parental strain was higher than towards the Omicron-subvariants, whereas specific T-cell levels towards parental spike and Omicron-subvariants did not differ indicating substantial cross-reactivity. Dialysis patients with prior infection had significantly higher spike-specific CD4+ T-cell levels with lower CTLA-4 expression compared to infection-naive patients. When compared to controls, no differences were observed between infection-naive individuals. Among convalescent individuals, CD4+ T-cell levels were higher in patients and neutralizing antibodies were higher in controls. Vaccination was overall well tolerated in both dialysis patients and controls with significantly less adverse events among patients. In conclusion, our study did not provide any evidence for impaired immunogenicity of the bivalent Omicron BA.4/5 vaccine in dialysis patients. Unlike in controls, previous infection of patients was even associated with higher levels of spike-specific CD4+ T cells, which may reflect prolonged encounter with antigen during infection.
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Affiliation(s)
- Saskia Bronder
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | | | - Rebecca Urschel
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Verena Klemis
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Tina Schmidt
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Stefanie Marx
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Amina Abu-Omar
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Franziska Hielscher
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Candida Guckelmus
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Marek Widera
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | | | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany.
- Center for Gender-specific Biology and Medicine (CGBM), Saarland University, Homburg, Germany.
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17
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Hao X, Bao Z, Dai R, Wu X, Li X, Zhang M, Li H, Xu L, Qiao P, Liu X, Hu W, Zhang Z, Fang J, Zhou M, Wang W, Qu J. A pilot study on Paxlovid therapy for hemodialysis patients with severe acute respiratory syndrome coronavirus 2 infections. Front Med 2024; 18:169-179. [PMID: 37978164 DOI: 10.1007/s11684-023-1011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/19/2023] [Indexed: 11/19/2023]
Abstract
We aimed to investigate the safety and efficacy of nirmatrelvir/ritonavir (Paxlovid) therapy for hemodialysis-dependent patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Thirteen hemodialysis patients infected with the Omicron variant of SARS-CoV-2 from April 3 to May 30, 2022, were recruited. Laboratory parameters and chest CT (computed tomography) imaging were analyzed. The treatment group included six patients who received 150 mg/100 mg of Paxlovid orally once daily for 5 days, whereas the control group included seven patients who received basic treatment. No serious adverse reactions or safety events were recorded. Four control patients progressed to moderate disease, and none in the treatment group showed progression of chest CT findings (P < 0.05). Paxlovid therapy tended toward early viral clearance and low viral load on Day 8. Moreover, 83.3% of the patients in the treatment group and 57.1% of the patients in the control group turned negative within 22 days. In the Paxlovid treatment group, we found significantly increased levels of lymphocytes (P=0.03) and eosinophils (P=0.02) and decreased levels of D-dimer on Day 8 compared with those on Day 1. Paxlovid therapy showed a potential therapeutic effect with good tolerance in hemodialysis patients. The optimal dose and effectiveness evaluation must be further investigated in a largeer cohort.
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Affiliation(s)
- Xu Hao
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zhiyao Bao
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ranran Dai
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaojing Wu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xin Li
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Muyin Zhang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Hao Li
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Lili Xu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Panpan Qiao
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xuefei Liu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Weiting Hu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ze Zhang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jie Fang
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Min Zhou
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Weiming Wang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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18
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Wilson A, Carswell C, McKeaveney C, Atkinson K, Burton S, McVeigh C, Graham-Wisener L, Jääskeläinen E, Johnston W, O'Rourke D, Reid J, Rej S, Walsh I, Noble H. Examining the acceptability and feasibility of the Compassionate Mindful Resilience (CMR) programme in adults living with chronic kidney disease: the COSMIC study findings. BMC Nephrol 2024; 25:45. [PMID: 38297189 PMCID: PMC10832231 DOI: 10.1186/s12882-024-03473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Individuals with chronic kidney disease experience difficult physical and psychological symptoms, that impact quality of life, and are at increased risk of anxiety and depression. Access to specialist psychological support is limited. This study aimed to support a new service development project, in collaboration with Kidney Care UK, to implement the Compassionate Mindful Resilience (CMR) programme, developed by MindfulnessUK, which provides accessible mindfulness techniques and practices to enhance compassion and resilience, and explore its feasibility for people living with stage 4 or 5 kidney disease and transplant. METHODS A multi-method feasibility design was utilised. Participants over 18 years, from the UK, with stage 4 or 5 kidney disease or post-transplant, and who were not currently undergoing psychotherapy, were recruited to the four-week CMR programme. Data was collected at baseline, post-intervention and three-months post to measure anxiety, depression, self-compassion, mental wellbeing, resilience, and mindfulness. The acceptability of the intervention for a kidney disease population was explored through qualitative interviews with participants, and the Mindfulness Teacher. RESULTS In total, 75 participants were recruited to the study, with 65 completing the CMR programme. The majority were female (66.2%) and post-transplant (63.1%). Analysis of completed outcome measures at baseline and post-intervention timepoints (n = 61), and three-months post intervention (n = 45) revealed significant improvements in participant's levels of anxiety (p < .001) and depression (p < .001), self-compassion (p = .005), mental wellbeing (p < .001), resilience (p.001), and mindfulness (p < .001). Thematic analysis of interviews with participants (n = 19) and Mindfulness Teacher (n = 1) generated three themes (and nine-subthemes); experiences of the CMR programme that facilitated subjective benefit, participants lived and shared experiences, and practicalities of programme participation. All participants interviewed reported that they found programme participation to be beneficial. CONCLUSION The findings suggest that the CMR programme has the potential to improve psychological outcomes among people with chronic kidney disease. Future randomized controlled trials are required to further test its effectiveness.
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Affiliation(s)
- Anna Wilson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Claire Carswell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
- Department of Health Sciences, University of York, York, UK
| | - Clare McKeaveney
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Stephanie Burton
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Clare McVeigh
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | | | - William Johnston
- Patient and Carer Education Partnership, School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Daniel O'Rourke
- Patient and Carer Education Partnership, School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Soham Rej
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast Northern, Ireland
- Knightsbridge Healthcare Group, Belfast, UK
- Institute of Psychosexual Medicine, London, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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19
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Ortiz A. CKD as a risk factor for severe COVID-19: a critical look back and lessons for the future. Nephrol Dial Transplant 2024; 39:174-176. [PMID: 37791399 DOI: 10.1093/ndt/gfad216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
- Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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20
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Covill LE, Sendel A, Campbell TM, Piiroinen I, Enoksson SL, Borgström EW, Hansen S, Ma K, Marits P, Norlin AC, Smith CIE, Kåhlin J, Eriksson LI, Bergman P, Bryceson YT. Evaluation of Genetic or Cellular Impairments in Type I IFN Immunity in a Cohort of Young Adults with Critical COVID-19. J Clin Immunol 2024; 44:50. [PMID: 38231281 PMCID: PMC10794435 DOI: 10.1007/s10875-023-01641-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
Several genetic and immunological risk factors for severe COVID-19 have been identified, with monogenic conditions relating to 13 genes of type I interferon (IFN) immunity proposed to explain 4.8% of critical cases. However, previous cohorts have been clinically heterogeneous and were not subjected to thorough genetic and immunological analyses. We therefore aimed to systematically investigate the prevalence of rare genetic variants causing inborn errors of immunity (IEI) and functionally interrogate the type I IFN pathway in young adults that suffered from critical COVID-19 yet lacked comorbidities. We selected and clinically characterized a cohort of 38 previously healthy individuals under 50 years of age who were treated in intensive care units due to critical COVID-19. Blood samples were collected after convalescence. Two patients had IFN-α autoantibodies. Genome sequencing revealed very rare variants in the type I IFN pathway in 31.6% of the patients, which was similar to controls. Analyses of cryopreserved leukocytes did not indicate any defect in plasmacytoid dendritic cell sensing of TLR7 and TLR9 agonists in patients carrying variants in these pathways. However, lymphocyte STAT phosphorylation and protein upregulation upon IFN-α stimulation revealed three possible cases of impaired type I IFN signaling in carriers of rare variants. Together, our results suggest a strategy of functional screening followed by genome analyses and biochemical validation to uncover undiagnosed causes of critical COVID-19.
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Affiliation(s)
- L E Covill
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - A Sendel
- Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - T M Campbell
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - I Piiroinen
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - S Lind Enoksson
- Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - E Wahren Borgström
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - S Hansen
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - K Ma
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - P Marits
- Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - A C Norlin
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - C I E Smith
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Kåhlin
- Division of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - L I Eriksson
- Division of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - P Bergman
- Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Y T Bryceson
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
- Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.
- Broegelmann Laboratory, Department of Clinical Sciences, University of Bergen, Bergen, Norway.
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21
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Baltu D, Kurt-Sukur ED, Tastemel Ozturk T, Gulhan B, Ozaltin F, Duzova A, Topaloglu R. COVID-19 in Children with Chronic Kidney Disease; Does it Differ Much? KLINISCHE PADIATRIE 2024. [PMID: 38224686 DOI: 10.1055/a-2207-3153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
BACKGROUND COVID-19 is known to have a mild course in children, however more data on pediatric chronic kidney disease (CKD) is needed. We aimed to assess the incidence and severity of COVID-19 in pediatric CKD patients. METHODS A questionnaire including demographics, COVID-19 history, symptoms, and vaccination status was applied to patients with CKD. We also retrospectively reviewed the presentation and outcomes of SARS-CoV-2 infection in this patient group from March 2020 to December 2021. RESULTS 220 patients were included, 48 were found to have experienced COVID-19. There was no significant difference regarding age, gender, underlying kidney disease, CKD stage, dialysis status, type or number of immunosuppressive medications, and glomerular filtration rate between patients with and without COVID-19. Most were infected by a household member (43.8%) and during outpatient or inpatient care (18.8%). Four (8.3%) were asymptomatic, and 43 (89.6%) had mild infection. Severe COVID-19 was observed in only one patient. Eleven (22.9%) patients with COVID-19 were previously vaccinated. Acute kidney injury was detected in 4 (8.3%); as stage 1 in all. Median follow-up after COVID-19 was 4.6 months. All patients fully recovered, and no renal disease flare or death was observed. CONCLUSIONS Although the vaccination rate was low in our cohort, the majority of the children with COVID-19 showed a mild course. Along with the vaccination, general precautions seemed to be successful for this population.
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Affiliation(s)
- Demet Baltu
- Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | | | - Bora Gulhan
- Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatih Ozaltin
- Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Duzova
- Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Rezan Topaloglu
- Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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22
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Yau K, Tam P, Chan CT, Hu Q, Qi F, Abe KT, Kurtesi A, Jiang Y, Estrada-Codecido J, Brown T, Liu L, Siwakoti A, Leis JA, Levin A, Oliver MJ, Colwill K, Gingras AC, Hladunewich MA. BNT162b2 versus mRNA-1273 Third Dose COVID-19 Vaccine in Patients with CKD and Maintenance Dialysis Patients. Clin J Am Soc Nephrol 2024; 19:85-97. [PMID: 37847518 PMCID: PMC10843183 DOI: 10.2215/cjn.0000000000000328] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND There is a lack of randomized controlled trial data regarding differences in immunogenicity of varying coronavirus disease 2019 (COVID-19) mRNA vaccine regimens in CKD populations. METHODS We conducted a randomized controlled trial at three kidney centers in Toronto, Ontario, Canada, evaluating the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody response after third dose vaccination. Participants ( n =273) with CKD not on dialysis or receiving dialysis were randomized 1:1 to third dose 30- µ g BNT162b2 (Pfizer-BioNTech) or 100- µ g mRNA-1273 (Moderna). The primary outcome of this study was SARS-CoV-2 IgG-binding antibodies to the receptor-binding domain (anti-RBD). Spike protein (antispike), nucleocapsid protein, and vaccine reactogenicity were also evaluated. Serology was measured before third dose and 1, 3, and 6 months after third dose. A subset of participants ( n =100) were randomly selected to assess viral pseudovirus neutralization against wild-type D614G, B.1.617.2 (Delta), and B.1.1.529 (Omicron BA.1). RESULTS Among 273 participants randomized, 94% were receiving maintenance dialysis and 59% received BNT162b2 for initial two dose COVID-19 vaccination. Third dose of mRNA-1273 was associated with higher mean anti-RBD levels (1871 binding antibody units [BAU]/ml; 95% confidence interval [CI], 829 to 2988) over a 6-month period in comparison with third dose BNT162b2 (1332 BAU/ml; 95% CI, 367 to 2402) with a difference of 539 BAU/ml (95% CI, 139 to 910; P = 0.009). Neither antispike levels nor neutralizing antibodies to wild-type, Delta, and Omicron BA.1 pseudoviruses were statistically different. COVID-19 infection occurred in 10% of participants: 15 (11%) receiving mRNA-1273 and 11 (8%) receiving BNT162b2. Third dose BNT162b2 was not associated with a significant different risk for COVID-19 in comparison with mRNA-1273 (hazard ratio, 0.78; 95% CI, 0.27 to 2.2; P = 0.63). CONCLUSIONS In patients with CKD, third dose COVID-19 mRNA vaccination with mRNA-1273 elicited higher SARS-CoV-2 anti-RBD levels in comparison with BNT162b2 over a 6-month period. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER COVID-19 Vaccine Boosters in Patients With CKD (BOOST KIDNEY), NCT05022329 .
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Affiliation(s)
- Kevin Yau
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Tam
- Division of Nephrology, Department of Medicine, Scarborough Health Network, Toronto, Ontario, Canada
| | - Christopher T. Chan
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Queenie Hu
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Freda Qi
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Kento T. Abe
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Kurtesi
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Yidi Jiang
- Clinical Trial Support, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jose Estrada-Codecido
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tyler Brown
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lisa Liu
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aswani Siwakoti
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jerome A. Leis
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Adeera Levin
- British Columbia Provincial Renal Agency, Vancouver, British Columbia, Canada
| | - Matthew J. Oliver
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Michelle A. Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
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23
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Ortiz A. Should we enlarge the indication for kidney biopsy in diabetics? The con part. Clin Kidney J 2024; 17:sfad267. [PMID: 38186897 PMCID: PMC10768755 DOI: 10.1093/ckj/sfad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Indexed: 01/09/2024] Open
Abstract
Diabetes is the most common cause of chronic kidney disease (CKD), a condition found in 850 million persons and projected to become the fifth global cause of death by 2040. Research is needed that examines kidney tissue to characterize distinct phenotypes in patients with diabetes mellitus (DM) and CKD so as to identify non-invasive biomarker signatures and develop targeted therapeutic approaches. However, from a routine care point of view, kidney biopsy is likely overused in patients with CKD and DM, as most biopsy results are not expected to be associated with a therapeutic approach that differs from standard kidney protection with triple or quadruple therapy (renin-angiotensin system blockade, sodium-glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists and glucagon-like peptide-1 receptor agonists). Moreover, expanding the kidney biopsy criteria will increase the absolute number of complications from kidney biopsies, which may reach 27 000 to 108 000 deaths of persons that would derive little benefit from kidney biopsy if all people with DM and severe CKD were biopsied globally. Finally, limited resources should be optimally allocated. The cost of one kidney biopsy can fund 7000 semiquantitative urinary albumin:creatinine ratio assessments that could identify earlier stages of the disease and allow treatment that prevents progression to a stage at which kidney biopsy may be considered.
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Affiliation(s)
- Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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24
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Jiang W, Chen Y, Zhao Y, Gao Y, Cheng T, Qian E, Hou Y, Lu K. COVID-19 and chronic kidney disease: a bibliometric analysis. Ann Med Surg (Lond) 2024; 86:336-344. [PMID: 38222697 PMCID: PMC10783392 DOI: 10.1097/ms9.0000000000001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/11/2023] [Indexed: 01/16/2024] Open
Abstract
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.
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Affiliation(s)
| | | | - Yuxin Zhao
- Third Clinical Medical College, Zhejiang Chinese Medical University
| | - Yang Gao
- Third Clinical Medical College, Zhejiang Chinese Medical University
| | - Tianyang Cheng
- Third Clinical Medical College, Zhejiang Chinese Medical University
| | | | | | - Keda Lu
- Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Rojas-Rivera JE, Bakkaloglu SA, Bolignano D, Nistor I, Sarafidis PA, Stoumpos S, Cozzolino MG, Ortiz A. Chronic kidney disease: the missing concept in the 2019 EULAR/ERA-EDTA recommendations for lupus nephritis. Nephrol Dial Transplant 2023; 39:151-158. [PMID: 37433583 DOI: 10.1093/ndt/gfad154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Indexed: 07/13/2023] Open
Abstract
Chronic kidney disease (CKD) is diagnosed when glomerular filtration rate (GFR) falls below 60 ml/min/1.73 m2 or urinary albumin:creatinine ratio (UACR) reaches ≥30 mg/g, as these two thresholds indicate a higher risk of adverse health outcomes, including cardiovascular mortality. CKD is classified as mild, moderate or severe, based on GFR and UACR values, and the latter two classifications convey a high or very high cardiovascular risk, respectively. Additionally, CKD can be diagnosed based on abnormalities detected by histology or imaging. Lupus nephritis (LN) is a cause of CKD. Despite the high cardiovascular mortality of patients with LN, neither albuminuria nor CKD are discussed in the 2019 European League Against Rheumatism (EULAR)/European Renal Association-European Dialysis and Transplant Association recommendations for the management of LN or the more recent 2022 EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases. Indeed, the proteinuria target values discussed in the recommendations may be present in patients with severe CKD and a very high cardiovascular risk who may benefit from guidance detailed in the 2021 European Society of Cardiology guidelines on cardiovascular disease prevention in clinical practice. We propose that the recommendations should move from a conceptual framework of LN as an entity separate from CKD to a framework in which LN is considered a cause of CKD and evidence generated from large CKD trials applies unless demonstrated otherwise.
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Affiliation(s)
- Jorge E Rojas-Rivera
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT, Madrid, Spain
- ISCIII RICORS2040 Kidney Disease Research Network, Madrid, Spain
| | - Sevcan A Bakkaloglu
- European Renal Association-European Renal Best Practice (ERA-ERBP), Parma, Italy
- Department of Pediatrics, Division of Pediatric Nephrology and Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Davide Bolignano
- European Renal Association-European Renal Best Practice (ERA-ERBP), Parma, Italy
- Renal Unit, "Magna Graecia" University, Catanzaro, Italy
| | - Ionut Nistor
- European Renal Association-European Renal Best Practice (ERA-ERBP), Parma, Italy
- University of Medicine and Pharmacy "Grigore T. Popa", Iaşi, Romania
- Department of Nephrology "Dr C.I. Parhon" Hospital, Iaşi, Romania
| | - Pantelis A Sarafidis
- European Renal Association-European Renal Best Practice (ERA-ERBP), Parma, Italy
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sokratis Stoumpos
- European Renal Association-European Renal Best Practice (ERA-ERBP), Parma, Italy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mario Gennaro Cozzolino
- European Renal Association-European Renal Best Practice (ERA-ERBP), Parma, Italy
- Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT, Madrid, Spain
- ISCIII RICORS2040 Kidney Disease Research Network, Madrid, Spain
- European Renal Association-European Renal Best Practice (ERA-ERBP), Parma, Italy
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Lim Y, Lee MH, Lee SK, Jeong S, Han HW. Increased Estimated GFR Is Negatively Associated With the Risk of SARS-CoV-2 Infection and Severe COVID-19 Within Normal to Mildly Decreased Levels: Nested Case-Control Study. J Korean Med Sci 2023; 38:e415. [PMID: 38111284 PMCID: PMC10727919 DOI: 10.3346/jkms.2023.38.e415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/21/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND While accumulating evidence indicates chronic kidney disease as a risk factor for coronavirus disease 2019 (COVID-19), the association between normal or mildly decreased kidney function and COVID-19 is unaddressed. Here, we have examined the association of an increase in estimated glomerular filtration rate (eGFR) with the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe COVID-19 outcomes among patients within normal to mildly decreased kidney function. METHODS The patients who participated in both health screenings from period I (2017-2018) to II (2019-2020) were enrolled to our study. All participants were categorized into four groups according to the changes in eGFR stage from period I to II: 1) persistently stage G1, 2) from stage G2 to G1, 3) from stage G1 to G2, 4) persistently stage G2. In addition, the changes in eGFR value were defined by subtracting its value of period I from II. Patients were followed up for SARS-CoV-2 infection from January 1, 2021 to any diagnosis of COVID-19 or December 31, 2021, whichever happened first. In addition, those with SARS-CoV-2 infection were followed-up for one month after diagnosis to analyze severe COVID-19. Adjusted odds ratio (aOR) was calculated using multivariable-adjusted logistic regression. RESULTS We identified 159,427 patients with and 1,804,798 patients without SARS-CoV-2 infection. The risk of SARS-CoV-2 infection decreased when eGFR stage changed from G2 to G1 (aOR, 0.957; 95% confidence interval [CI], 0.938-0.977) and persistently maintained at G1 (aOR, 0.966; 95% CI, 0.943-0.990), compared with the persistently stage G2 group. In addition, the risk showed an inverse relationship with changes in eGFR value, which was depicted by restricted cubic spline curves. For the overall risk of severe COVID-19, the persistently stage G1 showed the lowest risk (aOR, 0.897; 95% CI, 0.827-0.972), followed by those from stage G1 to G2 (aOR, 0.900; 95% CI, 0.828-0.978) and those from stage G2 to G1 (aOR, 0.931; 95% CI, 0.871-0.995), compared with the persistently stage G2 group. CONCLUSION An increase in eGFR was negatively associated with the risk of SARS-CoV-2 infection and severe COVID-19 among normal or mildly decreased kidney function. For severe COVID-19, maintaining higher baseline eGFR may act as a protective factor against its risk.
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Affiliation(s)
- Yohwan Lim
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea
- Institute of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea
| | - Myeong Hoon Lee
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea
- Institute of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea
| | - Su Kyoung Lee
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea
- Institute of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea
- Institute of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea.
| | - Hyun Wook Han
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea
- Institute of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea.
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Zhou Y, Zhang M, Wu X, Li X, Hao X, Xu L, Li H, Qiao P, Chen P, Wang W. Platelet-albumin-bilirubin score and neutrophil-to-lymphocyte ratio predict intensive care unit admission in patients with end-stage kidney disease infected with the Omicron variant of COVID-19: a single-center prospective cohort study. Ren Fail 2023; 45:2199097. [PMID: 37051667 PMCID: PMC10114985 DOI: 10.1080/0886022x.2023.2199097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES The objective of this study was to develop clinical scores to predict the risk of intensive care unit (ICU) admission in patients with COVID-19 and end stage kidney disease (ESKD). METHODS This was a prospective study in which 100 patients with ESKD were enrolled and divided into two groups: the ICU group and the non-ICU group. We utilized univariate logistic regression and nonparametric statistics to analyze the clinical characteristics and liver function changes of both groups. By plotting receiver operating characteristic curves, we identified clinical scores that could predict the risk of ICU admission. RESULTS Out of the 100 patients with Omicron infection, 12 patients were transferred to the ICU due to disease aggravation, with an average of 9.08 days from hospitalization to ICU transfer. Patients transferred to the ICU more commonly experienced shortness of breath, orthopnea, and gastrointestinal bleeding. The peak liver function and changes from baseline in the ICU group were significantly higher, with p values <.05. We found that the baseline platelet-albumin-bilirubin score (PALBI) and neutrophil-to-lymphocyte ratio (NLR) were good predictors of ICU admission risk, with area under curve values of 0.713 and 0.770, respectively. These scores were comparable to the classic Acute Physiology and Chronic Health Evaluation II (APACHE-II) score (p > .05). CONCLUSION Patients with ESKD and Omicron infection who are transferred to the ICU are more likely to have abnormal liver function. The baseline PALBI and NLR scores can better predict the risk of clinical deterioration and early transfer to the ICU for treatment.
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Affiliation(s)
- Yufen Zhou
- Department of Gastroenterology, Ruijin Hospital, Shanghai, China
| | - Muyin Zhang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xiaojing Wu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xin Li
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xu Hao
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Lili Xu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hao Li
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Panpan Qiao
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ping Chen
- Department of Gastroenterology, Ruijin Hospital, Shanghai, China
| | - Weiming Wang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
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Carriazo S, Ribagorda M, Pintor-Chocano A, Perez-Gomez MV, Ortiz A, Sanchez-Niño MD. Increased expression of SCARF genes favoring SARS-CoV-2 infection in key target organs in CKD. Clin Kidney J 2023; 16:2672-2682. [PMID: 38046008 PMCID: PMC10689187 DOI: 10.1093/ckj/sfad220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Indexed: 12/05/2023] Open
Abstract
Background Chronic kidney disease (CKD), especially diabetic CKD, is the condition that most increases the risk of lethal coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the underlying molecular mechanisms are unclear. SARS-CoV-2 and coronavirus-associated receptors and factors (SCARFs) regulate coronavirus cell entry and/or replication. We hypothesized that CKD may alter the expression of SCARF genes. Methods A literature search identified 34 SCARF genes of which we selected 21 involved in interactions between SARS-CoV/SARS-CoV-2 and host cells, and assessed their mRNA expression in target tissues of COVID-19 (kidneys, lungs, aorta and heart) in mice with adenine-induced CKD. Results Twenty genes were differentially expressed in at least one organ in mice with CKD. For 15 genes, the differential expression would be expected to favor SARS-CoV-2 infection and/or severity. Of these 15 genes, 13 were differentially expressed in the kidney and 8 were validated in human CKD kidney transcriptomics datasets, including those for the most common cause of CKD, diabetic nephropathy. Two genes reported to protect from SARS-CoV-2 were downregulated in at least two non-kidney target organs: Ifitm3 encoding interferon-induced transmembrane protein 3 (IFITM3) in lung and Ly6e encoding lymphocyte antigen 6 family member 6 (LY6E) in aorta. Conclusion CKD, including diabetic CKD, is associated with the differential expression of multiple SCARF genes in target organs of COVID-19, some of which may sensitize to SARS-CoV-2 infection. This information may facilitate developing therapeutic strategies aimed at decreasing COVID-19 severity in patients with CKD.
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Affiliation(s)
- Sol Carriazo
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, RICORS2040, Madrid, Spain
| | - Marta Ribagorda
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, RICORS2040, Madrid, Spain
| | - Aranzazu Pintor-Chocano
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, RICORS2040, Madrid, Spain
| | - Maria Vanessa Perez-Gomez
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, RICORS2040, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, RICORS2040, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Dolores Sanchez-Niño
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, RICORS2040, Madrid, Spain
- Departamento de Farmacología, Universidad Autónoma de Madrid, Madrid, Spain
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Carriazo S, Abasheva D, Duarte D, Ortiz A, Sanchez-Niño MD. SCARF Genes in COVID-19 and Kidney Disease: A Path to Comorbidity-Specific Therapies. Int J Mol Sci 2023; 24:16078. [PMID: 38003268 PMCID: PMC10671056 DOI: 10.3390/ijms242216078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/29/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has killed ~7 million persons worldwide. Chronic kidney disease (CKD) is the most common risk factor for severe COVID-19 and one that most increases the risk of COVID-19-related death. Moreover, CKD increases the risk of acute kidney injury (AKI), and COVID-19 patients with AKI are at an increased risk of death. However, the molecular basis underlying this risk has not been well characterized. CKD patients are at increased risk of death from multiple infections, to which immune deficiency in non-specific host defenses may contribute. However, COVID-19-associated AKI has specific molecular features and CKD modulates the local (kidney) and systemic (lung, aorta) expression of host genes encoding coronavirus-associated receptors and factors (SCARFs), which SARS-CoV-2 hijacks to enter cells and replicate. We review the interaction between kidney disease and COVID-19, including the over 200 host genes that may influence the severity of COVID-19, and provide evidence suggesting that kidney disease may modulate the expression of SCARF genes and other key host genes involved in an effective adaptive defense against coronaviruses. Given the poor response of certain CKD populations (e.g., kidney transplant recipients) to SARS-CoV-2 vaccines and their suboptimal outcomes when infected, we propose a research agenda focusing on CKD to develop the concept of comorbidity-specific targeted therapeutic approaches to SARS-CoV-2 infection or to future coronavirus infections.
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Affiliation(s)
- Sol Carriazo
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada;
- RICORS2040, 28049 Madrid, Spain;
| | - Daria Abasheva
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, 28049 Madrid, Spain; (D.A.); (D.D.)
| | - Deborah Duarte
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, 28049 Madrid, Spain; (D.A.); (D.D.)
| | - Alberto Ortiz
- RICORS2040, 28049 Madrid, Spain;
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, 28049 Madrid, Spain; (D.A.); (D.D.)
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Maria Dolores Sanchez-Niño
- RICORS2040, 28049 Madrid, Spain;
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, 28049 Madrid, Spain; (D.A.); (D.D.)
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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Wilson A, McKeaveney C, Carswell C, Atkinson K, Burton S, McVeigh C, Graham-Wisener L, Jääskeläinen E, Johnston W, O’Rourke D, Reid J, Rej S, Walsh I, Noble H. Experiences of People with Kidney Disease Following the Implementation of the Compassionate Mindful Resilience Programme: Qualitative Findings from the COSMIC Study. Healthcare (Basel) 2023; 11:2926. [PMID: 37998417 PMCID: PMC10671038 DOI: 10.3390/healthcare11222926] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Kidney disease is a progressive, debilitating condition. Patients experience challenging physical and psychological symptoms and are at increased risk of anxiety, depression, and poor mental wellbeing. Access to specialist psychological or social support is limited, with inadequate provision of psychosocial support available across UK renal units. The COSMIC study (examining the acceptability and feasibility of the Compassionate Mindful Resilience programme for adult patients with chronic kidney disease) aimed to support a new service development project, in partnership with Kidney Care UK, by implementing the Compassionate Mindful Resilience (CMR) programme, developed by MindfulnessUK, and explore its feasibility for patients with stage 4 or 5 kidney disease and kidney transplant recipients. This paper reports on the qualitative exploratory work which examined the experiences of study participants, their adherence to practice, and the acceptability of the intervention. METHOD Participants (n = 19) took part in semi-structured interviews, which were transcribed, coded, and thematically analysed. RESULTS Three themes (and nine subthemes) were reported: experiences of the CMR programme that facilitated subjective benefit, participants' lived and shared experiences, and the practicalities of CMR programme participation. All participants reported that they found taking part in the CMR programme to be a beneficial experience. CONCLUSION The CMR programme was found to be an acceptable intervention for people living with kidney disease and provided tools and techniques that support the mental health and wellbeing of this patient group. Further qualitative exploration into participant experience should be integrated within future trials of this intervention.
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Affiliation(s)
- Anna Wilson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (C.M.); (C.C.); (C.M.); (H.N.)
| | - Clare McKeaveney
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (C.M.); (C.C.); (C.M.); (H.N.)
| | - Claire Carswell
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (C.M.); (C.C.); (C.M.); (H.N.)
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | | | - Stephanie Burton
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (C.M.); (C.C.); (C.M.); (H.N.)
| | - Clare McVeigh
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (C.M.); (C.C.); (C.M.); (H.N.)
| | | | - Erika Jääskeläinen
- Research Unit of Population Health, University of Oulu, 90570 Oulu, Finland;
| | - William Johnston
- Patient and Carer Education Partnership, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK
| | - Daniel O’Rourke
- Patient and Carer Education Partnership, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (C.M.); (C.C.); (C.M.); (H.N.)
| | - Soham Rej
- Department of Psychiatry, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT7 1NN, UK
- Knightsbridge Healthcare Group, Belfast BT9 5UB, UK
- Institute of Psychosexual Medicine, London W4 5YA, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (C.M.); (C.C.); (C.M.); (H.N.)
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Quiroga B, Soler MJ, Ortiz A, de Sequera P. Lessons from SENCOVAC: A prospective study evaluating the response to SARS-CoV-2 vaccination in the CKD spectrum. Nefrologia 2023; 43:676-687. [PMID: 37150670 PMCID: PMC10160849 DOI: 10.1016/j.nefroe.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/10/2022] [Indexed: 05/09/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has negatively impacted on patients of the whole CKD spectrum, causing high rates of morbi-mortality. SARS-CoV-2 vaccines opened a new era, but patients with CKD (including kidney transplant, hemodialysis and peritoneal dialysis) were systematically excluded from pivotal clinical trials. The Spanish Society of Nephrology promoted the multicentric national SENCOVAC study aimed at assessing immunological responses after vaccination in patients with CKD. During the first year after vaccination, patients with non-dialysis CKD and those on hemodialysis and peritoneal dialysis presented good anti-Spike antibody responses to vaccination, especially after receiving the third and fourth doses. However, kidney transplant recipients presented suboptimal responses after any vaccination schedule (initial, third and fourth dose). Especially worrisome is the situation of a patients with a persistently negative humoral response that do not seroconvert after boosters. In this regard, monoclonal antibodies targeting SARS-CoV-2 have been approved for high-risk patients, although they may become obsolete as the viral genome evolves. The present report reviews the current status of SARS-CoV-2 vaccination in the CKD spectrum with emphasis on lessons learned from the SENCOVAC study. Predictors of humoral response, including vaccination schedules and types of vaccines, as well as the integration of vaccines, monoclonal antibodies and antiviral agents are discussed.
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Affiliation(s)
- Borja Quiroga
- IIS-La Princesa, Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain; RICORS2040 (Kidney Disease), Spain.
| | - Alberto Ortiz
- RICORS2040 (Kidney Disease), Spain; IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain.
| | - Patricia de Sequera
- RICORS2040 (Kidney Disease), Spain; Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
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Rai V. COVID-19 and Kidney: The Importance of Follow-Up and Long-Term Screening. Life (Basel) 2023; 13:2137. [PMID: 38004277 PMCID: PMC10672056 DOI: 10.3390/life13112137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
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.
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Affiliation(s)
- Vikrant Rai
- Department of Translational Research, Western University of Health Sciences, Pomona, CA 91766, USA
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Sever MS, Luyckx V, Tonelli M, Kazancioglu R, Rodgers D, Gallego D, Tuglular S, Vanholder R. Disasters and kidney care: pitfalls and solutions. Nat Rev Nephrol 2023; 19:672-686. [PMID: 37479903 DOI: 10.1038/s41581-023-00743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
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.
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Affiliation(s)
- Mehmet Sukru Sever
- Istanbul University, Istanbul School of Medicine, Department of Nephrology, Istanbul, Turkey.
| | - Valerie Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard, Medical School, Boston, MA, USA
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rumeyza Kazancioglu
- Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Darlene Rodgers
- Independent Nurse Consultant, American Society of Nephrology, Washington, DC, USA
| | - Dani Gallego
- European Kidney Health Alliance, Brussels, Belgium
- European Kidney Patient Federation, Wien, Austria
| | - Serhan Tuglular
- Marmara University, School of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
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Teo RZC, Yan H, Singh T, Khan BA. Outcomes and mortality of chronic haemodialysis patients in community-based dialysis centres in Singapore during the COVID-19 pandemic. Singapore Med J 2023:386396. [PMID: 37870041 DOI: 10.4103/singaporemedj.smj-2023-036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Affiliation(s)
- Rachel Zui Chih Teo
- Medical Services Department, The National Kidney Foundation; Department of Medicine, Duke-NUS Medical School, Singapore
| | - Hua Yan
- Medical Services Department, The National Kidney Foundation, Singapore
| | - Tripti Singh
- Medical Services Department, The National Kidney Foundation; Department of Medicine, Duke-NUS Medical School, Singapore
| | - Behram Ali Khan
- Medical Services Department, The National Kidney Foundation; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Pethő ÁG, Kevei P, Juha M, Kóczy Á, Ledó N, Tislér A, Takács I, Tabák ÁG. The impact of COVID-19 infection before the vaccination era on the hospitalized patients requiring hemodialysis: a single-center retrospective cohort. Ren Fail 2023; 45:2251593. [PMID: 37732362 PMCID: PMC10515667 DOI: 10.1080/0886022x.2023.2251593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/19/2023] [Indexed: 09/22/2023] Open
Abstract
Due to effective vaccinations, the COVID-19 (coronavirus disease 2019) infection that caused the pandemic has a milder clinical course. We aimed to assess the mortality of hospitalized COVID-19 patients before the vaccination era. We investigated the mortality in those patients between 1 October 2020 and 31 May 2021 who received hemodialysis treatment [patients with previously normal renal function (nCKD), patients with chronic kidney disease previously not requiring hemodialysis (CKDnonHD), chronic kidney disease (CKD), and patients on regular hemodialysis (pHD)]. In addition, participants were followed up for all-cause mortality in the National Health Service database until 1 December 2021. In our center, 83 of 108 (76.9%) were included in the analysis due to missing covariates. Over a median of 26 (interquartile range 11-266) days of follow-up, 20 of 22 (90.9%) of nCKD, 23 of 24 (95.8%) of CKDnonHD, and 17 of 37 (45.9%) pHD patients died (p < 0.001). In general, patients with nCKD had fewer comorbidities but more severe presentations. In contrast, the patients with pHD had the least severe symptoms (p < 0.001). In a model adjusted for independent predictors of all-cause mortality (C-reactive protein and serum albumin), CKDnonHD patients had increased mortality [hazard ratio (HR) 1.91, 95% confidence interval (CI), 1.02-3.60], while pHD patients had decreased mortality (HR 0.41, 95% CI 0.20-0.81) compared to nCKD patients. After further adjustment for the need for intensive care, the difference in mortality between the nCKD and pHD groups became non-significant. Despite the limitations of our study, it seems that the survival of previously hemodialysis patients was significantly better.
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Affiliation(s)
- Ákos Géza Pethő
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Kevei
- Hemodialysis Unit, Fresenius Medical Care Hungary, Budapest, Hungary
| | - Márk Juha
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ágnes Kóczy
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Nóra Ledó
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - András Tislér
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - István Takács
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ádám G. Tabák
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Epidemiology and Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Epidemiology and Public Health, University College London, London, UK
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Meena P, Abdellatif D, Tiwari V, Chatterjee S, Luyckx VA. Health Systems Preparedness for Infectious Disease Outbreaks: Relevance for Nephrology. Semin Nephrol 2023; 43:151465. [PMID: 38199828 DOI: 10.1016/j.semnephrol.2023.151465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
The coronavirus disease (COVID-19) crisis glaringly highlighted the critical need to develop resilient health care systems that are better prepared for epidemics. Millions of people died from COVID-19 itself, but almost three times as many died from health system disruptions. People living with kidney disease are highly vulnerable during outbreaks and pandemics and their needs must be included in preparedness planning. Health systems preparedness requires not only early identification and containment of outbreaks and maintenance of critical services during crises, but also bolstering population resilience and ensuring the safety of both health personnel and patients. Planning for surge capacity in an outbreak must include provision for both acute and chronic dialysis, and ensure access to medications for people with kidney diseases. Quality of care should not be compromised and must be monitored and improved where necessary. Technology, such as telemedicine, can support quality and continuity of care and minimize infection risks. Communication at all levels is crucial to ensure all stakeholders, including communities, have the necessary information to support cooperation and collaboration in effective outbreak responses. Research is important during and after pandemics to improve knowledge and build resilience at all levels, from outbreak detection to the development of therapeutics and optimizing equity in access to interventions. Only with adequate preparation and more resilient health systems can we hope, as a global community, to build on the harsh lessons learned during COVID-19, and improve the response to the next infectious disease outbreak, epidemic, or even pandemic.
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Affiliation(s)
- Priti Meena
- Department of Nephrology, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Vaibhav Tiwari
- Institute of Renal Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | | | - 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; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Mann JK, Reddy T, van der Stok M, Ngubane A, Mulaudzi T, Mchunu N, Nevhungoni P, Manickchund N, Manickchund P, Louise Cairns CH, Govender V, Ndung'u T, Suleman Moosa MY, Gosnell BI. Hen egg white bovine colostrum supplement reduces symptoms of mild/moderate COVID-19: a randomized control trial. Future Sci OA 2023; 9:FSO882. [PMID: 37621850 PMCID: PMC10445555 DOI: 10.2144/fsoa-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/03/2023] [Indexed: 08/26/2023] Open
Abstract
Aim The ability of a hen egg white bovine colostrum supplement to prevent severe COVID-19 was tested in a double-blind randomized control study. Methods Adults with mild/moderate COVID-19, risk factors for severe disease, and within 5 days of symptom onset were assigned to the intervention (n = 77) or placebo (n = 79) arms. Symptoms were documented until day 42 post-enrollment and viral clearance was assessed at 11-13 days post-symptom onset. Results One participant developed severe COVID-19. The severe-type symptom score was lower in the active arm at 11-13 days post-symptom onset (p = 0.049). Chest pain, fever/chills, joint pain/malaise, and sore throat were significantly less frequent in the active arm. No differences in viral clearance were observed. Conclusion The intervention reduced symptoms of mild/moderate COVID-19. Clinical Trial Registration DOH-27-062021-9191 (South African National Clinical Trials Register).
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Affiliation(s)
- Jaclyn Kelly Mann
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, 4091, South Africa
| | - Mary van der Stok
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Ayanda Ngubane
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Takalani Mulaudzi
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Nobuhle Mchunu
- Biostatistics Research Unit, South African Medical Research Council, Durban, 4091, South Africa
| | - Portia Nevhungoni
- Biostatistics Research Unit, South African Medical Research Council, Durban, 4091, South Africa
| | - Nithendra Manickchund
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Pariva Manickchund
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, 4001, South Africa
| | | | | | - Thumbi Ndung'u
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, 4001, South Africa
- Africa Health Research Institute, Durban, 4001, South Africa
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology & Harvard University, Cambridge, MA 02139, USA
- Division of Infection & Immunity, University College London, London, WC1E 6BT, UK
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Carvantes-Barrera A, Díaz-González L, Rosales-Rivera M, Chávez-Almazán LA. Risk Factors Associated with COVID-19 Lethality: A Machine Learning Approach Using Mexico Database. J Med Syst 2023; 47:90. [PMID: 37597034 DOI: 10.1007/s10916-023-01979-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/21/2023] [Indexed: 08/21/2023]
Abstract
Identifying risk factors associated with COVID-19 lethality is crucial in combating the ongoing pandemic. In this study, we developed lethality predictive models for each epidemiological wave and for the overall dataset using the Extreme Gradient Boosting technique and analyzed them using Shapley values to determine the contribution levels of various features, including demographics, comorbidities, medical units, and recent medical information from confirmed COVID-19 cases in Mexico between February 23, 2020, and April 15, 2022. The results showed that pneumonia and advanced age were the most important factors predicting patient death in all cohorts. Additionally, the medical unit where the patient received care acted as a risk or protective factor. IMSS medical units were identified as high-risk factors in all cohorts, except in wave four, while SSA medical units generally were moderate protective factors. We also found that intubation was a high-risk factor in the first epidemiological wave and a moderate-risk factor in the following waves. Female gender was a protective factor of moderate-high importance in all cohorts, while being between 18 and 29 years old was a moderate protective factor and being between 50 and 59 years old was a moderate risk factor. Additionally, diabetes (all cohorts), obesity (third wave), and hypertension (fourth wave) were identified as moderate risk factors. Finally, residing in municipalities with the lowest Human Development Index level represented a moderate risk factor. In conclusion, this study identified several significant risk factors associated with COVID-19 lethality in Mexico, which could aid policymakers in developing targeted interventions to reduce mortality rates.
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Affiliation(s)
- Alejandro Carvantes-Barrera
- Maestría en Optimización y Cómputo Aplicado, Universidad Autónoma del Estado de Morelos, Cuernavaca, 62209, Morelos, México
| | - Lorena Díaz-González
- Centro de Investigación en Ciencias, Universidad Autónoma del Estado de Morelos, Cuernavaca, 62209, Morelos, México.
| | - Mauricio Rosales-Rivera
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, 62209, México
| | - Luis A Chávez-Almazán
- Unidad de Innovación Clínica y Epidemiológica del Estado de Guerrero, Acapulco, Guerrero, 39715, México
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Frölke SC, Bouwmans P, Messchendorp AL, Vervoort JP, Abrahams AC, de Vries AP, Nieuwkerk PT, Hemmelder MH, Gansevoort RT, Hilbrands LB, Reinders ME, Sanders JSF, Bemelman FJ, Geerlings SE. Adherence to preventive measures after SARS-CoV-2 vaccination and after awareness of antibody response in kidney transplant recipients in the Netherlands: a nationwide questionnaire study. EClinicalMedicine 2023; 62:102103. [PMID: 37533418 PMCID: PMC10393559 DOI: 10.1016/j.eclinm.2023.102103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Background Kidney transplant recipients (KTRs) were advised to tightly adhere to government recommendations to curb the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) because of a high risk of morbidity and mortality and decreased immunogenicity after vaccination. The aim of this study was to analyse the change in adherence to preventive measures after vaccination and awareness of antibody response, and to evaluate its effectiveness. Methods In this large-scale, national questionnaire study, questionnaires were sent to 3531 KTRs enrolled in the Dutch RECOVAC studies, retrospectively asking for adherence to nine preventive measures on a 5-point Likert scale before and after SARS-CoV-2 vaccination and after awareness of antibody response. Blood samples were collected 28 days after the second vaccination. Antibody response was categorised as non-responder (≤50 BAU/mL), low-responder (>50 ≤ 300 BAU/mL) or high-responder (>300 BAU/mL), and shared with participants as a correlate of protection. Participants of whom demographics on sex and age, blood samples and completed questionnaires were available, were included. Our study took place between February 2021 and January 2022. The primary outcome of adherence before and after vaccination was assessed between August and October 2021 and compared via the Wilcoxon signed rank sum test. Logistic regression analysis was performed to estimate the association between antibody response and non-adherence, and adherence on acquiring SARS-CoV-2 infection. This study is registered at ClinicalTrials.gov (NCT04841785). Findings In 2939 KTRs (83%) who completed the first questionnaire on adherence to preventive measures, adherence was higher before than after vaccination (4.56, IQR 4.11-4.78 and 4.22, IQR 3.67-4.67, p < 0.001). Adherence after awareness of antibody response was analysed in 2399 KTRs (82%) of whom also blood samples were available, containing 949 non-responders, 500 low-responders and 950 high-responders. Compared to non-responders, low- and high-responders reported higher non-adherence. Higher adherence was associated with lower infection rates before and after vaccination (OR 0.67 [0.51-0.91], p = 0.008 and OR 0.48 [0.28-0.86], p = 0.010). Interpretation Adherence decreased after SARS-CoV-2 vaccination and in KTRs who were aware of a subsequent antibody response compared with those without. Preventive measures in this vulnerable group seem to be effective, regardless of vaccination status. This study starts a debate on sharing antibody results with the patient and future studies should elucidate whether decreased adherence in antibody responders is justified, also in view of future pandemics. Funding The Netherlands Organization for Health Research and Development and the Dutch Kidney Foundation.
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Affiliation(s)
- Sophie C. Frölke
- Amsterdam UMC Location University of Amsterdam, Renal Transplant Unit, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Pim Bouwmans
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - A. Lianne Messchendorp
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Johanna P.M. Vervoort
- Dutch Kidney Patient Association (NVN), Bussum, the Netherlands
- Global Health Unit, Department of Health Sciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Alferso C. Abrahams
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Aiko P.J. de Vries
- Department of Medicine, Division of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
- Leiden Transplant Centre, Leiden, the Netherlands
| | - Pythia T. Nieuwkerk
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Marc H. Hemmelder
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Ron T. Gansevoort
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Luuk B. Hilbrands
- Department of Nephrology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Marlies E.J. Reinders
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jan-Stephan F. Sanders
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Frederike J. Bemelman
- Amsterdam UMC Location University of Amsterdam, Renal Transplant Unit, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Suzanne E. Geerlings
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands
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Lee YS, Jamaluddin J, Ho BK. Characteristics and factors associated with severity of COVID-19 infections in primary care. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2023; 18:42. [PMID: 37593088 PMCID: PMC10431198 DOI: 10.51866/oa.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Introduction Primary care service plays a vital role in early clinical assessment of patients with COVID-19 in Malaysia. This study aimed to evaluate the potential risk factors of COVID-19 severity at presentation to primary care facilities in the post-vaccination period. Method Clinical records from the Selangkah system of all patients with COVID-19 aged above 18 years seen at COVID-19 assessment centres located in 10 government health clinics in Gombak district, Selangor, from 1 October to 31 December 2021 with complete documentation and outcomes were retrieved. Demographics, comorbidities, clinical features and vaccination statuses and types were retrospectively evaluated. The variables were compared between mild and severe diseases. Univariate and multivariable logistic regressions were used to identify the factors affecting disease severity. Results A total of 4406 patients (median age=37 years, men=51.2%) were analysed. Approximately 97.1% of the cases were mild, while 2.9% were severe. Fever, difficulty breathing, lethargy, throat irritation/runny nose, oxygen saturation of <95%, respiratory rate of >20 breaths per minute, CoronaVac vaccination and hypertension were the determinants of severity (P<0.05). Conclusion The high proportion (97.1%) of mild cases in this study compared with an earlier report (81.8%) during the pre-vaccination period may suggest the impact of vaccine, as 84.9% of this cohort was fully vaccinated. Our study also demonstrated a significant difference in COVID-19 severity between the vaccine types. The identified clinical features and comorbidities could assist primary care doctors in stratifying patients with COVID-19 judiciously in terms of hospital referral or home quarantine.
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Affiliation(s)
- Yeow Siong Lee
- MBBS (IMU), MMed (Family Medicine) (UM), Klinik Kesihatan Selayang Baru, Jalan Sungai Tua, Batu Caves, Selangor Darul Ehsan, Malaysia
| | - Jazlan Jamaluddin
- MD (Moscow), MMed (Family Medicine) (UiTM), Klinik Kesihatan Sauk, Jalan Besar Lenggong, Sauk, Kuala Kangsar, Perak, Malaysia.
| | - Bee Kiau Ho
- MBBS (UM), MMed (Family Medicine) (UM), Klinik Kesihatan Bandar Botanic, Blok A, Jalan Langat, Bandar Botanic, Klang, Selangor, Malaysia
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Örtqvist AK, Magnus MC, Dahlqvist E, Söderling J, Johansson K, Sandström A, Håberg SE, Stephansson O. Association between SARS-CoV-2 infection and newly diagnosed hypertension during pregnancy: prospective, population based cohort study. BMJ MEDICINE 2023; 2:e000465. [PMID: 37275554 PMCID: PMC10230329 DOI: 10.1136/bmjmed-2022-000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/26/2023] [Indexed: 06/07/2023]
Abstract
Objective To study the association between SARS-CoV-2 infection and newly diagnosed hypertension during pregnancy. Design Prospective, population based cohort study. Setting All singleton pregnancies after 22 completed gestational weeks registered in the Swedish Pregnancy Register and the Medical Birth Registry of Norway, from 1 March 2020 to 24 May 2022. Participants 312 456 individuals available for analysis (201 770 in Sweden and 110 686 in Norway), with pregnancies that reached 42 completed gestational weeks by the end of follow-up in the pregnancy registries, excluding individuals with SARS-CoV-2 infection before pregnancy and those with a diagnosis of pre-existing hypertension or onset of hypertension before 20 gestational weeks. Main outcome measures Newly diagnosed hypertension during pregnancy was defined as a composite outcome of a diagnosis of gestational hypertension, pre-eclampsia, HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome, or eclampsia, from gestational week 20 to one week after delivery. The association between SARS-CoV-2 infection and hypertension during pregnancy was investigated with a stratified Cox proportional hazard model, adjusting for maternal age, body mass index, parity, smoking, region of birth, education, income, coexisting medical conditions, previous hypertension during pregnancy, number of healthcare visits during the past year, and vaccination against SARS-CoV-2. Pre-eclampsia was also analysed as a separate outcome. Results Of 312 456 individuals available for analysis, 8% (n=24 566) had SARS-CoV-2 infection any time during pregnancy, 6% (n=18 051) had a diagnosis of hypertension during pregnancy, and 3% (9899) had pre-eclampsia. SARS-CoV-2 infection during pregnancy was not associated with an increased risk of hypertension during pregnancy (adjusted hazard ratio 0.99, 95% confidence interval 0.93 to 1.04) or pre-eclampsia (0.98, 0.87 to 1.10). The results were similar for SARS-CoV-2 infection in all gestational trimesters and in different time periods that corresponded to dominance of different variants of the SARS-CoV-2 virus. Conclusions This population based study did not find any evidence of an association between SARS-CoV-2 infection during pregnancy and an increased risk of hypertension during pregnancy or pre-eclampsia.
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Affiliation(s)
- Anne K. Örtqvist
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Visby Hospital, Visby, Sweden
| | - Maria C. Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Elisabeth Dahlqvist
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kari Johansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sandström
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Siri E. Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
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Poli MC, Vial C, Rey-Jurado E, González N, Cortés LJ, Hormazabal J, Ramírez-Riffo C, de la Cruz J, Ulloa C. A Third Dose of SARS-CoV-2 mRNA Vaccine Improves Immune Response in Chronic Kidney Disease Patients. Vaccines (Basel) 2023; 11:vaccines11051012. [PMID: 37243116 DOI: 10.3390/vaccines11051012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Chronic kidney disease (CKD) patients have an increased risk of morbidity and mortality following SARS-CoV-2 infection. Vaccination in these patients is prioritized, and monitoring of the immune response is paramount to define further vaccination strategies. This prospective study included a cohort of 100 adult CKD patients: 48 with kidney transplant (KT) and 52 on hemodialysis without prior COVID-19. The patients were assessed for humoral and cellular immune responses after four months of an anti-SARS-CoV-2 primary two-dose vaccination scheme (CoronaVac or BNT162b2) and one month after a booster third dose of BNT162b2 vaccine. We identified poor cellular and humoral immune responses in the CKD patients after a primary vaccination scheme, and these responses were improved by a booster. Robust polyfunctional CD4+ T cell responses were observed in the KT patients after a booster, and this could be attributed to a higher proportion of the patients having been vaccinated with homologous BNT162b2 schemes. However, even after the booster, the KT patients exhibited lower neutralizing antibodies, attributable to specific immunosuppressive treatments. Four patients suffered severe COVID-19 despite three-dose vaccination, and all had low polyfunctional T-cell responses, underscoring the importance of this functional subset in viral protection. In conclusion, a booster dose of SARS-CoV-2 mRNA vaccine in CKD patients improves the impaired humoral and cellular immune responses observed after a primary vaccination scheme.
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Affiliation(s)
- Maria Cecilia Poli
- Departamento de Pediatría, Clínica Alemana de Santiago, Santiago 7650568, Chile
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7610658, Chile
| | - Cecilia Vial
- Programa Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7610658, Chile
| | - Emma Rey-Jurado
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7610658, Chile
| | - Natalia González
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7610658, Chile
- Programa Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7610658, Chile
| | - Lina Jimena Cortés
- Programa Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7610658, Chile
| | - Juan Hormazabal
- Programa Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7610658, Chile
| | - Carolina Ramírez-Riffo
- Programa Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7610658, Chile
| | - Javiera de la Cruz
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7610658, Chile
| | - Camilo Ulloa
- Departamento de Medicina Interna, Unidad de Nefrología y Trasplante Renal, Clínica Alemana de Santiago, Santiago 7650568, Chile
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Walklin CG, Young HML, Asghari E, Bhandari S, Billany RE, Bishop N, Bramham K, Briggs J, Burton JO, Campbell J, Castle EM, Chilcot J, Cooper N, Deelchand V, Graham-Brown MPM, Hamilton A, Jesky M, Kalra PA, Koufaki P, McCafferty K, Nixon AC, Noble H, Saynor ZL, Sothinathan C, Taal MW, Tollitt J, Wheeler DC, Wilkinson TJ, Macdonald JH, Greenwood SA. The effect of a novel, digital physical activity and emotional well-being intervention on health-related quality of life in people with chronic kidney disease: trial design and baseline data from a multicentre prospective, wait-list randomised controlled trial (kidney BEAM). BMC Nephrol 2023; 24:122. [PMID: 37131125 PMCID: PMC10152439 DOI: 10.1186/s12882-023-03173-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Physical activity and emotional self-management has the potential to enhance health-related quality of life (HRQoL), but few people with chronic kidney disease (CKD) have access to resources and support. The Kidney BEAM trial aims to evaluate whether an evidence-based physical activity and emotional wellbeing self-management programme (Kidney BEAM) leads to improvements in HRQoL in people with CKD. METHODS This was a prospective, multicentre, randomised waitlist-controlled trial, with health economic analysis and nested qualitative studies. In total, three hundred and four adults with established CKD were recruited from 11 UK kidney units. Participants were randomly assigned to the intervention (Kidney BEAM) or a wait list control group (1:1). The primary outcome was the between-group difference in Kidney Disease Quality of Life (KDQoL) mental component summary score (MCS) at 12 weeks. Secondary outcomes included the KDQoL physical component summary score, kidney-specific scores, fatigue, life participation, depression and anxiety, physical function, clinical chemistry, healthcare utilisation and harms. All outcomes were measured at baseline and 12 weeks, with long-term HRQoL and adherence also collected at six months follow-up. A nested qualitative study explored experience and impact of using Kidney BEAM. RESULTS 340 participants were randomised to Kidney BEAM (n = 173) and waiting list (n = 167) groups. There were 96 (55%) and 89 (53%) males in the intervention and waiting list groups respectively, and the mean (SD) age was 53 (14) years in both groups. Ethnicity, body mass, CKD stage, and history of diabetes and hypertension were comparable across groups. The mean (SD) of the MCS was similar in both groups, 44.7 (10.8) and 45.9 (10.6) in the intervention and waiting list groups respectively. CONCLUSION Results from this trial will establish whether the Kidney BEAM self management programme is a cost-effective method of enhancing mental and physical wellbeing of people with CKD. TRIAL REGISTRATION NCT04872933. Registered 5th May 2021.
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Affiliation(s)
- C G Walklin
- Renal Therapies, King's College Hospital NHS Trust, London, UK
| | - Hannah M L Young
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.
| | - E Asghari
- Department of Nephrology, Guy's and St Thomas' NHS Trust, London, UK
| | - S Bhandari
- Department of Nephrology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - R E Billany
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - N Bishop
- School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, UK
| | - K Bramham
- Department of Women's Health, King's College London, London, UK
| | - J Briggs
- Renal Therapies, King's College Hospital NHS Trust, London, UK
| | - J O Burton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - J Campbell
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - E M Castle
- School of Physiotherapy, Department of Health Sciences, Brunel University, London, UK
| | - J Chilcot
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - V Deelchand
- Department of Nephrology, Royal Free Hospital, London, UK
| | | | - A Hamilton
- Department of Nephrology, Royal Exeter Hospital, Devon, UK
| | - M Jesky
- Department of Nephrology, Nottingham NHS Trust, Nottingham, UK
| | - P A Kalra
- Department of Nephrology, Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - P Koufaki
- Dietetics, Nutrition and Biological Sciences, Queen Margaret University, Edinburgh, UK
| | - K McCafferty
- Department of Nephrology, Barts Health NHS Trust, London, UK
| | - A C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - H Noble
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Z L Saynor
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - C Sothinathan
- Department of Physiotherapy, Chelsea and Westminster NHS Trust, London, UK
| | - M W Taal
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - J Tollitt
- Department of Renal Medicine, University College London, London, UK
| | - D C Wheeler
- National Institute of Health Research Leicester Biomedical Research Centre , Leicester, UK
| | - T J Wilkinson
- Institute for Applied Human Physiology, Bangor University, Bangor, Gwynedd, UK
| | - J H Macdonald
- Faculty of life sciences and medicine, King's College London, London, UK
| | - S A Greenwood
- Renal Therapies, King's College Hospital NHS Trust, London, UK
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Zolotov E, Sigal A, Havrda M, Raskova M, Girsa D, Hochfeld U, Krátká K, Rychlík I. Unveiling the Unexpected: Why Doctors Should Look beyond the Lungs when Predicting COVID-19 Mortality. Kidney Blood Press Res 2023; 48:347-356. [PMID: 37166324 DOI: 10.1159/000530803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/27/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION The main objective of this study was to identify the best combination of admission day parameters for predicting COVID-19 mortality in hospitalized patients. Furthermore, we sought to compare the predictive capacity of pulmonary parameters to that of renal parameters for mortality from COVID-19. METHODS In this retrospective study, all patients admitted to a tertiary hospital between September 1st, 2020, and December 31st, 2020, who were clinically symptomatic and tested positive for COVID-19, were included. We gathered extensive data on patient admissions, including laboratory results, comorbidities, chest X-ray (CXR) images, and SpO2 levels, to determine their role in predicting mortality. Experienced radiologists evaluated the CXR images and assigned a score from 0 to 18 based on the severity of COVID-19 pneumonia. Further, we categorized patients into two independent groups based on their renal function using the RIFLE and KDIGO criteria to define the acute kidney injury (AKI) and chronic kidney disease (CKD) groups. The first group ("AKI&CKD") was subdivided into six subgroups: normal renal function (A); CKD grade 2+3a (B); AKI-DROP (C); CKD grade 3b (D); AKI-RISE (E); and grade 4 + 5 CKD (F). The second group was based only on estimated glomerular filtration rate (eGFR) at the admission, and thus it was divided into four grades: grade 1, grade 2+3a, grade 3b, and grade 4 + 5. RESULTS The cohort comprised 619 patients. Patients who died during hospitalization had a significantly higher mean radiological score compared to those who survived, with a p value <0.01. Moreover, we observed that the risk for mortality was significantly increased as renal function deteriorated, as evidenced by the AKI&CKD and eGFR groups (p < 0.001 for each group). Regarding mortality prediction, the area under the curve (AUC) for renal parameters (AKI&CKD group, eGFR group, and age) was found to be superior to that of pulmonary parameters (age, radiological score, SpO2, CRP, and D-dimer) with an AUC of 0.8068 versus 0.7667. However, when renal and pulmonary parameters were combined, the AUC increased to 0.8813. Optimal parameter combinations for predicting mortality from COVID-19 were identified for three medical settings: Emergency Medical Service (EMS), the Emergency Department, and the Internal Medicine Floor. The AUC for these settings was 0.7874, 0.8614, and 0.8813, respectively. CONCLUSIONS Our study demonstrated that selected renal parameters are superior to pulmonary parameters in predicting COVID-19 mortality for patients requiring hospitalization. When combining both renal and pulmonary factors, the predictive ability of mortality significantly improved. Additionally, we identified the optimal combination of factors for mortality prediction in three distinct settings: EMS, Emergency Department, and Internal Medicine Floor.
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Affiliation(s)
- Eli Zolotov
- Internal Medicine Department, Hackensack University Medical Center, Hackensack, New Jersey, USA,
- Third Faculty of Medicine, Charles University, Prague, Czechia,
| | - Anat Sigal
- Third Faculty of Medicine, Charles University, Prague, Czechia
- Pediatrics Department, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Martin Havrda
- Department of Internal Medicine, Faculty Hospital Královské Vinohrady, Prague, Czechia
| | - Maria Raskova
- Department of Radiology, Faculty Hospital Královské Vinohrady, Prague, Czechia
| | - David Girsa
- Third Faculty of Medicine, Charles University, Prague, Czechia
- Department of Radiology, Faculty Hospital Královské Vinohrady, Prague, Czechia
- Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Uri Hochfeld
- Internal Medicine Department, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Karolína Krátká
- Department of Internal Medicine, Faculty Hospital Královské Vinohrady, Prague, Czechia
| | - Ivan Rychlík
- Third Faculty of Medicine, Charles University, Prague, Czechia
- Department of Internal Medicine, Faculty Hospital Královské Vinohrady, Prague, Czechia
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Raihan MJ, Khan MAM, Kee SH, Nahid AA. Detection of the chronic kidney disease using XGBoost classifier and explaining the influence of the attributes on the model using SHAP. Sci Rep 2023; 13:6263. [PMID: 37069256 PMCID: PMC10110580 DOI: 10.1038/s41598-023-33525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 04/14/2023] [Indexed: 04/19/2023] Open
Abstract
Chronic kidney disease (CKD) is a condition distinguished by structural and functional changes to the kidney over time. Studies show that 10% of adults worldwide are affected by some kind of CKD, resulting in 1.2 million deaths. Recently, CKD has emerged as a leading cause of mortality worldwide, making it necessary to develop a Computer-Aided Diagnostic (CAD) system to diagnose CKD automatically. Machine Learning (ML) based CAD system can be used by a clinician to automatically diagnoses mass people. Since ML models are considered a black box, it is also necessary to expose influential causes behind a model's prediction of a particular output. So that, a doctor can make a more rational decision based on the model's output and analysis of the features influence on the model. In this paper, we have used the XGBoost as the ML classifier to predict whether a patient has CKD or not. Using the XGBoost classifier, we have obtained an accuracy, precision, recall, and F1 score of [Formula: see text] and [Formula: see text] respectively using all [Formula: see text] features. Furthermore, we have used Biogeography Based Optimization (BBO) algorithm to find an effective subset of the features. The BBO algorithm selected almost half of the initial features. We have obtained an accuracy, precision, recall, and F1 score of [Formula: see text] and [Formula: see text] respectively using only 13 features selected by the BBO algorithm. Finally, we have explained the impact of the feature on the ML models using the SHapley Additive exPlanations (SHAP) analysis. Using SHAP analysis and BBO algorithm, we have found that hemoglobin and albumin mostly contribute to the detection of CKD.
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Affiliation(s)
- Md Johir Raihan
- Electronics and Communication Engineering Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Md Al-Masrur Khan
- Department of ICT Integrated Ocean Smart Cities Engineering, Dong-A University, Busan, 49315, South Korea
| | - Seong-Hoon Kee
- Department of ICT Integrated Ocean Smart Cities Engineering, Dong-A University, Busan, 49315, South Korea
| | - Abdullah-Al Nahid
- Electronics and Communication Engineering Discipline, Khulna University, Khulna, 9208, Bangladesh.
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Salgueira M, Almenara M, Gutierrez-Pizarraya A, Belmar L, Labrador PJ, Melero R, Serrano ML, Portolés JM, Molina A, Poch E, Ramos N, Lloret MJ, Echarri R, Díaz Mancebo R, González-Lara DM, Sánchez JE, Soler MJ. [Characterization of hospitalized patients with acute kidney injury associated with COVID-19 in Spain: Renal replacement therapy and mortality. FRA-COVID SEN Registry Data]. Nefrologia 2023:S0211-6995(23)00057-7. [PMID: 37359780 PMCID: PMC10076078 DOI: 10.1016/j.nefro.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/31/2023] [Indexed: 06/28/2023] Open
Abstract
Background and objectives Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI-COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed. Material and method In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality. Results Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60-78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases.The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4-10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41) and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, shorter kidney injury onset and recovery time (p < 0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55). Conclusions Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor for mortality.
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Affiliation(s)
- Mercedes Salgueira
- Unidad de Nefrología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Marina Almenara
- Unidad de Nefrología, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - Lara Belmar
- Unidad de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Pedro Jesús Labrador
- Unidad de Nefrología, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - Rosa Melero
- Unidad de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - María Luisa Serrano
- Unidad de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - José María Portolés
- Unidad de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Alicia Molina
- Unidad de Nefrología, Hospital Clinic, Barcelona, España
| | - Esteban Poch
- Unidad de Nefrología, Hospital Clinic, Barcelona, España
| | - Natalia Ramos
- Unidad de Nefrología, Hospital Vall d'Hebron, Barcelona, España
| | | | - Rocío Echarri
- Unidad de Nefrología, Hospital Universitario Infanta Sofía, Madrid, España
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Cugnata F, Scarale MG, De Lorenzo R, Simonini M, Citterio L, Querini PR, Castagna A, Di Serio C, Lanzani C. Profiling Covid-19 patients with respect to level of severity: an integrated statistical approach. Sci Rep 2023; 13:5498. [PMID: 37015962 PMCID: PMC10071456 DOI: 10.1038/s41598-023-32089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
A full understanding of the characteristics of Covid-19 patients with a better chance of experiencing poor vital outcomes is critical for implementing accurate and precise treatments. In this paper, two different advanced data-driven statistical approaches along with standard statistical methods have been implemented to identify groups of patients most at-risk for death or severity of respiratory distress. First, the tree-based analysis allowed to identify profiles of patients with different risk of in-hospital death (by Survival Tree-ST analysis) and severity of respiratory distress (by Classification and Regression Tree-CART analysis), and to unravel the role on risk stratification of highly dependent covariates (i.e., demographic characteristics, admission values and comorbidities). The ST analysis identified as the most at-risk group for in-hospital death the patients with age > 65 years, creatinine [Formula: see text] 1.2 mg/dL, CRP [Formula: see text] 25 mg/L and anti-hypertensive treatment. Based on the CART analysis, the subgroups most at-risk of severity of respiratory distress were defined by patients with creatinine level [Formula: see text] 1.2 mg/dL. Furthermore, to investigate the multivariate dependence structure among the demographic characteristics, the admission values, the comorbidities and the severity of respiratory distress, the Bayesian Network analysis was applied. This analysis confirmed the influence of creatinine and CRP on the severity of respiratory distress.
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Affiliation(s)
- Federica Cugnata
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Giovanna Scarale
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Rebecca De Lorenzo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Simonini
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorena Citterio
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere Querini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy.
- Biomedical Faculty, Università Della Svizzera Italiana, Lugano, Switzerland.
| | - Chiara Lanzani
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Roushani J, Thomas D, Oliver MJ, Ip J, Yeung A, Tang Y, Brimble KS, Levin A, Hladunewich MA, Cooper R, Blake PG. Clinical Outcomes and Vaccine Effectiveness for SARS-CoV-2 Infection in People Attending Advanced CKD Clinics: A Retrospective Provincial Cohort Study. Clin J Am Soc Nephrol 2023; 18:465-474. [PMID: 36795940 PMCID: PMC10103334 DOI: 10.2215/cjn.0000000000000087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND People with advanced CKD are at high risk of mortality and morbidity from coronavirus disease 2019 (COVID-19). We measured rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe outcomes in a large population attending advanced CKD clinics during the first 21 months of the pandemic. We examined risk factors for infection and case fatality, and we assessed vaccine effectiveness in this population. METHODS In this retrospective cohort study, we analyzed data on demographics, diagnosed SARS-CoV-2 infection rates, outcomes, and associated risk factors, including vaccine effectiveness, for people attending a province-wide network of advanced CKD clinics during the first four waves of the pandemic in Ontario, Canada. RESULTS In a population of 20,235 patients with advanced CKD, 607 were diagnosed with SARS-CoV-2 infection over 21 months. The case fatality rate at 30 days was 19% overall but declined from 29% in the first wave to 14% in the fourth. Hospitalization and intensive care unit (ICU) admission rates were 41% and 12%, respectively, and 4% started long-term dialysis within 90 days. Significant risk factors for diagnosed infection on multivariable analysis included lower eGFR, higher Charlson Comorbidity Index, attending advanced CKD clinics for more than 2 years, non-White ethnicity, lower income, living in the Greater Toronto Area, and long-term care home residency. Being doubly vaccinated was associated with lower 30-day case fatality rate (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.03 to 0.52). Older age (OR, 1.06 per year; 95% CI, 1.04 to 1.08) and higher Charlson Comorbidity Index (OR, 1.11 per unit; 95% CI, 1.01 to 1.23) were associated with higher 30-day case fatality rate. CONCLUSIONS People attending advanced CKD clinics and diagnosed with SARS-CoV-2 infection in the first 21 months of the pandemic had high case fatality and hospitalization rates. Fatality rates were significantly lower in those who were doubly vaccinated. PODCAST This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_04_10_CJN10560922.mp3.
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Affiliation(s)
- Jian Roushani
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Doneal Thomas
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Matthew J. Oliver
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane Ip
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Angie Yeung
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Yiwen Tang
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Kenneth Scott Brimble
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Adeera Levin
- British Columbia Provincial Renal Agency, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Michelle A. Hladunewich
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Cooper
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Peter G. Blake
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Carriazo S, Ortiz A, Fernandez-Fernandez B. First-Line Therapy for Type 2 Diabetes With Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists. Ann Intern Med 2023; 176:eL230005. [PMID: 37068289 DOI: 10.7326/l23-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Affiliation(s)
- Sol Carriazo
- Department of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
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Trionfetti F, Marchant V, González-Mateo GT, Kawka E, Márquez-Expósito L, Ortiz A, López-Cabrera M, Ruiz-Ortega M, Strippoli R. Novel Aspects of the Immune Response Involved in the Peritoneal Damage in Chronic Kidney Disease Patients under Dialysis. Int J Mol Sci 2023; 24:5763. [PMID: 36982834 PMCID: PMC10059714 DOI: 10.3390/ijms24065763] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
Chronic kidney disease (CKD) incidence is growing worldwide, with a significant percentage of CKD patients reaching end-stage renal disease (ESRD) and requiring kidney replacement therapies (KRT). Peritoneal dialysis (PD) is a convenient KRT presenting benefices as home therapy. In PD patients, the peritoneum is chronically exposed to PD fluids containing supraphysiologic concentrations of glucose or other osmotic agents, leading to the activation of cellular and molecular processes of damage, including inflammation and fibrosis. Importantly, peritonitis episodes enhance peritoneum inflammation status and accelerate peritoneal injury. Here, we review the role of immune cells in the damage of the peritoneal membrane (PM) by repeated exposure to PD fluids during KRT as well as by bacterial or viral infections. We also discuss the anti-inflammatory properties of current clinical treatments of CKD patients in KRT and their potential effect on preserving PM integrity. Finally, given the current importance of coronavirus disease 2019 (COVID-19) disease, we also analyze here the implications of this disease in CKD and KRT.
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Affiliation(s)
- Flavia Trionfetti
- Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
- Department of Epidemiology, Preclinical Research and Advanced Diagnostics, National Institute for Infectious Diseases L., Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
| | - Vanessa Marchant
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz-Universidad Autónoma Madrid, 28040 Madrid, Spain
- REDINREN/RICORS2040, 28029 Madrid, Spain
| | - Guadalupe T. González-Mateo
- Cell-Cell Communication & Inflammation Unit, Centre for Molecular Biology “Severo Ochoa” (CSIC-UAM), 28049 Madrid, Spain
- Premium Research, S.L., 19005 Guadalajara, Spain
| | - Edyta Kawka
- Department of Pathophysiology, Poznan University of Medical Sciences, 10 Fredry St., 61-701 Poznan, Poland
| | - Laura Márquez-Expósito
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz-Universidad Autónoma Madrid, 28040 Madrid, Spain
- REDINREN/RICORS2040, 28029 Madrid, Spain
| | - Alberto Ortiz
- IIS-Fundación Jiménez Díaz-Universidad Autónoma Madrid, 28040 Madrid, Spain
| | - Manuel López-Cabrera
- Cell-Cell Communication & Inflammation Unit, Centre for Molecular Biology “Severo Ochoa” (CSIC-UAM), 28049 Madrid, Spain
| | - Marta Ruiz-Ortega
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz-Universidad Autónoma Madrid, 28040 Madrid, Spain
- REDINREN/RICORS2040, 28029 Madrid, Spain
| | - Raffaele Strippoli
- Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
- Department of Epidemiology, Preclinical Research and Advanced Diagnostics, National Institute for Infectious Diseases L., Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
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