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Ehlerding G, Ries W, Kempkes-Koch M, Ziegler E, Ronová P, Krizsán M, Verešová J, Böke M, Erlenkötter A, Nitschel R, Zawada AM, Kennedy JP, Braun J, Larkin JW, Korolev N, Lang T, Ottillinger B, Stauss-Grabo M, Griesshaber B. Randomized investigation of increased dialyzer membrane hydrophilicity on hemocompatibility and performance. BMC Nephrol 2024; 25:220. [PMID: 38987671 PMCID: PMC11234537 DOI: 10.1186/s12882-024-03644-5] [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: 04/22/2024] [Accepted: 06/18/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Hemodialyzers should efficiently eliminate small and middle molecular uremic toxins and possess exceptional hemocompatibility to improve well-being of patients with end-stage kidney disease. However, performance and hemocompatibility get compromised during treatment due to adsorption of plasma proteins to the dialyzer membrane. Increased membrane hydrophilicity reduces protein adsorption to the membrane and was implemented in the novel FX CorAL dialyzer. The present randomized controlled trial compares performance and hemocompatibility profiles of the FX CorAL dialyzer to other commonly used dialyzers applied in hemodiafiltration treatments. METHODS This prospective, open, controlled, multicentric, interventional, crossover study randomized stable patients on post-dilution online hemodiafiltration (HDF) to FX CorAL 600, FX CorDiax 600 (both Fresenius Medical Care) and xevonta Hi 15 (B. Braun) each for 4 weeks. Primary outcome was β2-microglobulin removal rate (β2-m RR). Non-inferiority and superiority of FX CorAL versus comparators were tested. Secondary endpoints were RR and/or clearance of small and middle molecules, and intra- and interdialytic profiles of hemocompatibility markers, with regards to complement activation, cell activation/inflammation, platelet activation and oxidative stress. Further endpoints were patient reported outcomes (PROs) and clinical safety. RESULTS 82 patients were included and 76 analyzed as intention-to-treat (ITT) population. FX CorAL showed the highest β2-m RR (76.28%), followed by FX CorDiax (75.69%) and xevonta (74.48%). Non-inferiority to both comparators and superiority to xevonta were statistically significant. Secondary endpoints related to middle molecules corroborated these results; performance for small molecules was comparable between dialyzers. Regarding intradialytic hemocompatibility, FX CorAL showed lower complement, white blood cell, and platelet activation. There were no differences in interdialytic hemocompatibility, PROs, or clinical safety. CONCLUSIONS The novel FX CorAL with increased membrane hydrophilicity showed strong performance and a favorable hemocompatibility profile as compared to other commonly used dialyzers in clinical practice. Further long-term investigations should examine whether the benefits of FX CorAL will translate into improved cardiovascular and mortality endpoints. TRIAL REGISTRATION eMPORA III registration on 19/01/2021 at ClinicalTrials.gov (NCT04714281).
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Affiliation(s)
- Götz Ehlerding
- Zentrum für Nieren-, Hochdruck- und Stoffwechselerkrankungen, 30453, Hannover, Germany
| | - Wolfgang Ries
- Diakonissenkrankenhaus, Innere Medizin, Abtlg. Nephrologie, 24939, Flensburg, Germany
| | | | | | - Petra Ronová
- Fresenius Nephrocare Praha 9, Praha, 19061, Czechia
| | - Mária Krizsán
- Péterfy II. Dialízis Központ, Budapest, 1077, Hungary
| | - Jana Verešová
- Fresenius Nephrocare Nymburk, Nymburk, 28802, Czechia
| | - Mária Böke
- Váci Dialízis Központ, Vác, 2600, Hungary
| | - Ansgar Erlenkötter
- Fresenius Medical Care Deutschland GmbH, Biosciences, VS Dialyzers, Care Enablement, 66606, St. Wendel, Germany
| | - Robert Nitschel
- Fresenius Medical Care Deutschland GmbH, Biosciences, VS Dialyzers, Care Enablement, 66606, St. Wendel, Germany
| | - Adam M Zawada
- Fresenius Medical Care Deutschland GmbH, Product Development, VS Dialyzers, Care Enablement, 66606, St. Wendel, Germany
| | - James P Kennedy
- Fresenius Medical Care Deutschland GmbH, Product Development, VS Dialyzers, Care Enablement, 66606, St. Wendel, Germany
| | - Jennifer Braun
- Fresenius Medical Care Deutschland GmbH, Global Biomedical Evidence Generation, Global Medical Office, 61352, Bad Homburg, Germany
| | - John W Larkin
- Fresenius Medical Care, Global Medical Office, Waltham, MA, USA
| | - Natalia Korolev
- Fresenius Medical Care Deutschland GmbH, Global Biomedical Evidence Generation, Global Medical Office, 61352, Bad Homburg, Germany
| | - Thomas Lang
- Fresenius Medical Care Deutschland GmbH, Global Biomedical Evidence Generation, Global Medical Office, 61352, Bad Homburg, Germany
| | | | - Manuela Stauss-Grabo
- Fresenius Medical Care Deutschland GmbH, Global Biomedical Evidence Generation, Global Medical Office, 61352, Bad Homburg, Germany
| | - Bettina Griesshaber
- Fresenius Medical Care Deutschland GmbH, Global Biomedical Evidence Generation, Global Medical Office, 61352, Bad Homburg, Germany.
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Kardiasyah A, Syarani F, Bihar S, Lubis ND, Mutiara E, Syahputra H. Relationship between interleukin-6 (IL-6) levels and chest X-ray severity scoring in COVID-19 patients. NARRA J 2024; 4:e690. [PMID: 38798831 PMCID: PMC11125309 DOI: 10.52225/narra.v4i1.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/14/2024] [Indexed: 05/29/2024]
Abstract
The severity of coronavirus disease 2019 (COVID-19) may be measured by interleukin-6 (IL-6) and chest X-rays. Brixia score of the chest radiographs is usually used to monitor COVID-19 patients' lung problems. The aim of this study was to demonstrate the relationship between IL-6 levels and chest radiographs (Brixia score) that represent COVID-19 severity. A retrospective cohort study was conducted among COVID-19 patients who had a chest X-ray and examination of IL-6 levels at H. Adam Malik General Hospital, Medan, Indonesia. A multinomial logistic regression analysis was conducted to evaluate the association between IL-6 levels and the severity of the chest radiograph. A total of 76 COVID-19 patients were included in the study and 39.5% of them were 60-69 years old, with more than half were female (52.6%). A total of 17.1%, 48.7%, and 34.2% had IL-6 level of <7 pg/mL, 7-50 pg/mL and >50 pg/mL, respectively. There were 39.5%, 36.8% and 23.7% of the patients had mild, moderate and severe chest X-rays based on Brixia score, respectively. Statistics analysis revealed that moderate (OR: 1.77; 95% CI: 1.05- 3.32) and severe (OR: 1.33; 95% CI: 1.03-3.35) lung conditions in the chest X-rays were significantly associated with IL-6 levels of 7-50 pg/mL. IL-6 more than 50 pg/mL was associated with severe chest X-ray condition (OR: 1.97; 95% CI: 1.15-3.34). In conclusion, high IL-6 levels significantly reflected COVID-19 severity through chest X-rays in COVID-19 patients.
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Affiliation(s)
- Alzi Kardiasyah
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- Department of Pulmonology and Respiratory Medicine, Universitas Sumatera Utara General Hospital, Medan, Indonesia
| | - Fajrinur Syarani
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- Department of Pulmonology and Respiratory Medicine, Universitas Sumatera Utara General Hospital, Medan, Indonesia
| | - Syamsul Bihar
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- Department of Pulmonology and Respiratory Medicine, Universitas Sumatera Utara General Hospital, Medan, Indonesia
| | - Netty D. Lubis
- Department of Radiology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- Department of Radiology, Universitas Sumatera Utara General Hospital, Medan, Indonesia
| | - Erna Mutiara
- Department of Community and Preventive Medicine, Faculty of Public Health, Universitas Sumatera Utara, Medan, Indonesia
| | - Hafid Syahputra
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Universitas Sumatera Utara, Medan, Indonesia
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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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Spasiano A, De Luca G, Bartoli G, Dello Strologo A, Arena M, Grandaliano G. COVID-19: The Dysregulated Response to Infection - Why Consider Polymethylmethacrylate Membrane in Hemodialysis Patients? Blood Purif 2023; 53:373-378. [PMID: 37844557 DOI: 10.1159/000533738] [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: 04/13/2023] [Accepted: 08/19/2023] [Indexed: 10/18/2023]
Abstract
Since SARS-CoV-2 spread through China at the end of 2019, COVID-19 has been probably the most difficult challenge in the last decades for healthcare systems all around the world, still representing a danger for fragile patients with different comorbidities. Chronic dialysis patients affected by COVID-19 experienced severe disease with a higher mortality rate compared to the general population. Morbidity and mortality of this severe acute respiratory syndrome depend on both acute respiratory failure and systemic immunological involvement with consequent inflammation-mediated injury. Indeed, the most important determining factor of COVID-19 severity is the strength of the so-called "cytokine storm" associated with SARS-CoV-2 infection. Therefore, this severe infection varies clinically from an asymptomatic condition to a generalized and violent inflammatory response and acute respiratory distress syndrome, with consequent pulmonary interstitial edema and a high risk of multi-organ failure. The use of extracorporeal therapies targeting cytokine clearance to improve patients' outcomes has been widely debated, especially in end-stage kidney disease's patients on maintenance dialysis or in individuals affected by acute kidney injury admitted to intensive care units. Different studies were conducted to demonstrate how specific dialyzers could decrease the COVID-19 inflammatory state. The aim of this narrative review was to summarize main studies about this topic, focusing primarily on the role of polymethylmethacrylate dialyzer and underlining pros and cons of this sorbent.
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Affiliation(s)
- Andrea Spasiano
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianmarco De Luca
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia Bartoli
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Dello Strologo
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Arena
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Grandaliano
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Quiroga B, Soler MJ, Ortiz A, Sequera PD. Lessons from SENCOVAC: A prospective study evaluating the response to SARS-CoV-2 vaccination in the CKD spectrum. Nefrologia 2022; 43:S0211-6995(22)00201-6. [PMID: 36540904 PMCID: PMC9756643 DOI: 10.1016/j.nefro.2022.12.006] [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: 11/15/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] 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, 08035 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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Interleukin-6 and Outcome of Chronic Hemodialysis Patients with SARS-CoV-2 Pneumonia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111659. [PMID: 36422198 PMCID: PMC9699479 DOI: 10.3390/medicina58111659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
Background and Objectives: Chronic hemodialysis (CHD) patients are at increased risk of SARS-CoV-2 infection and the related complications and mortality of COVID-19 due to the high rate of comorbidities combined with advanced age. This observational study investigated the clinical manifestations of SARS-CoV-2 infection in CHD and the risk factors for patients′ death. Materials and Methods: The study included 26 CHD patients with SARS-CoV-2 pneumonia detected by positive RT-PCR on nasopharyngeal swabs and high-resolution computed tomography at hospital admission, aged 71 + 5.9 years, 14 of which (53.8%) were male, 20 (77%) under hemodiafiltration, and 6 (23%) on standard hemodialysis, with a median follow-up of 30 days. Results: Simple logistic regression analysis revealed that the factors associated with a higher risk of death were older age (OR: 1.133; 95%CI: 1.028−1.326, p = 0.0057), IL-6 levels at admission (OR: 1.014; 95%CI: 1.004−1.028, p = 0.0053), and C-reactive protein (OR: 1.424; 95%CI: 1.158−2.044, p < 0.0001). In the multiple logistic regression model, circulating IL-6 values at admission remained the only significant prognosticator of death. The ROC curve indicated the discriminatory cut-off value of 38.20 pg/mL of blood IL-6 for predicting death in chronic hemodialysis patients with SARS-CoV-2 pneumonia (sensitivity: 100%; specificity: 78%; AUC: 0.8750; p = 0.0027). Conclusions: This study identified a threshold of IL-6 levels at hospital admission for death risk in CHD patients with SARS-CoV-2 pneumonia. This might represent a valuable outcome predictor, feasibly better than other clinical, radiological, or laboratory parameters and preceding the IL-6 peak, which is unpredictable.
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Donati G, Gasperoni L, Napoli M, Scrivo A, Zappulo F, Abenavoli C, Hu L, Angelini A, Di Nunzio M, Tringali E, Cingolani A, Marchegiani BC, Rigotti A, La Manna G. Anti-Inflammatory Approach in Chronic Dialysis Patients with SARS-CoV-2: ATA or PMMA Dialyzers? Blood Purif 2022; 52:210-218. [PMID: 36323242 PMCID: PMC9782266 DOI: 10.1159/000526319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/21/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION High-flux hemodialysis membranes may modulate the cytokine storm of SARS-CoV-2, but their impact on chronic hemodialysis (CHD) patients is unknown. The aim of the study was the evaluation of asymmetric cellulose triacetate (ATA) and polymethylmethacrylate (PMMA) dialyzers on inflammatory markers and clinical outcomes in CHD patients with SARS-CoV-2. METHODS A prospective, observational study on CHD patients with SARS-CoV-2 was carried out. Patients were enrolled from March 2020 to May 2021. Pre- and postdialysis C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) were determined at each session. Patients who underwent on-line hemodiafiltration (OLHDF) with a PMMA dialyzer were compared with those treated with OLHDF with a ATA dialyzer. The primary endpoint was the differences in the reduction ratio per session (RR) of CRP, PCT, IL-6, and IL-6 RR >25%. RESULTS We consecutively enrolled 74 CHD patients with COVID-19, 48 were treated with ATA membrane, and 26 with PMMA. Median IL-6 RR was higher in the ATA group compared to PMMA (17.08%, IQR -9.0 to 40.0 vs. 2.95%, IQR -34.63 to 27.32). Median CRP RR was 7.77% (IQR 2.47-13.77) in the ATA group versus 4.8% (IQR -2.65 to 11.38) in the PMMA group (p = 0.0017). Median PCT-RR% was 77.38% (IQR 70.92-82.97) in ATA group versus 54.59% (IQR 42.62-63.16) in the PMMA group (p < 0.0001). A multiple logistic regression analysis with IL-6 RR >25% as the outcome including the membrane employed, pre-dialysis IL-6, CRP, PCT, and ferritin showed that ATA led to a higher probability to reach the outcome (OR 1.891, 95% CI 1.273-2.840, p = 0.0018) while higher CRP favors the risk of lower IL-6 RR values (OR 0.910, 95% CI 0.868-0.949, p ≤ 0.0001). CONCLUSIONS In SARS-CoV-2 CHD patients treated with OLHDF, ATA showed a better anti-inflammatory profile, regarding IL-6 RR, compared to PMMA.
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Affiliation(s)
- Gabriele Donati
- Nephrology, Dialysis and Renal Transplantation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy,Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Gasperoni
- Nephrology and Dialysis Unit, Azienda USL della Romagna, Infermi Hospital, Rimini, Italy
| | - Marianna Napoli
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Anna Scrivo
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Fulvia Zappulo
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Chiara Abenavoli
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Lilio Hu
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Andrea Angelini
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Miriam Di Nunzio
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Edoardo Tringali
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Alessandra Cingolani
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Beatrice Claudia Marchegiani
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Angelo Rigotti
- Nephrology and Dialysis Unit, Azienda USL della Romagna, Infermi Hospital, Rimini, Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy,*Gaetano La Manna,
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Carriazo S, Aparicio-Madre MI, Tornero-Molina F, Fernández-Lucas M, Paraiso-Cuevas V, González-Parra E, del Río-Gallegos F, Marques-Vidas M, Alcázar-Arroyo R, Martins-Muñoz J, Sánchez-Villanueva R, Gil-Casares B, Gutiérrez-Martínez E, Martínez-Rubio MP, Ortiz A. Impact of different COVID-19 waves on kidney replacement therapy epidemiology and mortality: REMER 2020. Nephrol Dial Transplant 2022; 37:2253-2263. [PMID: 35927791 PMCID: PMC9384646 DOI: 10.1093/ndt/gfac234] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Kidney replacement therapy (KRT) confers the highest risk of death from coronavirus disease 2019 (COVID-19). However, most data refer to the early pandemic waves. Whole-year analysis compared with prior secular trends are scarce. METHODS We present the 2020 REMER Madrid KRT registry, corresponding to the Spanish Region hardest hit by COVID-19. RESULTS In 2020, KRT incidence decreased 12% versus 2019, while KRT prevalence decreased by 1.75% for the first time since records began and the number of kidney transplants (KTs) decreased by 16%. Mortality on KRT was 10.2% (34% higher than the mean for 2008-2019). The 2019-2020 increase in mortality was larger for KTs (+68%) than for haemodialysis (+24%) or peritoneal dialysis (+38%). The most common cause of death was infection [n = 419 (48% of deaths)], followed by cardiovascular [n = 200 (23%)]. Deaths from infection increased by 167% year over year and accounted for 95% of excess deaths in 2020 over 2019. COVID-19 was the most common cause of death (68% of infection deaths, 33% of total deaths). The bulk of COVID-19 deaths [209/285 (73%)] occurred during the first COVID-19 wave, which roughly accounted for the increased mortality in 2020. Being a KT recipient was an independent risk factor for COVID-19 death. CONCLUSIONS COVID-19 negatively impacted the incidence and prevalence of KRT, but the increase in KRT deaths was localized to the first wave of the pandemic. The increased annual mortality argues against COVID-19 accelerating the death of patients with short life expectancy and the temporal pattern of COVID-19 mortality suggests that appropriate healthcare may improve outcomes.
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Affiliation(s)
- Sol Carriazo
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040; Madrid, Spain
| | - Manuel I Aparicio-Madre
- RЄMЭЯ. Oficina Regional de Coordinación de Trasplantes de la Comunidad de Madrid, Madrid, Spain
| | | | | | | | - Emilio González-Parra
- 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, 28049 Madrid, Spain
| | | | - María Marques-Vidas
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Hospital Puerta de Hierro; Madrid, Spain
| | | | | | | | | | | | | | - 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, 28049 Madrid, Spain
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Jafrin S, Aziz MA, Islam MS. Elevated Levels of Pleiotropic Interleukin-6 (IL-6) and Interleukin-10 (IL-10) are Critically Involved With the Severity and Mortality of COVID-19: An Updated Longitudinal Meta-Analysis and Systematic Review on 147 Studies. Biomark Insights 2022; 17:11772719221106600. [PMID: 35747885 PMCID: PMC9209786 DOI: 10.1177/11772719221106600] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/26/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives Disruption in the natural immune reaction due to SARS-CoV-2 infection can initiate a potent cytokine storm among COVID-19 patients. An elevated level of IL-6 and IL-10 during a hyperinflammatory state plays a vital role in increasing the risk of severity and mortality. In this study, we aimed to evaluate the potential of circulating IL-6 and IL-10 levels as biomarkers for detecting the severity and mortality of COVID-19. Methods This study was conducted according to the Cochrane Handbook and PRISMA guidelines. Authorized databases were searched to extract suitable studies using specific search terms. RevMan 5.4 was applied for performing the meta-analysis. Mean differences in IL-6 and IL-10 levels were calculated among COVID-19 patients via a random-effects model. NOS scoring, publication bias and sensitivity analyses were checked to ensure study quality. Results A total of 147 studies were selected, with 31 909 COVID-19 patients under investigation. In the severity analysis, the mean concentration of IL-6 was significantly higher in the severe COVID-19 cases than in the non-severe cases (MD: 19.98; P < .001; 95% CI: 17.56, 22.40). Similar result was observed for IL-10 mean concentration in severe COVID-19 cases (MD: 1.35; P < .001; 95% CI: 0.90, 1.80). In terms of mortality analysis, circulating IL-6 showed sharp elevation in the deceased patients (MD: 42.11; P < .001; 95% CI: 36.86, 47.36). IL-10 mean concentration was higher in the dead patients than in the survived patients (MD: 4.79; P < .001; 95% CI: 2.83, 6.75). Publication bias was not found except for comparing IL-6 levels with disease severity. Sensitivity analysis also reported no significant deviation from the pooled outcomes. Conclusions Elevated levels of circulating IL-6 and IL-10 signifies worsening of COVID-19. To monitor the progression of SARS-CoV-2 infection, IL-6 and IL-10 should be considered as potential biomarkers for severity and mortality detection in COVID-19. Systematic review registration INPLASY registration number: INPLASY202240046.
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Affiliation(s)
- Sarah Jafrin
- Laboratory of Pharmacogenomics and Molecular Biology, Department of Pharmacy, Faculty of Science, Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
| | - Md Abdul Aziz
- Department of Pharmacy, Faculty of Pharmacy and Health Sciences, State University of Bangladesh, Dhaka, Bangladesh
| | - Mohammad Safiqul Islam
- Laboratory of Pharmacogenomics and Molecular Biology, Department of Pharmacy, Faculty of Science, Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
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10
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Wang F, Ao G, Wang Y, Liu F, Bao M, Gao M, Zhou S, Qi X. Risk factors for mortality in hemodialysis patients with COVID-19: a systematic review and meta-analysis. Ren Fail 2021; 43:1394-1407. [PMID: 34629011 PMCID: PMC8510603 DOI: 10.1080/0886022x.2021.1986408] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background New evidence from studies on risk factors for mortality in hemodialysis (HD) patients with COVID-19 became available. We aimed to review the clinical risk factors for fatal outcomes in these patients. Methods We performed meta-analysis using the PubMed, EMBASE, and Cochrane databases. A fixed- or random-effects model was used for calculating heterogeneity. We used contour-enhanced funnel plot and Egger’s tests to assess potential publication bias. Results Twenty-one studies were included. The proportion of males was lower in the survivor group than in the non-survivor group (OR = 0.75, 95% CI [0.61, 0.94]). The proportion of respiratory diseases was significantly lower in the survivor group than in the non-survivor group (OR = 0.42, 95% CI [0.29, 0.60]). The proportion of patients with fever, cough, and dyspnea was significantly lower in the survivor group (fever: OR = 0.53, 95% CI [0.31, 0.92]; cough: OR = 0.50, 95% CI [0.38, 0.65]; dyspnea: OR = 0.25, 95% CI [0.14, 0.47]) than in the non-survivor group. Compared with the non-survivor group, the survivor group had higher albumin and platelet levels and lower leucocyte counts. Conclusions Male patients might have a higher risk of developing severe COVID-19. Comorbidities, such as respiratory diseases could also greatly influence the clinical prognosis of COVID-19. Clinical features, such as fever, dyspnea, cough, and abnormal platelet, leucocyte, and albumin levels, could imply eventual death. Our findings will help clinicians identify markers for the detection of high mortality risk in HD patients at an early stage of COVID-19.
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Affiliation(s)
- Fengping Wang
- Department of Nephrology, Chengdu Second People's Hospital, Chengdu, PR China
| | - Guangyu Ao
- Department of Nephrology, Chengdu First People's Hospital, Chengdu, PR China
| | - Yushu Wang
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, PR China.,Chengdu West China Clinical Research Center Co., Ltd, Chengdu, PR China
| | - Fuqiang Liu
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, PR China
| | - Mulong Bao
- Department of Intensive Care Unit, Chengdu First People's Hospital, Chengdu, PR China
| | - Ming Gao
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, PR China
| | - Shulu Zhou
- Department of Nephrology, Chengdu First People's Hospital, Chengdu, PR China
| | - Xin Qi
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & the Third People's Hospital of Chengdu, Chengdu, PR China
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11
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Toda M, Fujii K, Yoshifuji A, Kondo Y, Itoh K, Sekine K, Kikuchi T, Ryuzaki M. Clinical efficacy and safety of combination therapy of tocilizumab and steroid pulse therapy for critical COVID-19 in HD patients. Clin Exp Nephrol 2021; 26:75-85. [PMID: 34436742 PMCID: PMC8390024 DOI: 10.1007/s10157-021-02126-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Critical coronavirus disease 2019 (COVID-19) has a high fatality rate, especially in hemodialysis (HD) patients, with this poor prognosis being caused by systemic hyperinflammation; cytokine storms. Steroid pulse therapy or tocilizumab (TCZ) have insufficient inhibitory effects against cytokine storms in critical cases. This study evaluated the clinical effects and safety of combining steroid pulse therapy and TCZ. METHODS From September 2020 to May 2021, 201 patients with COVID-19 were admitted to our hospital. Before February 2021, patients with an oxygen demand exceeding 8 L/min were intubated and treated with standard therapy (dexamethasone and antiviral therapy). After February 2021, patients underwent high-flow nasal cannula oxygen therapy and were treated with TCZ (8 mg/kg) and methylprednisolone (mPSL) (500 mg/day [≤ 75 kg], 1000 mg/day [> 75 kg]) for 3 days. We compared background characteristics, laboratory findings, and prognosis between non-HD and HD patients and between patients who received and did not receive TCZ and mPSL pulse therapy. RESULTS Among non-HD patients, the TCZ + mPSL pulse group had significantly higher survival rates and lower secondary infection rates (p < 0.05), than the standard therapy group. All HD patients in the standard therapy group with oxygen demand exceeding 8 L/min died. Contrastingly, all patients in the TCZ + mPSL pulse group survived, with their oxygen demand decreasing to 0-1 L/min within 3 weeks post-administration. CONCLUSION TCZ combined with mPSL pulse therapy improved the survival rate without significant adverse events in critical HD and non-HD patients with COVID-19 by strongly suppressing systemic hyperinflammation.
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Affiliation(s)
- Masataro Toda
- Department of Nephrology, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan
| | - Kentaro Fujii
- Department of Nephrology, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan
| | - Ayumi Yoshifuji
- Department of Nephrology, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan.
| | - Yasushi Kondo
- Department of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuto Itoh
- Department of General Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Kazuhiko Sekine
- Department of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Takahide Kikuchi
- Department of Hematology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Munekazu Ryuzaki
- Department of Nephrology, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan
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12
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SARS-CoV-2 vs. Hepatitis Virus Infection Risk in the Hemodialysis Population: What Should We Expect? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115748. [PMID: 34071948 PMCID: PMC8198690 DOI: 10.3390/ijerph18115748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/25/2021] [Indexed: 02/08/2023]
Abstract
Since the dramatic rise of the coronavirus infection disease 2019 (COVID-19) pandemic, patients receiving dialysis have emerged as especially susceptible to this infection because of their impaired immunologic state, chronic inflammation and the high incidence of comorbidities. Although several strategies have thus been implemented to minimize the risk of transmission and acquisition in this population worldwide, the reported severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence varies across studies but is higher than in the general population. On the contrary, the screening for hepatitis viruses (HBV and HCV) has seen significant improvements in recent years, with vaccination in the case of HBV and effective viral infection treatment for HCV. In this sense, a universal SARS-CoV-2 screening and contact precaution appear to be effective in preventing further transmission. Finally, regarding the progress, an international consensus with updated protocols that prioritize between old and new indicators would seem a reasonable tool to address these unexpended changes for the nephrology community.
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13
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Chang CY, Wu MS, Chang CH, Lin CC, Lin HL, Kao CC, Chen HH, Li A, Hsu CC, Lin YC. Effect of dialyzer membranes on mortality in uremic patients undergoing long-term hemodialysis: A Nationwide population-based study using the Taiwan Dialysis Registry Data System 2005-2012. Ther Apher Dial 2021; 26:55-63. [PMID: 33928757 DOI: 10.1111/1744-9987.13665] [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: 01/19/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/27/2022]
Abstract
The characteristics in dialyzer are associated with mortality in patients with end-stage renal disease (ESRD) receiving hemodialysis (HD). This study is to investigate the effects of dialyzer membranes on 3-year mortality in ESRD patients. From the long-term nationwide population database. Prevalent HD patients during 2005-2012 were enrolled. Our main analysis to calculate the effect was cox regression multivariate model. Overall, the mean age of all population (N = 73 565) was 61.0 ± 13.6 years, the observation period is 2.46 years ±0.98 within 3 years and 64.6% used polysulfone (PS), polymethyl methacrylate (PMMA) (11.6%), polyethersulfone (11.4%), and cellulose triacetate (CTA) (10.7%), ethylene vinyl alcohol (EVAL) (hazard ratio [HR] 2.72, 95% confidence interval [CI] 1.71-4.33) and CTA (HR 1.35, 95% CI 1.12-1.64) were associated with higher mortality than PS, but PMMA was not. EVAL and CTA adversely affected mortality and PMMA had no protective role. Further investigations on membrane characters on HD patients are warranted. Taipei Medical University (TMU) (TMU-JIRB (No. N201804051).
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Affiliation(s)
- Chih-Yu Chang
- Department of Materials Science and Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan.,Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Chen-Hao Chang
- Department of Internal Medicine, Makai Memorial Hospital, Taipei, Taiwan
| | - Chih-Chieh Lin
- Department of Internal Medicine, Makai Memorial Hospital, Taipei, Taiwan
| | - Hsiang-Ling Lin
- Department of Internal Medicine, Makai Memorial Hospital, Taipei, Taiwan
| | - Chih-Chin Kao
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsi-Hsien Chen
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Albert Li
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Hunan, Taiwan
| | - Yen-Chung Lin
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
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14
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De La Flor JC, Valga F, Marschall A, Monzon T, Albarracín C, Ruiz E, Rodeles M. Targeting Cytokine Storm in COVID-19: A Role of Online Hemodiafiltration with Asymmetric Cellulose Triacetate in Maintenance Hemodialysis Patients-A Report of 10 Cases. Case Rep Nephrol 2021; 2021:5575928. [PMID: 33747583 PMCID: PMC7958139 DOI: 10.1155/2021/5575928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/13/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023] Open
Abstract
Early reports have suggested that maintenance hemodialysis (MHD) patients could be more susceptible to a severe course of COVID-19. Among the therapeutic approaches, the use of drugs that reduce the cytokine storm characteristic of this disease has been proposed. Some dialyzers, such as the new generation of asymmetric cellulose triacetate (ATA) membranes, could favor the effective elimination of medium-sized molecules and other inflammatory mediators. In this case series, we describe in depth the clinical, analytical, and radiological details, therapeutic aspects, and outcomes of the case series of 10 MHD patients of our dialysis unit, who tested positive for SARS-CoV-2 from 5 October to 30 November 2020. Furthermore, we evaluate the removal of hyperinflammatory parameters with the ATA membrane in postdilution online hemodiafiltration (OL-HDF) in these patients through a variety of biomarkers of systemic inflammation from the diagnosis until stripping. Biochemical blood analysis was carried out at baseline and at days 7 and 14 after diagnosis, respectively. 50% of the patients presented COVID-19 pneumonia and required hospital admission. Median hospitalization time was 21 days. A total of 4 patients developed severe pneumonia (3 of them died) and 1 patient developed moderate pneumonia. Patients who died (n = 3) were more likely to present bilateral pneumonia (100% vs 14.3%) at diagnosis and less reduction in interleukin 6 (IL-6) at day 14, as compared to those who survived. The use of the ATA membrane could be considered a therapeutic option, due to its immunomodulatory effect in MHD patients with SARS-CoV-2 infection, especially at the beginning of the disease, where the inflammatory component is predominant.
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Affiliation(s)
- José C. De La Flor
- Department of Nephrology, Central Defense Gomez Ulla Hospital, Madrid, Spain
| | - Francisco Valga
- Department of Nephrology, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Alexander Marschall
- Department of Cardiology, Central Defense Gomez Ulla Hospital, Madrid, Spain
| | - Tania Monzon
- Department of Hemodialysis, Avericum S.L., Las Palmas de Gran Canaria, Spain
| | - Cristina Albarracín
- Department of Nephrology, Central Defense Gomez Ulla Hospital, Madrid, Spain
| | - Elisa Ruiz
- Department of Nephrology, Central Defense Gomez Ulla Hospital, Madrid, Spain
| | - Miguel Rodeles
- Department of Nephrology, Central Defense Gomez Ulla Hospital, Madrid, Spain
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15
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Quiroga B, Muñoz Ramos P, Giorgi M, de Santos A, Núñez A, Ortiz A, Redondo Polo C, Almería Gómez O, Marcos-Jiménez A, Esparcia Pinedo L, Barril G. Dynamic assessment of interleukin-6 during hemodialysis and mortality in coronavirus disease-19. Ther Apher Dial 2021; 25:908-916. [PMID: 33497039 PMCID: PMC8013682 DOI: 10.1111/1744-9987.13626] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/14/2020] [Accepted: 01/24/2021] [Indexed: 12/15/2022]
Abstract
The impact of the newly discovered severe acute respiratory syndrome coronavirus 2 causing coronavirus disease‐19 (COVID‐19) in hemodialysis patients remains poorly characterized. Some hemodialysis techniques reduce systemic inflammation but their impact on COVID‐19 has not been addressed. The aim of this prospective study was to evaluate factors associated with mortality in COVID‐19 hemodialysis patients, including the impact of reducing interleukin‐6 using a cytokine adsorbent filter. This is a prospective single‐center study including 16 hemodialysis patients with COVID‐19. All were dialyzed using a polymethyl methacrylate (PMMA) filter. Interleukin‐6 levels were obtained before and after the first admission hemodialysis session and at 1 week. Baseline comorbidities, laboratory values, chest X‐ray, and treatments were recorded and compared between survivors and non‐survivors. Out of 16 patients (13 males, mean age 72 ± 15 years), 4 (25%) died. Factors associated with mortality were dialysis vintage (P = 0.01), chest X‐ray infiltrates (P = 0.032), serum C‐reactive protein (P = 0.05), and lactate dehydrogenase (P = 0.02) at 1 week, oxygen therapy requirement (P = 0.02) and anticoagulation (P < 0.01). At admission, non‐survivors had higher predialysis and postdialysis interleukin‐6 levels (P = 0.02 for both) and did not present the reduction of interleukin‐6 levels during the dialysis session with PMMA filter that was observed in survivors (survivors vs. non‐survivors: 25.0 [17.5–53.2]% vs. −2.8 [−109.4–12.8]% reduction, P = 0.04). A positive balance of interleukin‐6 during the admission dialysis was associated with mortality (P = 0.008). In conclusion, in hemodialysis COVID‐19 patients, a positive interleukin‐6 balance during the admission hemodialysis session was associated with higher mortality.
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Affiliation(s)
- Borja Quiroga
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Martin Giorgi
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Antonio de Santos
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Almudena Núñez
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.,Fundacion Renal Iñigo Alvarez de Toledo-IRSIN and REDINREN, Madrid, Spain
| | | | - Olga Almería Gómez
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Ana Marcos-Jiménez
- Inmunology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Guillermina Barril
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
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