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Bacharaki D, Karagiannis M, Giannakopoulos P, Papachristou E, Divanis D, Sardeli A, Petrou D, Nikolopoulos P, Bratsiakou A, Zoi V, Piliouras N, Damoraki G, Liakopoulos V, Goumenos D, Giamarellos-Bourboulis EJ. Immune responses of patients on maintenance hemodialysis after infection by SARS-CoV-2: a prospective observational cohort study. BMC Infect Dis 2023; 23:581. [PMID: 37674148 PMCID: PMC10481459 DOI: 10.1186/s12879-023-08569-2] [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: 02/20/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Immune dysregulation in patients with acute COVID-19 under chronic hemodialysis (CHD) is fully not elucidated. The changes of mononuclear counts and mediators before and after HD and associations with final outcome were studied. METHOD In this prospective study, hospitalized patients with moderate-to-severe COVID-19 under CHD and matched comparators under HD were analyzed for their absolute counts of lymphoid cells and circulating inflammatory mediators. Blood samples were collected before start and at the end of the first HD session; dialysate samples were also collected. RESULT Fifty-nine patients with acute COVID-19 under CHD and 20 uninfected comparators under CHD were enrolled. Circulating concentrations of tumor necrosis factor-alpha (TNFα), interleukin (IL)-10, interferon-γ and platelet-derived growth factor-A were increased in patients. Concentrations of mediators did not differ before and after HD. Significant decreases of CD4-lymphocytes and CD19-lymphocytes were found in patients. The decrease of the expression of HLA-DR on CD14-monocytes was associated with unfavorable outcome (defined as WHO-CPS 6 or more by day 28); increased counts of CD19-lymphocytes were associated with better outcomes. CONCLUSION Patients under CHD develop an inflammatory reaction to SARS-CoV-2 characterized by increase of inflammatory mediators, decrease of circulating T-lymphocytes and decrease of the expression of HLA-DR on CD14-monocytes.
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Affiliation(s)
- Dimitra Bacharaki
- Department of Nephrology, University General Hospital Attikon, Athens, Greece.
| | - Minas Karagiannis
- Department of Nephrology, University General Hospital Attikon, Athens, Greece
| | | | - Evangelos Papachristou
- Department of Nephrology, Rion University Hospital, University of Patras, Patras, Greece
| | - Dimitrios Divanis
- 2nd Department of Nephrology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aggeliki Sardeli
- Department of Nephrology, University General Hospital Attikon, Athens, Greece
| | - Dimitra Petrou
- Department of Nephrology, University General Hospital Attikon, Athens, Greece
| | - Petros Nikolopoulos
- Department of Nephrology, University General Hospital Attikon, Athens, Greece
| | - Adamantia Bratsiakou
- Department of Nephrology, Rion University Hospital, University of Patras, Patras, Greece
| | - Vassiliki Zoi
- Department of Nephrology, University General Hospital Attikon, Athens, Greece
| | - Nikitas Piliouras
- Department of Nephrology, University General Hospital Attikon, Athens, Greece
| | - Georgia Damoraki
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Goumenos
- Department of Nephrology, Rion University Hospital, University of Patras, Patras, Greece
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Pongsittisak W, Satpanich P, Jaturapisanukul S, Keawvichit R, Prommool S, Trakranvanich T, Ngamvichukorn T, Kurathong S. Medium Cut-Off versus Low-Flux Dialyzers in Hemodialysis Patients with COVID-19: Clinical Outcomes and Reduction in Interleukin-6. Blood Purif 2023; 52:591-599. [PMID: 37231799 DOI: 10.1159/000530162] [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: 08/30/2022] [Accepted: 03/09/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has caused extensive morbidity and mortality worldwide. Hemodialysis (HD) patients are both vulnerable to COVID-19 infection and tend to suffer greater disease severity and mortality. This retrospective study aimed to compare medium cut-off (MCO) and low-flux (LF) membrane dialyzers in terms of interleukin-6 (IL-6) reduction, change in inflammatory state, intradialytic complications, and mortality in chronic HD patients with COVID-19. METHOD HD patients with a confirmed COVID-19 infection were admitted to the hospital for 10-14 days and underwent HD at the COVID-HD unit. Choice of dialyzer membrane used (MCO vs. LF) depended on the primary nephrologist(s). We collected data on demographics, baseline characteristics, laboratory results, diagnosis, treatments, HD prescription, hemodynamic status during HD, and mortality at 14 and 28 days after. RESULTS IL-6 reduction ratio (RR) in the MCO group was 9.7 (interquartile range, 71.1) percent, which was significantly higher than that of the LF group (RR, -45.7 [interquartile range, 70.2] percent). The incidence rate of intradialytic hypotension in the MCO group was 3.846 events per 100 dialysis hours (95% confidence interval [CI], 1.954-6.856), which was significantly lower than that of the LF group (9.057; 95% CI, 5.592-13.170). Overall, mortality was not significantly different between the two groups. CONCLUSION The MCO membrane was more effective in removing IL-6 and was better tolerated than the LF membrane. Large, randomized controlled trials are required to confirm the relative benefits of the MCO membrane, especially mortality. However, due to the COVID-19 pandemic, our results suggest that the MCO membrane may be beneficial in chronic HD patients with COVID-19.
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Affiliation(s)
- Wanjak Pongsittisak
- Nephrology and Renal Replacement Therapy Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Panchalee Satpanich
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Solos Jaturapisanukul
- Nephrology and Renal Replacement Therapy Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Rassamon Keawvichit
- Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Surazee Prommool
- Nephrology and Renal Replacement Therapy Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Thananda Trakranvanich
- Nephrology and Renal Replacement Therapy Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Tanun Ngamvichukorn
- Nephrology and Renal Replacement Therapy Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sathit Kurathong
- Nephrology and Renal Replacement Therapy Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Murt A, Yadigar S, Yalin SF, Dincer MT, Parmaksiz E, Altiparmak MR. Arteriovenous fistula as the vascular access contributes to better survival of hemodialysis patients with COVID-19 infection. J Vasc Access 2023; 24:22-26. [PMID: 34082588 PMCID: PMC9846374 DOI: 10.1177/11297298211021253] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND While COVID-19 in chronic hemodialysis patients has high mortality and the pandemic will not end in the near future, effective follow up strategies should be implemented for these patients. Surgeries have been triaged according to their level of urgencies and arteriovenous fistula (AVF) operations were among elective surgeries. This study aimed to analyze the effect of vascular access on the outcomes of hemodialysis patients who had COVID-19. METHODS One hundred four hemodialysis patients who had COVID-19 were retrospectively analyzed. Seventy-two of them had AVF as the vascular access while 32 of them had tunneled catheters. Inflammatory markers and outcomes of patients with AVFs and catheters were compared. A logistic regression analysis was performed in order to define factors that contribute to better outcomes in hemodialysis patients. RESULTS COVID-19 had high mortality rate in hemodialysis patients (36.5%). Patients with catheters have higher peak ferritin levels (p = 0.02) and longer hospital stay (p = 0.00). Having AVF as the vascular access (OR = 3.36; 95% CI: 1.05-10.72; p = 0.041) and using medium cut-off dialyzers (OR = 7.99; 95% CI: 1.53-41.65; p = 0.014) were related to higher survival of the patients. COVID severity was inversely proportional to the survival (p = 0.000). CONCLUSIONS AVFs contribute to higher survival of hemodialysis patients with COVID-19. Even in the pandemic era, end stage renal disease patients should be given the opportunity to have their vascular access properly created.
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Affiliation(s)
- Ahmet Murt
- Department of Nephrology, Cerrahpasa
Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey,Ahmet Murt, Nephrology Unit, Internal
Medicine Department, Cerrahpasa Medical Faculty, Istanbul University –
Cerrahpasa, Istanbul, 34303, Turkey.
| | - Serap Yadigar
- Department of Nephrology, Kartal Dr.
Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Serkan Feyyaz Yalin
- Department of Nephrology, Kartal Dr.
Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Department of Nephrology, Cerrahpasa
Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Ergun Parmaksiz
- Department of Nephrology, Kartal Dr.
Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- Department of Nephrology, Cerrahpasa
Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
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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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Esposito P, Cipriani L, Verzola D, Grignano MA, De Amici M, Testa G, Grosjean F, Russo E, Garibotto G, Rampino T, Viazzi F. Effects of Different Dialysis Strategies on Inflammatory Cytokine Profile in Maintenance Hemodialysis Patients with COVID-19: A Randomized Trial. J Clin Med 2021; 10:jcm10071383. [PMID: 33808205 PMCID: PMC8037035 DOI: 10.3390/jcm10071383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/17/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023] Open
Abstract
Uncontrolled inflammation plays a relevant role in the pathogenesis of coronavirus disease-19 (COVID-19). Here, we studied the time trend of inflammatory markers in a population of hemodialysis (HD) patients affected by COVID-19, undergoing two different dialysis approaches. In a prospective study, thirty-one maintenance HD patients with COVID-19 were randomized to expanded HD (HDx), performed using a medium cut-off membrane, or standard treatment using a protein-leaking dialyzer (PLD). Circulating levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), soluble TLR4 (sTLR4), and interferon-gamma (IFN-γ), were collected at diagnosis, and one and two weeks after. Compared with 14 non-infected HD patients, COVID-19 patients showed lymphopenia and higher ferritin and lactate dehydrogenase levels. Moreover, COVID-19 patients had higher levels of IL-10 (15.2 (12.5) vs. 1.2 (1.4) pg/mL, p = 0.02). Twenty-nine patients were randomized to HDx (n = 15) or PLD (n = 14). After a single treatment, IL-8 showed a significant reduction in both groups, whereas IL-10 decreased only in HDx. All over the study, there were no significant modifications in circulating cytokine levels between the two groups, except for a parallel increase of IL-8 and IL-10 at one week control in the HDx group. No correlations were found between cytokine levels and clinical outcomes. In maintenance HD patients, COVID-19 is not related to a sustained inflammatory response. Therefore, modulation of inflammation seems not to be a suitable therapeutic target in this specific population.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (L.C.); (D.V.); (E.R.); (G.G.); (F.V.)
- IRCCS Ospedale Policlinico San Martino, Clinica Nefrologica, Dialisi, Trapianto, 16132 Genova, Italy
- Correspondence:
| | - Leda Cipriani
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (L.C.); (D.V.); (E.R.); (G.G.); (F.V.)
| | - Daniela Verzola
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (L.C.); (D.V.); (E.R.); (G.G.); (F.V.)
| | - Maria Antonietta Grignano
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, 27100 Pavia, Italy; (M.A.G.); (F.G.); (T.R.)
| | - Mara De Amici
- Laboratory of Immuno-Allergology of Clinical Chemistry and Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Giorgia Testa
- Pediatrics Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy;
| | - Fabrizio Grosjean
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, 27100 Pavia, Italy; (M.A.G.); (F.G.); (T.R.)
| | - Elisa Russo
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (L.C.); (D.V.); (E.R.); (G.G.); (F.V.)
| | - Giacomo Garibotto
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (L.C.); (D.V.); (E.R.); (G.G.); (F.V.)
| | - Teresa Rampino
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, 27100 Pavia, Italy; (M.A.G.); (F.G.); (T.R.)
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (L.C.); (D.V.); (E.R.); (G.G.); (F.V.)
- IRCCS Ospedale Policlinico San Martino, Clinica Nefrologica, Dialisi, Trapianto, 16132 Genova, Italy
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