One-year impact of COVID-19 pandemic on renal replacement therapy and kidney transplantation in a tertiary center in Southern Brazil

INTRODUCTION

Patients on renal replacement therapy (RRT) and kidney transplant recipients (KTR) present multiple factors that may increase the risk of death from coronavirus disease 2019 (COVID-19). This study aimed to evaluate the incidence and impact of COVID-19 in RRT patients and KTRs.

METHODS

Between March 2020 and February 2021, we monitored the RRT population of thirteen dialysis facilities that refer patients for transplantation to our center, a tertiary hospital in Southern Brazil. In the same period, we also monitor COVID-19 incidence and mortality in our KTR population. Demographical, clinical, and COVID-19-related information were analyzed.

RESULTS

We evaluated 1545 patients in the dialysis centers, of which 267 (17.4%) were infected by COVID-19 and 53 (19.9%) died. Among 275 patients on the kidney transplant waiting list, 63 patients (22.9%) were infected and seven (11.1%) died. COVID-19 was the leading cause of death (29.2%) among patients on the waiting list. Within the population of 1360 KTR, 134 (9.85%) were diagnosed with COVID-19 and 20 (14.9%) died. The number of kidney transplants decreased by 56.7% compared with the same period in the previous twelve months.

CONCLUSION

In the study period, patients on RRT and KTRs presented a high incidence of COVID-19 and high COVID-19-related lethality. The impact on the patients on the transplant waiting list was less pronounced. The lethality rate observed in both cohorts seems to be related to age, comorbidities, and disease severity.

Impacto de um ano da Pandemia COVID 19 na terapia renal substitutiva e no transplante renal em centro terciário no Sul do Brasil

Resumo Introdução: Pacientes em terapia renal substitutiva (TRS) e receptores de transplante renal (RTR) apresentam múltiplos fatores que podem aumentar o risco de óbito por doença do coronavírus 2019 (COVID-19). Este estudo teve como objetivo avaliar incidência e impacto da COVID-19 em pacientes em TRS e RTR. Métodos: Entre Março de 2020 e Fevereiro de 2021, monitoramos a população em TRS de treze unidades de diálise que encaminham pacientes para transplante ao nosso centro, um hospital terciário no Sul do Brasil. No mesmo período, também monitoramos a incidência e mortalidade da COVID-19 em nossa população de RTR. Foram analisadas informações demográficas, clínicas e relacionadas à COVID-19. Resultados: Avaliamos 1545 pacientes nos centros de diálise, dos quais 267 (17,4%) foram infectados pela COVID-19 e 53 (19,9%) foram a óbito. Entre 275 pacientes na lista de espera para transplante renal, 63 (22,9%) foram infectados e sete (11,1%) foram a óbito. COVID-19 foi a principal causa de óbito (29,2%) entre pacientes na lista de espera. Dentre a população de 1360 RTR, 134 (9,85%) foram diagnosticados com COVID-19 e 20 (14,9%) foram a óbito. O número de transplantes renais diminuiu em 56,7% comparado ao mesmo período nos doze meses anteriores. Conclusão: No período do estudo, pacientes em TRS e RTR apresentaram alta incidência de COVID-19 e alta letalidade relacionada à COVID-19. O impacto nos pacientes na lista de espera para transplante foi menos pronunciado. A taxa de letalidade observada em ambas as coortes parece estar relacionada à idade, comorbidades e gravidade da doença.

Histomorphometry and expression of Cdc47 and caspase-3 in hyperthyroid rat uteri and placentas during gestation and postpartum associated with fetal development

In two different experiments, the effects of hyperthyroidism on the histomorphometry and expression of Cdc47 and caspase-3 were evaluated in the uteri and placentas during gestation and postpartum. Fetal development was also evaluated during gestation. In the first experiment, 36 adult female Wistar rats were divided into two groups of 18 animals each: (1) hyperthyroid; and (2) euthyroid (control). Female rats were mated and killed at 7, 14 and 19 days of gestation. Uteri and placentas were weighed and subjected to histomorphometric and immunohistochemical evaluation to determine the expression of Cdc47 and caspase-3. Ovaries were also evaluated for weight and subjected to morphometric analysis. Fetuses were quantified and weighed individually. In the second experiment, 12 adult female Wistar rats were divided into two groups of six animals each: (1) hyperthyroid; and (2) euthyroid (control). Female rats were mated and killed 2 days postpartum. Uteri were evaluated in the same way as for the first experiment. Hyperthyroidism increased ovulation and conception rates without disturbing the size and viability of the fetuses. In the pregnant uteri, hyperthyroidism did not change the thickness of the layers or the expression of Cdc47 and caspase-3. However, in the placentas, hyperthyroidism increased the medium diameter of trophoblast cells, as well as the thickness and the expression of Cdc47 of spongiotrophoblast cells, at 14 days of gestation. During uterine involution, hyperthyroidism significantly increased the expression of Cdc47 and reduced the expression of caspase-3 in the uterine layers. In conclusion, hyperthyroidism increased the conception rate because of an ovulation gain, induced significant placental changes during pregnancy and, in the uterus, increased Cdc47 expression and decreased caspase-3 expression after parturition.

Black-eye patterns: a representation of three-dimensional symmetries in thin domains

What is believed to be the first experimental evidence for Turing patterns was observed in the CIMA reaction by De Kepper and colleagues. Ouyang and Swinney performed further experiments in a "thin" layer of gel. Patterns observed at onset were basically two-dimensional. However, beyond onset a structure that does not typically occur in two-dimensional domains was observed-the black-eye pattern. In this paper we use the full three-dimensionality of the patterned layer to find a setting where black-eye patterns naturally occur. We propose that black-eye patterns have the symmetry of a body-centered-cubic lattice.

Effects of captopril on interstitial collagen in the myocardium after infarction in rats

BACKGROUND

Myocardial infarction is an important cause of heart failure because it cause tissue loss and contractility disturbances. In chronically infarcted hearts the increase in the collagen content in the extracellular matrix of the surviving viable myocardium has been considered a major factor contributing to development of heart failure. Postinfarction neuroendocrine activation involving the renin-angiotensin system has been implicated in this cardiac fibrosis.

METHODS AND RESULTS

As collagen synthesis and degradation are dynamic processes and postinfarction remodeling is a time-dependent phenomenon, rats submitted to coronary artery ligation to produce myocardial infarction were treated with captopril after infarction (30 mg/kg, intraperitoneally, daily) to investigate whether blockade of the renin-angiotensin system can prevent postinfarction myocardial hypertrophy and reactive fibrosis. Groups of rats with myocardial infarction were treated with captopril throughout the protocol period (6 weeks), or during the first 3 weeks after infarction (early therapy), or only during the last 3 weeks of the protocol (late therapy). Untreated groups of rats with or without myocardial infarction were used as control subjects. All animals were killed 6 weeks after surgery to evaluate hypertrophy of heart chambers and collagen deposition in the right ventricle wall and in surviving left ventricular muscle. Protein and hydroxyproline concentrations were assayed biochemically in these tissue homogenates. Only rats with an infarct covering 20 to 40% of the left ventricular surface were included in the study. In the control uninfarcted group (n = 12), hydroxyproline content was 152 +/- 12 micrograms in the right ventricle and 370 +/- 30 micrograms in the left ventricle. These values increased (P < .05) to 232 +/- 13 and 630 +/- 46 micrograms, respectively, in the group with myocardial infarction (n = 8) without treatment. These values were significantly reduced (P < .05) to 160 +/- 9 micrograms in the right ventricle and 520 +/- 40 micrograms in the left ventricle in the group with myocardial infarction treated with captopril for 6 weeks. The percentage decreases in collagen content and myocardial weight produced by captopril were similar. Thus, hydroxyproline concentration (mg hydroxyproline muscle), which increases significantly in both ventricles after myocardial infarction, was not modified by captopril therapy. Protein concentration in the right and left ventricular muscles decreased after myocardial infarction. This decrease was enhanced in the infarcted groups submitted to captopril treatment, mainly in the group treated for 6 weeks. Lesser effects on hypertrophy and hydroxyproline content were observed in the groups of rats treated with captopril in only the earlier or later phase of infarction.

CONCLUSIONS

It is concluded that captopril reduces similarly postinfarction hypertrophy and collagen deposition in surviving myocardium. These effects, although less intense, also occur when the drug is used for a short period immediately after myocardial infarction or when used later, when ventricular remodeling is almost fully developed.

Influence of chronic captopril therapy on the mechanical performance of the infarcted rat heart

The influence of angiotensin converting enzyme inhibition of hemodynamic changes, development of postinfarction myocardial hypertrophy and left ventricular performance was studied in rats. Infarction was produced under ether anaesthesia by ligature of the descending anterior branches of the left coronary artery. Control rats were submitted to a sham surgery. Groups of infarcted (Inf) and sham-operated control (SO) animals were daily treated with intraperitoneal injections of captopril (Cap, 30 mg kg-1) or saline (Sal) for 4-5 weeks. This Cap dose produced a similar decrease in arterial blood pressure in Inf and SO animals. The intraventricular pressures measured in anaesthetized rats showed a marked elevation in the right ventricular systolic (38 +/- 4 mmHg) and end diastolic (4 +/- 1 mmHg) pressures in the Inf group compared with the SO group (24 +/- 1 mmHg and 1 +/- 0.4 mmHg, respectively). Cap did not change the pressure overload in the right ventricle. In the left ventricle, however, the end diastolic pressure of the Inf group under Cap was significantly reduced in relation to Sal (12 +/- 3 mmHg and 19 +/- 2 mmHg, respectively, P < 0.05). The post infarction myocardial hypertrophy was depressed by Cap only in the right heart chambers. Thus the right ventricular weight to body weight ratio (mg/g) increased from 0.56 +/- 0.03 in the SO-Sal group to 0.96 +/- 0.07 (P < 0.05) in the Inf-Sal group and decreased to 0.73 +/- 0.04 (P < 0.05) in the Inf group under Cap. The infarction-induced hypertrophy of the left heart chambers was unaffected by Cap. Left ventricular function was assessed in the hearts perfused in vitro according to the Langendorff technique. The peak isovolumic systolic pressure (ISP) developed at different diastolic pressures (0-30 mmHg) and Ca2+ concentrations (0.62 and 1.25 mM) was measured. The ISP and the positive inotropic response to Ca2+ was similarly depressed in both groups of infarcted hearts. Thus the chronic administration of Cap to Inf rats reduces the left ventricular filling pressure but does not reduce the postinfarction pulmonary hypertension. Despite this latter finding, Cap therapy was able to significantly reduce the post-infarction hypertrophy in both right heart chambers. Cap therapy did not change significantly left ventricular systolic function and Ca2+ responsiveness of the myocardium surviving to infarction.

Effects of aluminum on the mechanical and electrical activity of the Langendorff-perfused rat heart

The effect of aluminum (Al3+) chloride (1, 5, 10, 50 and 100 microM) on myocardial electromechanical activity was studied in 10 Langendorff-perfused hearts from adult female Wistar rats. Al3+ decreased the development of isovolumic systolic pressure from 34.3 +/- 2.95 mmHg under control conditions to 11.8 +/- 1.53 mmHg at 100 microM AlCl3 (P < 0.01) (diastolic pressure = 0 mmHg). The atrial and ventricular rates also decreased, but only with AlCl3 concentrations greater than 1 microM (from 180 +/- 5 to 94 +/- 11 bpm for atrial rate and from 180 +/- 5 to 78 +/- 7 bpm for ventricular rate). Reduction of coronary flow was also observed, reaching 60% at 100 microM Al3+. A delay in atrioventricular conduction occurred at 10 microM Al3+, increasing progressively up to 100 microM (62.3 +/- 4 ms in the Al(3+)-free solution to 143 +/- 34 ms in the presence of 100 microM Al3+, P < 0.01, ANOVA). QRS duration did not change as a function of increasing Al3+ concentrations (37.1 +/- 1.7 ms in the Al(3+)-free solution vs 32.1 +/- 1.6 ms in the presence of 100 microM Al3+). No qualitative changes in ECG were observed. These data show that the toxic effects of Al3+ on the myocardium are reflected in reduced systolic pressure development and coronary flow and increased PR interval. These effects are discussed in terms of the inhibition of nucleotide hydrolysis by Al3+.