Cardiovascular complications after COVID-19 in chronic kidney disease, dialysis and kidney transplant patients

Evaluation of the changes in electrocardiographic ventricular repolarization parameters after COVID-19 recovery in hemodialysis patients

INTRODUCTION

Coronavirus disease-2019 (COVID-19) has cardiac manifestations. Data about electrocardiogram (ECG) changes after COVID-19 recovery is limited in hemodialysis patients. We aimed to investigate the changes in ventricular repolarization parameters after COVID-19 recovery in hemodialysis patients.

METHODS

Fifty-five hemodialysis patients who recovered from COVID-19 infection were included. QT interval, Tp-e interval, corrected QT (QTc), QTc dispersion, and Tp-e dispersion values were determined on the patients' ECGs, taken before COVID-19 and at least 1 month after recovery. The patients' data before COVID-19 infection and after recovery were compared.

RESULTS

It was found that longest QTc (QTcmax) and QTc dispersion values after recovery were prolonged compared with pre-infection period (427 ± 28 ms vs. 455 ± 26 ms, p = 0.000 and 39 ± 16 ms vs. 65 ± 20 ms, p = 0.000).

CONCLUSION

In our hemodialysis patients, ventricular repolarization parameters increased after COVİD-19 recovery. In hemodialysis patients, already predisposed to arrhythmic deaths, arrhythmia risk after COVİD-19 recovery may become more pronounced.

Intrarenal small artery thrombosis in a transplant recipient patient infected with Covid-19 after kidney transplantation: A rare case report

Currently, renal arteriovenous thrombosis induced by Covid-19 infection in patients after renal transplantation is very rare. We present a recent kidney transplant recipient who developed Covid-19 infection and later developed intrarenal small artery thrombosis. Finally, the patient's respiratory tract infection symptoms gradually disappeared after treatment. However, hemodialysis replacement therapy has to be continued due to the injury of the transplanted kidney function. In this case, we first reported that Covid-19 infection may induce intrarenal small artery thrombosis after kidney transplantation, which caused local ischemic necrosis of the transplanted kidney. We found that patients are at a high risk of Covid-19 infection at the early stage after kidney transplantation, and their clinical symptoms may be severe. In addition, even with anticoagulant therapy, Covid-19 infection may still increase the risk of thrombosis to some extent for patients who have undergone kidney transplantation, and we need to be alert to this rare complication in the future clinical work.

Unraveling mechanistic insights into the role of microbiome in neurogenic hypertension: A comprehensive review

Neurogenic hypertension, a complex and multifactorial cardiovascular disorder, is known to be influenced by various genetic, environmental, and lifestyle factors. In recent years, there has been growing interest in the role of the gut microbiome in hypertension pathogenesis. The bidirectional communication between the gut microbiota and the central nervous system, known as the microbiota-gut-brain axis, has emerged as a crucial mechanism through which the gut microbiota exerts its influence on neuroinflammation, immune responses, and blood pressure regulation. Recent studies have shown how the microbiome has a substantial impact on a variety of physiological functions, such as cardiovascular health. The increased sympathetic activity to the gut may cause microbial dysbiosis, increased permeability of the gut, and increased inflammatory reactions by altering a number of intestinal bacteria producing short-chain fatty acids (SCFAs) and the concentrations of lipopolysaccharide (LPS) in the plasma. Collectively, these microbial metabolic and structural compounds stimulate sympathetic stimulation, which may be an important stage in the onset of hypertension. The result is an upsurge in peripheral and central inflammatory response. In addition, it has recently been shown that a link between the immune system and the gut microbiota might play a significant role in hypertension. The therapeutic implications of the gut microbiome including probiotic usage, prebiotics, dietary modifications, and fecal microbiota transplantation in neurogenic hypertension have also been found. A large body of research suggests that probiotic supplementation might help reduce chronic inflammation and hypertension that have an association with dysbiosis in the gut microbiota. Overall, this review sheds light on the intricate interplay between the gut microbiome and neurogenic hypertension, providing valuable insights for both researchers and clinicians. As our knowledge of the microbiome's role in hypertension expands, novel therapeutic strategies and diagnostic biomarkers may pave the way for more effective management and prevention of this prevalent cardiovascular disorder. Exploring the potential of the microbiome in hypertension offers an exciting avenue for future research and offers opportunities for precision medicine and improved patient care.

Overcoming obstacles in Panama to starting a renal biopsy program in a rural area during the COVID-19 pandemic

Due to the many implemented restrictions, the SARS-CoV-2 pandemic has rendered some tasks more difficult, for instance, the evaluation of outpatients. Panama's tertiary care hospital for kidney biopsy referral was transformed into a COVID-only hospital in order to assist the large number of COVID-19 patients. In order to face the impossibility of following patients with nephrotic or nephritic syndrome, a biopsy program was implemented in a southern province in Panama. Thirty kidney biopsies were carried out over a 1-year period. This experience shows that kidney biopsy programs, that are usually run only in large referral centers, can also be implemented in small nephrology centers, allowing to obtain accurate diagnoses and to guide correct treatment.