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Gundogmus AG, Oguz EG, Guler-Cimen S, Kocyigit Y, Dogan AE, Ayli MD. Psychological review of hemodialysis patients and kidney transplant recipients during the COVID-19 pandemic. World J Clin Cases 2023; 11:3780-3790. [PMID: 37383129 PMCID: PMC10294154 DOI: 10.12998/wjcc.v11.i16.3780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/11/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Kidney transplantation (KT) and end-stage renal disease (ESRD) requiring hemodialysis (HD) increase the incidence of morbidity and mortality associated with coronavirus disease 2019 (COVID-19) infection. The COVID-19 pandemic has had a negative effect on the psychological well-being of COVID-19 patients, especially those with a high-risk of infectious complications. The prevalence of anxiety and depression is known to be higher in ESRD patients undergoing HD than in the general population. On the other hand, KT recipients have different treatment requirements compared to HD patients, including adherence to complex immunosuppressive regimens and compliance with follow-up appointments. We hypothesized that psychosocial difficulties and stressors would differ between ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic. If so, each group may require different interventions to maintain their psychosocial well-being.
AIM To measure and compare the levels of stress, anxiety, depression, concerns related to the pandemic, and coping skills in ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic.
METHODS This cross-sectional study was performed at a training and research hospital. The study included ESRD patients undergoing HD (HD group) and KT recipients (with stable graft function for ≥ 6 mo prior to the study) (KT group). Patients completed a demographics form, the impact of events scale, the hospital anxiety and depression scale, and the Connor-Davidson resilience scale. Laboratory findings at the last clinical follow-up were recorded. The χ2 test was used to assess the relationship between the HD and KT groups and the categorical variables. The relationships between the scale scores were analyzed using Pearson’s correlation test, and differences between the groups were analyzed using the independent groups t-test.
RESULTS The study included 125 patients, of which 89 (71.2%) were in the HD group and 36 (28.8%) were in the KT group. The levels of anxiety and depression were higher in the HD group than in the KT group [9.36 ± 4.38 vs 6.89 ± 4.06 (P = 0.004) and 8.78 ± 4.05 vs 6.42 ± 4.26 (P = 0.004), respectively], whereas the post-traumatic stress score was higher in the KT group [46.75 ± 13.98 vs 37.66 ± 18.50 (P = 0.009)]. The concern with the highest intensity in the HD group was transmission of COVID-19 to family and friends (93.3%) and in the KT group was loss of caregiver and social support (77.8%). Concerns regarding financial hardship, stigmatization, loneliness, limited access to health care services, failure to find medical supplies, and transmission of COVID-19 to family and friends were more prevalent in the HD group. Connor-Davidson resilience scale tenacity and personal competence, tolerance, and negative affect scores were higher in the KT group than in the HD group [43.47 ± 11.39 vs 33.72 ± 12.58, 15.58 ± 4.95 vs 11.45 ± 5.05, and 68.75 ± 17.39 vs 55.39 ± 18.65 (P < 0.001), respectively]. Biochemical parameters, such as creatine, urea, phosphorus, parathyroid hormone, and calcium, were lower, and the albumin and hemoglobin values were higher in the KT group than in the HD group (P < 0.001).
CONCLUSION Psychosocial difficulties and the level of stress differ in ESRD patients undergoing HD and KT recipients; therefore, psychosocial interventions should be tailored for each patient group.
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Affiliation(s)
| | - Ebru Gok Oguz
- Department of Nephrology, Etlik City Hospital, Ankara 65100, Cankaya, Turkey
| | - Sanem Guler-Cimen
- Department of General Surgery, Etlik City Hospital, Ankara 65100, Cankaya, Turkey
| | - Yasemin Kocyigit
- Department of Psychiatry, Etlik City Hospital, Ankara 65100, Cankaya, Turkey
| | - Ahmet Emin Dogan
- Department of Urology, Etlik City Hospital, Ankara 65100, Cankaya, Turkey
| | - Mehmet Deniz Ayli
- Department of Nephrology, Etlik City Hospital, Ankara 65100, Cankaya, Turkey
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Abstract
The practice and clinical outcomes of peritoneal dialysis (PD) have demonstrated significant improvement over the past 20 years. The aim of this review is to increase awareness and update healthcare professionals on current PD practice, especially with respect to patient and technique survival, patient modality selection, pathways onto PD, understanding patient experience of care and use prior to kidney transplantation. These improvements have been impacted, at least in part, by greater emphasis on shared decision-making in dialysis modality selection, the use of advanced laparoscopic techniques for PD catheter implantation, developments in PD connecting systems, glucose-sparing strategies, and modernising technology in managing automated PD patients remotely. Evidence-based clinical guidelines such as those prepared by national and international societies such as the International Society of PD have contributed to improved PD practice underpinned by a recognition of the place of continuous quality improvement processes.
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Affiliation(s)
- Ayman Karkar
- Medical Affairs - Renal Care, Scientific Office, Baxter A.G., Dubai, United Arab Emirates
| | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, UK
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Igbokwe MC, Asaolu SO, Muoka MO, Olatise OO. Impact of COVID-19 on renal replacement therapy: perspective from a Nigerian renal transplant centre. Pan Afr Med J 2022; 42:90. [PMID: 36034001 PMCID: PMC9379428 DOI: 10.11604/pamj.2022.42.90.33387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/25/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction COVID-19 has had a huge impact on the health system and the world at large. Patients with kidney failure are a select group which have been affected significantly by the scourge of the disease. In the COVID-19 era, renal replacement therapy (RRT) in the form of dialysis and kidney transplantation required modifications in many centres in order to maintain high quality care and reduce infection rates among this susceptible group of patients. The objectives were to describe some of the challenges experienced in one of the leading renal care centres in Nigeria during the height of the COVID-19 pandemic and analyse the impact of practice changes on select outcomes. Methods a retrospective cross-sectional review of haemodialysis activities and kidney transplantation among chronic kidney disease patients was done over a 15-month period ranging from April, 2019 to June, 2021. Data was extracted from the electronic media record (EMR) and analysed using SPSS version 22. Results there was an initial significant drop in the number of haemodialysis sessions and kidney transplant surgeries by 16.7% and 66% respectively in the first 2 months of COVID-19 in our centre following the national lockdown. The mean monthly kidney transplant rate was 9±3.29 before the COVID-19 and the national lockdown, this figure reduced to 3.0±0.1 during the lockdown. Activities however normalized at 6 months following the initial lockdowns have remarkable exceeded pre-COVID numbers as at early 2021. Conclusion after the initial drop in numbers of patients for haemodialysis and renal transplantation, there was an increase in numbers in the following months. It was instructive to put several steps in place in order to continue to offer high level RRT in the COVID-19 pandemic. RRT can safely be practiced in the COVID-19 pandemic.
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Affiliation(s)
- Martin Chukwudum Igbokwe
- Urology Unit, Department of Surgery, Zenith Medical and Kidney Centre, Abuja, Nigeria,,Corresponding author: Martin Chukwudum Igbokwe, Urology Unit, Department of Surgery, Zenith Medical and Kidney Centre, Abuja, Nigeria.
| | | | - Michael Obinna Muoka
- Department of Clinical Research, Zenith Medical and Kidney Centre, Abuja, Nigeria
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Amsei TQM, Gorayeb-Polacchini FS, Caldas HC, Fernandes-Charpiot IMM, Ferreira-Baptista MAS, Abbud-Filho M. Effect of the COVID-19 Pandemic on Kidney Transplant and on Chronic Dialysis Patients. Transplant Proc 2022; 54:1282-1285. [PMID: 35589414 PMCID: PMC8995325 DOI: 10.1016/j.transproceed.2022.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/10/2022] [Accepted: 02/09/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The reported fatality rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients receiving maintenance dialysis or kidney transplant are higher than in the general population. The aim of this study was to evaluate the impact of SARS-CoV-2 infection in chronic dialysis patients (DPs) compared with kidney transplant recipients (KTxRs). METHODS A study evaluating 266 COVID-19-positive patients (112 DPs and 154 KTxRs) was conducted in a single center from March 1, 2020, to June 30, 2021. All patients were confirmed for COVID-19 infection by reverse transcription polymerase chain reaction or antigen test. RESULTS KTxRs were younger (49 ± 12.4 vs 61 ± 14.6 years; P < .0001) and had significantly fewer coexisting disorders than the DPs. A higher percentage of KTxRs required hospitalization (70% vs 49.4%, P = .002) and intensive care unit admission (39% vs 25%, P = .01). The fatality rate was 24% in both groups. DISCUSSION There is no consensus among studies about the higher fatality rate between KTxRs and DPs who develop COVID-19. In our study, we also did not find a different fatality rate. CONCLUSION In spite of KTxRs being younger and having fewer coexisting disorders, compared with DPs, they presented a higher hospitalization and intensive care unit necessity rate but a similar fatality rate.
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Affiliation(s)
- Thamiris Quiqueto Marinelli Amsei
- Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil,Kidney Transplant and Dialysis Unit, Hospital de Base-FUNFARME, Sao Jose do Rio Preto, Brazil
| | - Fernanda Salomão Gorayeb-Polacchini
- Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil,Kidney Transplant and Dialysis Unit, Hospital de Base-FUNFARME, Sao Jose do Rio Preto, Brazil
| | - Heloisa Cristina Caldas
- Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil
| | - Ida Maria Maximina Fernandes-Charpiot
- Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil,Kidney Transplant and Dialysis Unit, Hospital de Base-FUNFARME, Sao Jose do Rio Preto, Brazil
| | - Maria Alice Sperto Ferreira-Baptista
- Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil,Kidney Transplant and Dialysis Unit, Hospital de Base-FUNFARME, Sao Jose do Rio Preto, Brazil
| | - Mario Abbud-Filho
- Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil,Kidney Transplant and Dialysis Unit, Hospital de Base-FUNFARME, Sao Jose do Rio Preto, Brazil,Address correspondence to Mario Abbud-Filho, MD, PhD, Departamento de Medicina/Nefrologia, Laboratório de Imunologia e Transplante Experimental - LITEX, Faculdade de Medicina de São José do Rio Preto - FAMERP, Brigadeiro Faria Lima Avenue, number 5416, 15090-000 São Jose do Rio Preto, SP, Brazil. Tel: (+55) 173201-5739
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Gorayeb-Polacchini FS, Caldas HC, Abbud-Filho M. Desfechos clínicos da COVID-19 em pacientes submetidos à hemodiálise crônica e diálise peritoneal. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2021-0261pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Antecedentes: A incidência e a taxa de letalidade da síndrome respiratória aguda grave por coronavírus 2 relatadas em pacientes em diálise crônica são mais elevadas do que na população em geral. Procuramos estudar os desfechos após o diagnóstico da doença por coronavírus 2019 (COVID-19) em pacientes submetidos à hemodiálise crônica (HD) ou diálise peritoneal (DP) em um único centro no Brasil. Métodos: Dos 522 pacientes em diálise avaliados entre 1º de Março de 2020 e 1º de Outubro de 2021, aqueles que apresentaram sintomas ou tiveram histórico de contato próximo com pacientes com COVID-19 foram testados com reação em cadeia da polimerase de transcrição reversa por meio de amostras de esfregaços nasofaríngeos. Resultados: Dos 522 pacientes, 120 foram positivos para infecção por COVID-19, dos quais 86% estavam em HD e 14% no programa de DP. A incidência por 10.000 habitantes foi maior no grupo HD do que no grupo DP (2.423,5 vs. 1.752,5). A mortalidade por 10.000 habitantes (470,5 vs. 927,8) e a taxa de letalidade (19,4 vs. 52,9%, p = 0,005) foram mais elevadas no grupo DP. O grupo DP também apresentou uma maior necessidade de hospitalização, terapia intensiva e ventilação mecânica. Conclusões: Recomendamos cautela ao considerar estratégias de transferência de pacientes do programa de HD para o de DP a fim de minimizar o risco de COVID-19 para pacientes em HD.
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Affiliation(s)
| | | | - Mario Abbud-Filho
- Hospital de Base de São José do Rio Preto, Brasil; Laboratório de Imunologia e Transplante Experimental, Brasil
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6
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Ramsay I, Sharrocks K, Warne B, Sithole N, Ravji P, Bousfield R, Jones N, Leong CE, Suliman M, Tsui R, Toleman MS, Moody C, Smith R, Whitehorn J, Gouliouris T, Penciu F, Hofling C, Cunningham C, Enoch DA, Moore E. Investigation of healthcare-associated SARS-CoV-2 infection: Learning outcomes from an investigative process in the initial phase of the pandemic. J Infect Prev 2022; 23:197-205. [PMID: 36003131 PMCID: PMC9117956 DOI: 10.1177/17571774221092553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Healthcare-associated (HCA) SARS-CoV-2 infection is a significant contributor
to the spread of the 2020 pandemic. Timely review of HCA cases is essential
to identify learning to inform infection prevention and control (IPC)
policies and organisational response. Aim To identify key areas for improvement through rapid investigation of HCA
SARS-CoV-2 cases and to implement change. Methods Cases were identified based on date of first positive SARS-CoV-2 PCR sample
in relation to date of hospital admission. Cases were reviewed using a
structured gap analysis tool to identify key learning points. These were
discussed in weekly multidisciplinary meetings to gain consensus on learning
outcomes, level of harm incurred by the patient and required actions.
Learning was then promptly fed back to individual teams and the
organisation. Findings Of the 489 SARS-CoV-2 cases admitted between 10th March and
23rd June 2020, 114 suspected HCA cases (23.3%) were
reviewed; 58/489 (11.8%) were ultimately deemed to be HCA. Five themes were
identified: individual patient vulnerability, communication, IPC
implementation, policy issues and organisational response. Adaptations to
policies based on these reviews were completed within the course of the
initial phase of the pandemic. Conclusion This approach enabled timely learning and implementation of control measures
and policy development.
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Affiliation(s)
- Isobel Ramsay
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Katherine Sharrocks
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ben Warne
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nyarie Sithole
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pooja Ravji
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rachel Bousfield
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nick Jones
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Clare E Leong
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mohamed Suliman
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rachel Tsui
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
| | | | - Christine Moody
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
| | - Richard Smith
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
| | - James Whitehorn
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Theodore Gouliouris
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Christian Hofling
- Infectious Diseases, Universidade Estadual de Campinas, Campinas, Brazil
| | - Chris Cunningham
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - David A Enoch
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
| | - Elinor Moore
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Eidininkienė M, Cesarskaja J, Talačkaitė S, Traškaitė-Juškevičienė V, Macas A. Mini Review: Co-Existing Diseases and COVID-19—A One Way Ticket? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084738. [PMID: 35457604 PMCID: PMC9029116 DOI: 10.3390/ijerph19084738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 01/25/2023]
Abstract
Background and aims. Many patients with SARS-CoV-2 virus infection have various comorbidities. Their presence in the background of coronavirus has a tendency to worsen the course of the disease and increase the risk of unfavorable outcomes. Understanding the interactions between SARS-CoV-2 and the most common comorbidities is key to the successful management of these patients. Methods. We systematically searched Medline, Springer and Elsevier databases and accessed the full text on SARS-CoV-2 virus infection and the following conditions: cardiovascular, renal, immunosuppression, metabolic disorder and hematological in order to prepare a narrative review on this topic. Results. Patients with underlying cardiovascular diseases are more likely to suffer from severe forms of COVID-19. Cardiovascular diseases were also noted as the most frequent comorbidities among coronavirus patients. Metabolic syndrome and its components have been identified as the second most common comorbidity among fatal cases of COVID-19. Infected patients with acute kidney injury also show a higher mortality rate among the others. Immunocompromised patients, such as organ recipients and cancer and hematologic patients, develop more severe forms of COVID-19 and are at higher risk of admission to ICUs and requiring mechanical ventilation. Higher mortality rates among those patients have also been observed. Conclusions. Based on recent studies, patients with co-existing diseases are at higher risk for severe courses of COVID-19 virus infection and unfavorable outcomes. Cardiovascular diseases, metabolic syndrome and immunosuppressive and kidney diseases in the presence of coronavirus may lead to longer and more aggressive treatment in the ICU and increased mortality rate.
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Affiliation(s)
- Mantė Eidininkienė
- Medical Academy, Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (J.C.); (S.T.); (V.T.-J.); (A.M.)
- Correspondence: ; Tel.: +370-606-797-54
| | - Jelena Cesarskaja
- Medical Academy, Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (J.C.); (S.T.); (V.T.-J.); (A.M.)
| | - Simona Talačkaitė
- Medical Academy, Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (J.C.); (S.T.); (V.T.-J.); (A.M.)
| | - Vilma Traškaitė-Juškevičienė
- Medical Academy, Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (J.C.); (S.T.); (V.T.-J.); (A.M.)
- Department of Anesthesiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, LT-50160 Kaunas, Lithuania
| | - Andrius Macas
- Medical Academy, Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (J.C.); (S.T.); (V.T.-J.); (A.M.)
- Department of Anesthesiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, LT-50160 Kaunas, Lithuania
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Piccoli GB. What have we learnt from the COVID-19 epidemic? Considerations of a troubled editor after two troubled years. J Nephrol 2022; 35:1-2. [PMID: 35072937 PMCID: PMC8785393 DOI: 10.1007/s40620-022-01262-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lugli G, Ottaviani MM, Botta A, Ascione G, Bruschi A, Cagnazzo F, Zammarchi L, Romagnani P, Portaluri T. The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review. Mediterr J Hematol Infect Dis 2022; 14:e2022012. [PMID: 35070219 PMCID: PMC8746940 DOI: 10.4084/mjhid.2022.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Italy has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy. METHODS A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19. RESULTS Of the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine. CONCLUSIONS Our work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios.
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Affiliation(s)
- Gianmarco Lugli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Matteo Maria Ottaviani
- Department of Neurosurgery, University Politecnica delle Marche, Ancona, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Alessandro Bruschi
- Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Infectious and Tropical Disease, University Hospital Careggi, Florence, Italy
| | - Paola Romagnani
- Nephrology and Dialysis Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Tommaso Portaluri
- IN Srl, Udine, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
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Gorayeb-Polacchini FS, Caldas HC, Abbud-Filho M. Clinical outcomes of COVID-19 in patients undergoing chronic hemodialysis and peritoneal dialysis. J Bras Nefrol 2022; 44:505-510. [PMID: 35616362 PMCID: PMC9838679 DOI: 10.1590/2175-8239-jbn-2021-0261en] [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: 11/24/2021] [Accepted: 03/04/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The reported incidence and fatality rate of the severe acute respiratory syndrome coronavirus 2 in patients receiving chronic dialysis are higher than in the general population. We sought to study the outcomes following coronavirus disease 2019 (COVID-19) diagnosis in patients undergoing chronic hemodialysis (HD) or peritoneal dialysis (PD) in a single center in Brazil. METHODS Of the 522 patients on dialysis evaluated between March 1, 2020, and October 1, 2021, those presenting symptoms or with a history of close contact with COVID-19 patients were tested with reverse-transcription polymerase chain reaction of samples from nasopharyngeal swabs. RESULTS Of the 522 patients, 120 were positive for COVID-19 infection, of which 86% were on HD and 14% in the PD program. The incidence per 10,000 inhabitants was higher in the HD group than in the PD group (2,423.5 vs. 1,752.5). The mortality per 10,000 inhabitants (470.5 vs. 927.8) and the fatality rate (19.4 vs. 52.9%, p = 0.005) were higher in the PD group. The PD group also had a higher need for hospitalization, intensive care, and mechanical ventilation. CONCLUSIONS We advise caution when considering strategies to transfer patients from HD to the PD program to minimize the risk of COVID-19 for patients on HD.
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Affiliation(s)
- Fernanda Salomão Gorayeb-Polacchini
- Hospital de Base de São José do Rio Preto, Faculdade de Medicina de São José do Rio Preto, Divisão de Nefrologia, São José do Rio Preto, SP, Brasil.,Faculdade de Medicina de São José do Rio Preto, Laboratório de Imunologia e Transplante Experimental, São José do Rio Preto, SP, Brasil
| | - Heloisa Cristina Caldas
- Faculdade de Medicina de São José do Rio Preto, Laboratório de Imunologia e Transplante Experimental, São José do Rio Preto, SP, Brasil
| | - Mario Abbud-Filho
- Hospital de Base de São José do Rio Preto, Faculdade de Medicina de São José do Rio Preto, Divisão de Nefrologia, São José do Rio Preto, SP, Brasil.,Faculdade de Medicina de São José do Rio Preto, Laboratório de Imunologia e Transplante Experimental, São José do Rio Preto, SP, Brasil
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SARS-CoV-2 Infection in Patients on Dialysis: Incidence and Outcomes in the Lazio Region, Italy. J Clin Med 2021; 10:jcm10245818. [PMID: 34945114 PMCID: PMC8708577 DOI: 10.3390/jcm10245818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/25/2021] [Accepted: 12/09/2021] [Indexed: 01/08/2023] Open
Abstract
Patients with end-stage kidney disease represent a frail population and might be at higher risk of SARS-CoV-2 infection. The Lazio Regional Dialysis and Transplant Registry collected information on dialysis patients with a positive swab. The study investigated incidence of SARS-CoV-2 infection, mortality and their potential associated factors in patients undergoing maintenance hemodialysis (MHD) in the Lazio region. Method: The occurrence of infection was assessed among MHD patients included in the RRDTL from 1 March to 30 November 2020. The adjusted cumulative incidence of infection and mortality risk within 30 days of infection onset were estimated. Logistic and Cox regression models were applied to identify factors associated with infection and mortality, respectively. Results: The MHD cohort counted 4942 patients; 256 (5.2%) had COVID-19. The adjusted cumulative incidence was 5.1%. Factors associated with infection included: being born abroad, educational level, cystic renal disease/familial nephropathy, vascular disease and being treated in a dialysis center located in Local Health Authority (LHA) Rome 2. Among infected patients, 59 (23.0%) died within 30 days; the adjusted mortality risk was 21.0%. Factors associated with 30-day mortality included: age, malnutrition and fever at the time of swab. Conclusions: Factors associated with infection seem to reflect socioeconomic conditions. Factors associated with mortality, in addition to age, are related to clinical characteristics and symptoms at the time of swab.
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Cardiovascular complications after COVID-19 in chronic kidney disease, dialysis and kidney transplant patients. Int Urol Nephrol 2021; 54:1551-1563. [PMID: 34811606 PMCID: PMC8608362 DOI: 10.1007/s11255-021-03059-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/11/2021] [Indexed: 02/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is associated with increased mortality in patients with chronic kidney disease (CKD), dialysis patients and kidney transplant recipients (KTR). Cardiovascular complications, such as sudden arrhythmias, thromboembolic events, coronary events, cardiomyopathies and heart failure, may present in about 10–20% of patients with COVID-19. Patients with CKD, dialysis patients and KTR are all at increased cardiovascular risk and present with more cardiovascular complications after COVID-19 compared to the general population. During the pandemic, health care giving has rapidly changed by reducing elective outpatient reviews, which may refrain these high-risk patients from the appropriate management of their medical conditions, further increasing cardiovascular risk. Importantly, acute kidney injury (AKI) is another common complication of severe COVID-19 and associates with increased mortality. A large proportion of the AKI patients need renal replacement treatment, while 30% of them may not present renal function recovery and remain dialysis-dependent after discharge, thereby having potentially increased future cardiovascular risk. This review summarizes current knowledge regarding the cardiovascular events and mortality in patients with CKD or undergoing hemodialysis and in KTR.
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Chazot C, de Kerautem C, Hebibi H, Heimig MO, Weis L, Attroun A, Jean G, Rousseau P, Saibi S, Flangakis S, Raulet B, Maufroy P, Brunet JL, Lachaux-Vaillier S, Privat S, Pourrat S, Thuillet B, Rabasco F, Théodose M, Levannier M, Tahiri K. [COVID-19 crisis management during the first three waves in a large dialysis organisation: Feedback from NephroCare France]. Nephrol Ther 2021; 18:21-28. [PMID: 34920973 PMCID: PMC8570404 DOI: 10.1016/j.nephro.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
At the start of the COVID crisis, NephroCare operated 40 dialysis units in 7 regions, with 2,740 hemodialysis patients. The national COVID-19 crisis team implemented early the necessary measures to ensure the safety of dialysis patients and caregivers in the context of the pandemic. These measures were mostly traditional, but some were specific to our organization. They were modified during the 3 successive waves. The first wave mainly impacted NephroCare Ile-de-France which recorded 75% of the contaminations with an impact on the dialysis parameters of non-COVID patients which was not found during the second wave due to reduced stress (34% of contaminations) and a better management of COVID+ patients. The effectiveness of the measures put in place is suggested by the absence of PCR+ in asymptomatic patients and the perfect adequacy of the anti-SARS-CoV2 antibodies with the diagnosis of COVID in one severely impacted Ile-de-France unit, opposite to literature reporting significant rates of positive PCR or serology in asymptomatic patients. In addition, the contamination rate was calculated below the national rate reported by the Biomedicine Agency. The third wave was marked by the implementation of the anti-SARS-CoV2 vaccination with a proportion of vaccinated patients not different from national data and a decrease in COVID cases at the end of the third wave while the national incidence remained stable on the period. In conclusion, this experience of facing an unprecedented serious situation showed the responsiveness of the organization, significant innovations and the efficacy of the implemented measures.
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Affiliation(s)
- Charles Chazot
- Fresenius Medical Care Groupe France, 47, allée des pépinières, 94260 Fresnes, France.
| | - Claire de Kerautem
- NephroCare Marne-La-Vallée, 2-4, Cr de la Gondoire, 77600 Marne-la-Vallée, France
| | - Hadia Hebibi
- NephroCare Villejuif, 1, mail du Professeur Georges Mathé, Villejuif Biopark, 94800 Villejuif, France
| | | | - Lise Weis
- NephroCare Marne-La-Vallée, 2-4, Cr de la Gondoire, 77600 Marne-la-Vallée, France
| | - Arsène Attroun
- NephroCare Etampes, 26, avenue Charles de Gaulle, 91150 Étampes, France
| | - Guillaume Jean
- NephroCare Tassin-Charcot, 7, avenue du Maréchal Foch, 69110 Sainte-Foy-Les Lyon, France
| | | | - Samah Saibi
- NephroCare Île-de-France, 47, allée des pépinières, 94260 Fresnes, France
| | - Sabine Flangakis
- NephroCare Occitanie, 22, avenue Bernard IV, 31600 Muret, France
| | - Benjamin Raulet
- NephroCare France, 47, allée des pépinières, 94260 Fresnes, France
| | - Pascal Maufroy
- Fresenius Medical Care Groupe France, 47, allée des pépinières, 94260 Fresnes, France
| | - Jean-Louis Brunet
- Fresenius Medical Care Groupe France, 47, allée des pépinières, 94260 Fresnes, France
| | | | - Sophie Privat
- Fresenius Medical Care Groupe France, 47, allée des pépinières, 94260 Fresnes, France
| | - Solène Pourrat
- Fresenius Medical Care Groupe France, 47, allée des pépinières, 94260 Fresnes, France
| | - Bernard Thuillet
- Fresenius Medical Care Groupe France, 47, allée des pépinières, 94260 Fresnes, France
| | | | - Maxime Théodose
- NephroCare France, 47, allée des pépinières, 94260 Fresnes, France
| | - Martial Levannier
- NephroCare Béziers, 130, rue Dimitri Amilakvari, 34500 Béziers, France
| | - Kais Tahiri
- Fresenius Medical Care Groupe France, 47, allée des pépinières, 94260 Fresnes, France
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14
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Alfano G, Ferrari A, Magistroni R, Fontana F, Cappelli G, Basile C. The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review. J Nephrol 2021; 34:1387-1403. [PMID: 34417996 PMCID: PMC8379591 DOI: 10.1007/s40620-021-01136-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients undergoing in-centre haemodialysis (HD) are particularly exposed to the dire consequences of COVID-19. The present systematic scoping review aims to identify the extent, range, and nature of articles related to COVID-19 and maintenance HD: it reports specifically the prevalence of the COVID-19 pandemic in the HD population, implementation of strategies for the prevention, mitigation and containment of the COVID-19 pandemic in HD centres, demographic and clinical characteristics, and outcomes of the pediatric and adult HD patients. METHODS A multi-step systematic search of the literature in Pubmed, Scopus, Ovid Medline, Embase and Web of Science, published between December 1, 2019, and January 30, 2021 was performed. Two authors separately screened the titles and abstracts of the documents and ruled out irrelevant articles. A report of the papers that met inclusion criteria was performed; then, a descriptive analysis of the characteristics of the included articles and a narrative synthesis of the results were performed. RESULTS The review process ended with the inclusion of 145 articles. Most of them were based on single-centre experiences, which spontaneously developed best practices. Most studies were conducted in high-income countries (69.7%) and a part of them (9.6%) were not in English. Prevalence of COVID-19 among dialysis patients accounted for 0%-37.6%. Preventive measures were reported in 54% of the included articles, with particular emphasis on education, triage, hygiene, and containment measures. Patients experienced a heterogeneous spectrum of symptoms that led 35%-88.2% of them to hospital admission. Median and mean hospital length of stay ranged from 8 to 28.5 and 16.2 to 22 days, respectively. Admission to intensive care units varied widely across studies (from 2.6% to 70.5%) and was associated with high mortality (42.8%-100%). Overall, prognosis was poor in 0%-47% of the hospitalized patients. CONCLUSIONS This systematic scoping review provides an overview of the current knowledge on the impact of COVID-19 on the frail world of HD patients. Furthermore, it may help to implement the existing strategies of COVID-19 prevention and provide a list of unmet needs (safe transport, testing, shelter). Finally, it may be a stimulus for performing systematic reviews and meta-analyses which will form the basis for evidence-based guidelines.
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Affiliation(s)
- Gaetano Alfano
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Annachiara Ferrari
- Nephrology and Dialysis Unit, AUSL Reggio Emilia-IRCCS S. Maria Nuova, Reggio Emilia, Italy
| | - Riccardo Magistroni
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Francesco Fontana
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Via Battisti 192, Acquaviva delle Fonti, 74121 Taranto, Italy
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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15
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Blanchi S, Torreggiani M, Chatrenet A, Fois A, Mazé B, Njandjo L, Bianco G, Lepori N, Pili A, Michel PA, Sileno G, Arazzi M, Esposito V, Pani A, Versino E, Esposito C, Fessi H, Cabiddu G, Piccoli GB. COVID-19 Vaccine Hesitancy in Patients on Dialysis in Italy and France. Kidney Int Rep 2021; 6:2763-2774. [PMID: 34518807 PMCID: PMC8425747 DOI: 10.1016/j.ekir.2021.08.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Patients on dialysis (HDPs) are a category at high risk from COVID-19 and thus a high-priority group for vaccination. COVID-19 vaccine hesitancy has been a concern since the availability of the first vaccine. The objective of this study was to determine hesitancy rates and factors associated with hesitancy toward COVID-19 vaccination in HDP. Methods HDP were surveyed with an ad hoc questionnaire in 4 large dialysis facilities in Europe: Le Mans and Paris, in France, and Cagliari and Pavia, in Italy. The questionnaire explored different domains associated with vaccine hesitancy, such as perception of disease severity, sources of information about the vaccine and the disease, and confidence in the health care system. Results A total of 417 patients (average age 69 years, 60% men) agreed to answer the questionnaire. Hesitancy was associated with younger age (P = 0.003), lower perception of disease severity (P < 0.001) and vaccine efficacy (P < 0.001), and lower trust in vaccination (P < 0.001) and in the health care system and scientists (P < 0.001) in the univariate analysis. In the multivariate models, concerns about side effects (P = 0.004) and vaccine efficacy (P < 0.001) and living in France (P = 0.04) remained associated with higher vaccine hesitancy, whereas having received an influenza vaccine (P = 0.032) and trusting scientists (P = 0.032) were associated with a more positive attitude toward vaccination. Conclusions HDPs have a good understanding of the risks associated with COVID-19. Vaccine hesitancy was not associated with educational level, age, or gender but rather with lack of confidence in vaccine efficacy and concerns about safety. HDPs were quite skeptical about the health care system but generally trusted scientists.
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Affiliation(s)
- Sophie Blanchi
- Department of Infectious Diseases, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Antoine Chatrenet
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France.,Laboratory "Movement, Interactions, Performance" (EA 4334), Le Mans University, Le Mans, France
| | - Antioco Fois
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
| | - Béatrice Mazé
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
| | - Linda Njandjo
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
| | - Giovanna Bianco
- Unit of Nephrology, San Michele Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Nicola Lepori
- Unit of Nephrology, San Michele Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Alessio Pili
- Unit of Nephrology, San Michele Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | | | | | - Marta Arazzi
- Nephrology and Dialysis, ICS Maugeri SpA SB, Pavia, Italy
| | | | - Antonello Pani
- Department of Medical Science and Public Health, University of Cagliari, Nephrology, San Michele Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Elisabetta Versino
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Ciro Esposito
- Nephrology and Dialysis, ICS Maugeri SpA SB, Pavia, Italy
| | - Hafedh Fessi
- Department of Nephrology, Hospital Tenon, Paris, France
| | - Gianfranca Cabiddu
- Department of Medical Science and Public Health, University of Cagliari, Nephrology, San Michele Hospital, ARNAS G. Brotzu, Cagliari, Italy
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16
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SARS-CoV-2 assessment in an outpatient dialysis facility of a single center in Brazil. Braz J Infect Dis 2021; 25:101595. [PMID: 34273270 PMCID: PMC8257428 DOI: 10.1016/j.bjid.2021.101595] [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: 04/22/2021] [Revised: 06/09/2021] [Accepted: 06/20/2021] [Indexed: 01/08/2023] Open
Abstract
Background The reported incidence and fatality rates of SARS-CoV-2 infection in patients receiving maintenance dialysis are higher than those of the general population. Objective This study sought to characterize the clinical characteristics and outcomes following COVID-19 infection in this population in a single center in Brazil. Methods Out of 497 dialysis patients evaluated between March 1st, 2020 and February 1st, 2021, those presenting symptoms or history of close contact with COVID-19 patients were tested. Disease severity was categorized as mild, moderate, or severe. Results Out of the 497 patients, 8.8% tested positive for COVID-19. These patients were predominantly male (59%), mean age 57.5 ± 17. Hospitalization was required for 45.4% of patients and 15.9% received mechanical ventilation. Symptoms such as fever, cough, dyspnea and asthenia were more frequent in the severe group. Neutrophil to lymphocyte ratio, C- reactive protein, glutamic oxalacetic transaminase and lactic dehydrogenase were significantly higher in the severe group, while hemoglobin and lymphocyte counts were significantly lower. Chest CT >50% of ground glass lesions was the risk factor associated with severe disease and need for hospitalization. The incidence of a thromboembolic event was of 22.7% in this population. The incidence, mortality, and case fatality rates were 954.4/10,000 patients, 151.8/10,000 patients, and 15.9%, respectively. Conclusions The incidence, mortality and case fatality rates in our cohort were significantly higher than those reported for the general population. To institute appropriate control measures and early vaccination in dialysis facilities is imperative to prevent the spread of COVID-19 infection.
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17
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Li KK, Woo YM, Stirrup O, Hughes J, Ho A, Filipe ADS, Johnson N, Smollett K, Mair D, Carmichael S, Tong L, Nichols J, Aranday-Cortes E, Brunker K, Parr YA, Nomikou K, McDonald SE, Niebel M, Asamaphan P, Sreenu VB, Robertson DL, Taggart A, Jesudason N, Shah R, Shepherd J, Singer J, Taylor AHM, Cousland Z, Price J, Lees JS, Jones TPW, Lopez CV, MacLean A, Starinskij I, Gunson R, Morris STW, Thomson PC, Geddes CC, Traynor JP, Breuer J, Thomson EC, Mark PB. Genetic epidemiology of SARS-CoV-2 transmission in renal dialysis units - A high risk community-hospital interface. J Infect 2021; 83:96-103. [PMID: 33895226 PMCID: PMC8061788 DOI: 10.1016/j.jinf.2021.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/18/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Patients requiring haemodialysis are at increased risk of serious illness with SARS-CoV-2 infection. To improve the understanding of transmission risks in six Scottish renal dialysis units, we utilised the rapid whole-genome sequencing data generated by the COG-UK consortium. METHODS We combined geographical, temporal and genomic sequence data from the community and hospital to estimate the probability of infection originating from within the dialysis unit, the hospital or the community using Bayesian statistical modelling and compared these results to the details of epidemiological investigations. RESULTS Of 671 patients, 60 (8.9%) became infected with SARS-CoV-2, of whom 16 (27%) died. Within-unit and community transmission were both evident and an instance of transmission from the wider hospital setting was also demonstrated. CONCLUSIONS Near-real-time SARS-CoV-2 sequencing data can facilitate tailored infection prevention and control measures, which can be targeted at reducing risk in these settings.
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Affiliation(s)
- Kathy K Li
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Y Mun Woo
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Ana Da Silva Filipe
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Natasha Johnson
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Katherine Smollett
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Daniel Mair
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Stephen Carmichael
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Lily Tong
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Jenna Nichols
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Elihu Aranday-Cortes
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Kirstyn Brunker
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Yasmin A Parr
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Kyriaki Nomikou
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Sarah E McDonald
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Marc Niebel
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Patawee Asamaphan
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Vattipally B Sreenu
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - David L Robertson
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Aislynn Taggart
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Natasha Jesudason
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Rajiv Shah
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - James Shepherd
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Josh Singer
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Alison H M Taylor
- Renal Unit, University Hospital Monklands, Monkscourt Ave, Airdrie ML6 0JS, Canada
| | - Zoe Cousland
- Renal Unit, University Hospital Monklands, Monkscourt Ave, Airdrie ML6 0JS, Canada
| | - Jonathan Price
- Renal Unit, University Hospital Monklands, Monkscourt Ave, Airdrie ML6 0JS, Canada
| | - Jennifer S Lees
- Renal Unit, University Hospital Monklands, Monkscourt Ave, Airdrie ML6 0JS, Canada; Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Timothy P W Jones
- Department of Infectious Diseases, University Hospital Monklands, Monkscourt Ave, Airdrie ML60JS, Canada
| | - Carlos Varon Lopez
- Department of Microbiology, University Hospital Monklands, Monkscourt Ave, Airdrie ML6 0JS, Canada
| | - Alasdair MacLean
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, UK
| | - Igor Starinskij
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, UK
| | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, UK
| | - Scott T W Morris
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Peter C Thomson
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Colin C Geddes
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Jamie P Traynor
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Judith Breuer
- Institute of Child Health University College London, Cruciform Building, Gower Street, London, WC1E 6BT, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK; Department of Clinical Research, London School of Hygiene and Tropical Medicine, UK.
| | - Patrick B Mark
- MRC-University of Glasgow Centre for Virus Research, Sir Michael Stoker building, 464 Bearsden Road, Glasgow, G61 1QH, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.
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18
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Jang H, Polgreen PM, Segre AM, Pemmaraju SV. COVID-19 modeling and non-pharmaceutical interventions in an outpatient dialysis unit. PLoS Comput Biol 2021; 17:e1009177. [PMID: 34237062 PMCID: PMC8291695 DOI: 10.1371/journal.pcbi.1009177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 07/20/2021] [Accepted: 06/14/2021] [Indexed: 01/07/2023] Open
Abstract
This paper describes a data-driven simulation study that explores the relative impact of several low-cost and practical non-pharmaceutical interventions on the spread of COVID-19 in an outpatient hospital dialysis unit. The interventions considered include: (i) voluntary self-isolation of healthcare personnel (HCPs) with symptoms; (ii) a program of active syndromic surveillance and compulsory isolation of HCPs; (iii) the use of masks or respirators by patients and HCPs; (iv) improved social distancing among HCPs; (v) increased physical separation of dialysis stations; and (vi) patient isolation combined with preemptive isolation of exposed HCPs. Our simulations show that under conditions that existed prior to the COVID-19 outbreak, extremely high rates of COVID-19 infection can result in a dialysis unit. In simulations under worst-case modeling assumptions, a combination of relatively inexpensive interventions such as requiring surgical masks for everyone, encouraging social distancing between healthcare professionals (HCPs), slightly increasing the physical distance between dialysis stations, and-once the first symptomatic patient is detected-isolating that patient, replacing the HCP having had the most exposure to that patient, and relatively short-term use of N95 respirators by other HCPs can lead to a substantial reduction in both the attack rate and the likelihood of any spread beyond patient zero. For example, in a scenario with R0 = 3.0, 60% presymptomatic viral shedding, and a dialysis patient being the infection source, the attack rate falls from 87.8% at baseline to 34.6% with this intervention bundle. Furthermore, the likelihood of having no additional infections increases from 6.2% at baseline to 32.4% with this intervention bundle.
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Affiliation(s)
- Hankyu Jang
- Department of Computer Science, The University of Iowa, Iowa City, Iowa, United States of America
| | - Philip M. Polgreen
- Department of Internal Medicine, Division of Infectious Diseases, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Alberto M. Segre
- Department of Computer Science, The University of Iowa, Iowa City, Iowa, United States of America
| | - Sriram V. Pemmaraju
- Department of Computer Science, The University of Iowa, Iowa City, Iowa, United States of America
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Bulbul E, Dogan P, Sendir M, Kaya A, Ozdemir C. Determination of problems experienced during the COVID-19 pandemic by individuals receiving hemodialysis treatment. Hemodial Int 2021; 26:74-82. [PMID: 34196085 DOI: 10.1111/hdi.12960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/19/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients receiving hemodialysis treatment are among the risk groups during the COVID-19 pandemic. They must cope with many factors simultaneously like anxiety about being ill, social isolation, inadequate information about protective precautions, and the need to attend regular treatment. OBJECTIVES This study was performed with the aim of determining problems experienced by individuals receiving hemodialysis treatment during the pandemic. DESIGN This was a descriptive and cross-sectional type study. PARTICIPANTS The research included 234 patients receiving chronic hemodialysis treatment. MEASUREMENTS For collection of data in the research, a patient descriptive information form and COVID-19 phobia scale (CP19-S) scale were used. RESULTS Patients receiving hemodialysis treatment were determined to have high levels of compliance with individual precautions required during the pandemic. Of patients, 87.6% were determined to experience concern about bringing infection from the dialysis unit to family members. The mean total points for CP19-S were 59.80 ± 14.49. Patients who were female, had low educational level, were not employed, had heart disease in addition to kidney failure, with hemodialysis age from 6 to 8 years, who did not want to go to the dialysis center and had not received education about the pandemic (p < 0.001) were identified to have high phobia at statistically significant levels. CONCLUSIONS Changes occurring in normal life and to hemodialysis treatment during the pandemic cause concern and anxiety in many patients. In this process, providing patients with education about the pandemic and protective methods is very important.
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Affiliation(s)
- Elif Bulbul
- Hamidiye Faculty of Nursing, University of Health Sciences-Turkey, Istanbul, Turkey
| | - Pinar Dogan
- Faculty of Health Sciences, Nursing Department, Istanbul Medipol University, Istanbul, Turkey
| | - Merdiye Sendir
- Hamidiye Faculty of Nursing, University of Health Sciences-Turkey, Istanbul, Turkey
| | - Abdulsamed Kaya
- Vocational School of Health Services, Mus Alparslan University, Mus, Turkey
| | - Cevriye Ozdemir
- Incesu Vocational School of Health Services, Kayseri University, Kayseri, Turkey
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20
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Rombolà G, Heidempergher M, Cornacchiari M, Baragetti I, Pieruzzi F. SARS-CoV-2 and Hemodialysis: diffusion and mortality in patients and health care team. Reflections from the Lombardy experience. J Nephrol 2021; 34:277-279. [PMID: 33646561 PMCID: PMC7919233 DOI: 10.1007/s40620-021-01003-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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21
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Navarrete JE, Tong DC, Cobb J, Rahbari-Oskoui FF, Hosein D, Caberto SC, Lea JP, Franch HA. Epidemiology of COVID-19 Infection in Hospitalized End-Stage Kidney Disease Patients in a Predominantly African-American Population. Am J Nephrol 2021; 52:190-198. [PMID: 33827078 PMCID: PMC8089403 DOI: 10.1159/000514752] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/25/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND End-stage kidney disease patients on dialysis are particularly susceptible to COVID-19 infection due to comorbidities, age, and logistic constraints of dialysis making social distancing difficult. We describe our experience with hospitalized dialysis patients with COVID-19 and factors associated with mortality. METHODS From March 1, 2020, to May 31, 2020, all dialysis patients admitted to 4 Emory Hospitals and tested for COVID-19 were identified. Sociodemographic information and clinical and laboratory data were obtained from the medical record. Death was defined as an in-hospital death or transfer to hospice for end-of-life care. Patients were followed until discharge or death. RESULTS Sixty-four dialysis patients with COVID-19 were identified. Eighty-four percent were African-American. The median age was 64 years, and 59% were males. Four patients were on peritoneal dialysis, and 60 were on hemodialysis for a median time of 3.8 years, while 31% were obese. Fever (72%), cough (61%), and diarrhea (22%) were the most common symptoms at presentation. Thirty-three percent required admission to intensive care unit, and 23% required mechanical ventilation. The median length of stay was 10 days, while 11 patients (17%) died during hospitalization and 17% were discharged to a temporary rehabilitation facility. Age >65 years (RR 13.7, CI: 1.9-100.7), C-reactive protein >100 mg/dL (RR 8.3, CI: 1.1-60.4), peak D-dimer >3,000 ng/mL (RR 4.3, CI: 1.03-18.2), bilirubin >1 mg/dL (RR 3.9, CI: 1.5-10.4), and history of peripheral vascular disease (RR 3.2, CI: 1.2-9.1) were associated with mortality. Dialysis COVID-19-infected patients were more likely to develop thromboembolic complications than those without COVID-19 (RR 3.7, CI: 1.3-10.1). CONCLUSION In a predominantly African-American population, the mortality of end-stage kidney disease patients admitted with COVID-19 infection was 17%. Age, C-reactive protein, D-dimer, bilirubin, and history of peripheral vascular disease were associated with worse survival.
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Affiliation(s)
- José E. Navarrete
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David C. Tong
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jason Cobb
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Darya Hosein
- Clinical Research Coordinator I, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sheryl C. Caberto
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Medical Subspecialties Service Line, Atlanta Department of Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Janice P. Lea
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Harold A. Franch
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Medical Subspecialties Service Line, Atlanta Department of Veterans Affairs Medical Center, Decatur, Georgia, USA
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22
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Sanchez-Russo L, Billah M, Chancay J, Hindi J, Cravedi P. COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences. J Clin Med 2021; 10:900. [PMID: 33668833 PMCID: PMC7956338 DOI: 10.3390/jcm10050900] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023] Open
Abstract
Acute kidney injury (AKI) is a common finding in patients with coronavirus disease 2019 (COVID-19) and has been associated with higher rates of death when compared to COVID-19 patients without kidney injury. Whereas the definitive pathogenesis of COVID-19-related AKI (CoV-AKI) is not clear, histopathologic evidence seems to point at multiple etiologies for the disease, including indirect and direct viral kidney injury. The high incidence of CoV-AKI, along with the aggressive clinical presentation of this entity, have increased the demands for kidney replacement therapies, rapidly overwhelming the supplies of healthcare systems even in major tertiary care centers. As a result, nephrologists have come up with alternatives to maximize the efficiency of treatments and have developed non-conventional therapeutic alternatives such as the implementation of acute peritoneal dialysis for critically ill patients. The long-term implications of CoV-AKI are yet unknown, though early studies suggest that around one third of the patients who survive will remain dependent on kidney replacement therapy. Nephrologists and healthcare workers need to be familiar with the clinical presentation and therapeutic challenges of CoV-AKI in order to develop strategies to mitigate the burden of the disease for patients, and for services providing kidney replacement therapies.
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Affiliation(s)
| | | | | | | | - Paolo Cravedi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (L.S.-R.); (M.B.); (J.C.); (J.H.)
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23
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Tan X, Chen G, Yuan F, Liu Y, Liu H. Inflated Cost Burden of Hemodialysis during COVID-19 Pandemic. Blood Purif 2021; 50:979-980. [PMID: 33524977 PMCID: PMC7900468 DOI: 10.1159/000513699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/08/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Xia Tan
- Department of Nephrology, Key Lab of Kidney Disease and Blood Purification in Hunan, The Second Xiangya Hospital of Central South University, Renal Research Institute of Central South University, Xiangya, China
| | - Guochun Chen
- Department of Nephrology, Key Lab of Kidney Disease and Blood Purification in Hunan, The Second Xiangya Hospital of Central South University, Renal Research Institute of Central South University, Xiangya, China
| | - Fang Yuan
- Department of Nephrology, Key Lab of Kidney Disease and Blood Purification in Hunan, The Second Xiangya Hospital of Central South University, Renal Research Institute of Central South University, Xiangya, China
| | - Yinghong Liu
- Department of Nephrology, Key Lab of Kidney Disease and Blood Purification in Hunan, The Second Xiangya Hospital of Central South University, Renal Research Institute of Central South University, Xiangya, China
| | - Hong Liu
- Department of Nephrology, Key Lab of Kidney Disease and Blood Purification in Hunan, The Second Xiangya Hospital of Central South University, Renal Research Institute of Central South University, Xiangya, China,
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24
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Nordio M, Reboldi G, Di Napoli A, Quintaliani G, Alberici F, Postorino M, Aucella F, Messa P, Brunori G. Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey. J Nephrol 2021; 34:325-335. [PMID: 33387336 PMCID: PMC7776284 DOI: 10.1007/s40620-020-00946-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022]
Abstract
Background and aim Over 80% (365/454) of the nation’s centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. Methods We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. Results Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20–1.51], positive healthcare workers (IRR 1.09, 95% CI 1.02–1.17), test-all policy (IRR 5.94, 95% CI 3.36–10.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001–1.003) (all p < 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94–0.98) (p < 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence ≥ 229 per 100,000 and at ≥ 3 positive healthcare workers. Conclusions Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center’s testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely.
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Affiliation(s)
- Maurizio Nordio
- Unit of Nephrology, General Hospital, Piazzale Ospedale, 23, 31100, Treviso, Italy
| | | | - Anteo Di Napoli
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | - Giuseppe Quintaliani
- Italian Society of Nephrology, Viale dell'Università, 11, 00185, Rome, RM, Italy
| | - Federico Alberici
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Maurizio Postorino
- Unit of Nephrology, Grande Ospedale Metropolitano Reggio Calabria, Reggio Calabria, Italy
| | - Filippo Aucella
- Nephrology and Dialysis Unit, IRCCS "Casa Sollievo Della Sofferenza" Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy
| | - Piergiorgio Messa
- Division of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuliano Brunori
- Italian Society of Nephrology, Viale dell'Università, 11, 00185, Rome, RM, Italy. .,Nephrology and Dialysis Unit, Hospital of Trento, Trento, Italy.
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25
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Alabbas A, Harvey E, Kirpalani A, Teoh CW, Mammen C, Pederson K, Nemec R, Davis TK, Mathew A, McCormick B, Banks CA, Frenette CH, Clark DA, Zimmerman D, Qirjazi E, Mac-Way F, Vorster H, Antonsen JE, Kappel JE, MacRae JM, Hemmett J, Tennankore KK, Moist LM, Copland M, McCormick M, Suri RS, Singh RS, Davison SN, Lemaire M, Chanchlani R. Canadian Association of Paediatric Nephrologists COVID-19 Rapid Response: Home and In-Center Dialysis Guidance. Can J Kidney Health Dis 2021; 8:20543581211053458. [PMID: 34777841 PMCID: PMC8586166 DOI: 10.1177/20543581211053458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE PROGRAM This article provides guidance on optimizing the management of pediatric patients with end-stage kidney disease (ESKD) who will be or are being treated with any form of home or in-center dialysis during the COVID-19 pandemic. The goals are to provide the best possible care for pediatric patients with ESKD during the pandemic and ensure the health care team's safety. SOURCES OF INFORMATION The core of these rapid guidelines is derived from the Canadian Society of Nephrology (CSN) consensus recommendations for adult patients recently published in the Canadian Journal of Kidney Health and Disease (CJKHD). We also consulted specific documents from other national and international agencies focused on pediatric kidney health. Additional information was obtained by formal review of the published academic literature relevant to pediatric home or in-center hemodialysis. METHODS The Leadership of the Canadian Association of Paediatric Nephrologists (CAPN), which is affiliated with the CSN, solicited a team of clinicians and researchers with expertise in pediatric home and in-center dialysis. The goal was to adapt the guidelines recently adopted for Canadian adult dialysis patients for pediatric-specific settings. These included specific COVID-19-related themes that apply to dialysis in a Canadian environment, as determined by a group of senior renal leaders. Expert clinicians and nurses with deep expertise in pediatric home and in-center dialysis reviewed the revised pediatric guidelines. KEY FINDINGS We identified 7 broad areas of home dialysis practice management that may be affected by the COVID-19 pandemic: (1) peritoneal dialysis catheter placement, (2) home dialysis training, (3) home dialysis management, (4) personal protective equipment, (5) product delivery, (6) minimizing direct health care providers and patient contact, and (7) caregivers support in the community. In addition, we identified 8 broad areas of in-center dialysis practice management that may be affected by the COVID-19 pandemic: (1) identification of patients with COVID-19, (2) hemodialysis of patients with confirmed COVID-19, (3) hemodialysis of patients not yet known to have COVID-19, (4) management of visitors to the dialysis unit, (5) handling COVID-19 testing of patients and staff, (6) safe practices during resuscitation procedures in a pandemic, (7) routine hemodialysis care, and (8) hemodialysis care under fixed dialysis resources. We make specific suggestions and recommendations for each of these areas. LIMITATIONS At the time when we started this work, we knew that evidence on the topic of pediatric dialysis and COVID-19 would be severely limited, and our resources were also limited. We did not, therefore, do formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. Thus, this article's advice and recommendations are primarily expert opinions and subject to the biases associated with this level of evidence. To expedite the publication of this work, we created a parallel review process that may not be as robust as standard arms' length peer-review processes. IMPLICATIONS We intend these recommendations to help provide the best care possible for pediatric patients prescribed in-center or home dialysis during the COVID-19 pandemic, a time of altered priorities and reduced resources.
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Affiliation(s)
- Abdullah Alabbas
- Division of Nephrology, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Elizabeth Harvey
- Division of Nephrology, Department of Paediatrics, University of Toronto, ON, Canada
| | - Amrit Kirpalani
- Division of Nephrology, Department of Paediatrics, Western University, London, ON, Canada
| | - Chia Wei Teoh
- Division of Nephrology, Department of Paediatrics, University of Toronto, ON, Canada
| | - Cherry Mammen
- Division of Nephrology, Department of Pediatrics, The University of British Columbia, Vancouver, Canada
| | - Kristen Pederson
- Division of Nephrology, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Rose Nemec
- Division of Nephrology, Department of Paediatrics, University of Toronto, ON, Canada
| | - T. Keefe Davis
- Division of Nephrology, Department of Medicine & Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Anna Mathew
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Cheryl A. Banks
- Prince Edward Island Provincial Renal Program, Summerside, Canada
| | - Charles H. Frenette
- Division of Infectious Diseases, Infection Prevention and Control, Department of Medicine, McGill University, Montreal, QC, Canada
| | - David A. Clark
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health, Halifax, Canada
| | | | - Elena Qirjazi
- Division of Nephrology, Department of Medicine, Alberta Health Services, University of Calgary, Canada
| | - Fabrice Mac-Way
- Division of Nephrology, Department of Medicine, Hôtel-Dieu de Québec Hospital, CHU de Québec-Université Laval, Quebec City, Canada
| | | | - John E. Antonsen
- Hemodialysis Committee, British Columbia Renal Agency, Vancouver, Canada
| | - Joanne E. Kappel
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Jennifer M. MacRae
- Division of Nephrology, Department of Medicine, Alberta Health Services, University of Calgary, Canada
| | - Juliya Hemmett
- Division of Nephrology, Department of Medicine, Alberta Health Services, University of Calgary, Canada
| | - Karthik K. Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health, Halifax, Canada
| | - Louise M. Moist
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | | | | | - Rita S. Suri
- Division of Nephrology, Department of Medicine, Research Institute, McGill University, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, QC, Canada
| | - Rajinder S. Singh
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Sara N. Davison
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Mathieu Lemaire
- Division of Nephrology, Department of Paediatrics, University of Toronto, ON, Canada
- Mathieu Lemaire, Division of Nephrology, Department of Paediatrics, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children’s Hospital, Hamilton, ON, Canada
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26
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Stefan G, Mehedinti AM, Andreiana I, Zugravu AD, Cinca S, Busuioc R, Miler I, Stancu S, Petrescu L, Dimitriu I, Moldovanu E, Crasnaru DE, Gugonea G, Georgescu V, Strambu VD, Capusa C. Clinical features and outcome of maintenance hemodialysis patients with COVID-19 from a tertiary nephrology care center in Romania. Ren Fail 2020; 43:49-57. [PMID: 33307933 PMCID: PMC7745841 DOI: 10.1080/0886022x.2020.1853571] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is limited information about the clinical characteristics, treatment and outcome of maintenance hemodialysis patients with COVID-19. Moreover, regional differences are also conceivable since the extend and severity of outbreaks varied among countries. METHODS In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of 37 maintenance hemodialysis patients (median age 64 years, 51% men) hospitalized with COVID-19 from 24 March to 22 May 2020 as confirmed by real-time PCR. RESULTS The most common symptoms at admission were fatigue (51%), fever (43%), dyspnea (38%) and cough (35%). There were 59% mild/moderate patients and 41% severe/critical patients. Patients in the severe/critical group had a significantly higher atherosclerotic burden since diabetic kidney disease and vascular nephropathies were the most common primary kidney diseases and eighty percent of them had coronary heart disease. Also, Charlson comorbidity score was higher in this group. At admission chest X-ray, 46% had ground-glass abnormalities. Overall, 60% patients received hydroxychloroquine, 22% lopinavir-ritonavir, 11% tocilizumab, 24% systemic glucocorticoids, and 54% received prophylactic anticoagulation. Seven (19%) patients died during hospitalization and 30 were discharged. The main causes of death were cardiovascular (5 patients) and respiratory distress syndrome (2 patients). In Cox regression analysis, lower oxygen saturation, anemia and hypoalbuminemia at admission were associated with increased mortality. CONCLUSIONS In conclusion, we observed a high mortality rate among maintenance hemodialysis patients hospitalized for COVID-19. Anemia, lower serum albumin and lower basal oxygen saturation at admission were factors associated with poor prognosis.
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Affiliation(s)
- Gabriel Stefan
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Ana Maria Mehedinti
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Iuliana Andreiana
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Adrian Dorin Zugravu
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Simona Cinca
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Ruxandra Busuioc
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Ioana Miler
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Simona Stancu
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ligia Petrescu
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioana Dimitriu
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Elena Moldovanu
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | | | - Georgeta Gugonea
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | | | - Victor Dan Strambu
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.,Department of Surgery,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Capusa
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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27
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Connealy MB, Lew SQ, Alsamman M, Lange JJ, Pourmand A. The emergency department care for hemodialysis patient during the COVID-19 pandemic. Am J Emerg Med 2020; 40:47-54. [PMID: 33348223 PMCID: PMC7732232 DOI: 10.1016/j.ajem.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/14/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic poses significant challenges to patients with end-stage kidney disease who receive treatment in outpatient dialysis centers. These patients represent a fragile population that is at higher risk for both infection and transmission. At the start of the pandemic, many suspected COVID-19 dialysis patients were diverted to the emergency department (ED) for testing/treatment, placing a tremendous burden on the ED and inpatient dialysis units. Several recommendations and guidelines have been established to optimize patient care while also decreasing the burden on the ED and inpatient dialysis units and maximizing the ability to perform outpatient hemodialysis. As the pandemic continues, dialysis facilities will have an increasing burden to provide safe and accessible dialysis, while also being able to direct patients to the ED for either emergent dialysis or COVID-19 treatment/testing. We reviewed opinions, recommendations and guidelines developed by professional organizations and dialysis facilities for the management of "patients under investigation" (PUIs) and COVID-19 positive patients that depend on whether the suspicion occurs while the patient is at home vs. at the dialysis center.
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Affiliation(s)
- Margeaux B Connealy
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Susie Q Lew
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Marya Alsamman
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Joel J Lange
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
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28
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Rozanova L, Temerev A, Flahault A. Comparing the Scope and Efficacy of COVID-19 Response Strategies in 16 Countries: An Overview. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249421. [PMID: 33339119 PMCID: PMC7765483 DOI: 10.3390/ijerph17249421] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/29/2020] [Accepted: 12/14/2020] [Indexed: 01/12/2023]
Abstract
This article synthesizes the results of case studies on the development of the coronavirus disease 2019 (COVID-19) pandemic and control measures by governments in 16 countries. When this work was conducted, only 6 months had passed since the pandemic began, and only 4 months since the first events were recognized outside of China. It was too early to draw firm conclusions about the effectiveness of measures in each of the selected countries; however, the authors present some efforts to identify and classify response and containment measures, country-by-country, for future comparison and analysis. There is a significant variety of policy tools and response measures employed in different countries, and while it is still hard to directly compare the different approaches based on their efficacy, it will definitely provide many inputs for the future data analysis efforts.
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Affiliation(s)
- Liudmila Rozanova
- Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland; (A.T.); (A.F.)
- Global Studies Institute, University of Geneva, 1205 Geneva, Switzerland
- Correspondence:
| | - Alexander Temerev
- Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland; (A.T.); (A.F.)
| | - Antoine Flahault
- Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland; (A.T.); (A.F.)
- Global Studies Institute, University of Geneva, 1205 Geneva, Switzerland
- Swiss School of Public Health (SSPH+), 8001 Zurich, Switzerland
- Hôpitaux Universitaires de Genève (HUG), 1205 Geneva, Switzerland
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29
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Coca A, Burballa C, Centellas-Pérez FJ, Pérez-Sáez MJ, Bustamante-Munguira E, Ortega A, Dueñas C, Arenas MD, Pérez-Martínez J, Ruiz G, Crespo M, Llamas F, Bustamante-Munguira J, Pascual J. Outcomes of COVID-19 Among Hospitalized Patients With Non-dialysis CKD. Front Med (Lausanne) 2020; 7:615312. [PMID: 33344488 PMCID: PMC7744802 DOI: 10.3389/fmed.2020.615312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome-Corona Virus 2 has generated significant impact on global health worldwide. COVID-19 can cause pneumonia and organ injury. Chronic kidney disease (CKD) has been associated with increased mortality in previous epidemics, but there is a paucity of data regarding actual risks for non-dialysis CKD patients with COVID-19. Methods: Multicenter, observational cohort study including 136 non-dialysis CKD patients and 136 age- and sex-matched controls that required hospitalization due to COVID-19. Patients with end-stage renal disease, a kidney transplant or without registered baseline glomerular filtration rate prior to COVID-19 infection were excluded. CKD and acute kidney injury (AKI) were defined according to KDIGO criteria. Results: CKD patients had higher white blood cell count and D-dimer and lower lymphocyte percentage. No differences were found regarding symptoms on admission. CKD was associated with higher rate of AKI (61 vs. 24.3%) and mortality (40.4 vs. 24.3%). Patients with AKI had the highest hazard for death (AKI/non-CKD HR:7.04, 95% CI:2.87–17.29; AKI/CKD HR:5.25, 95% CI: 2.29–12.02), followed by CKD subjects without AKI (HR:3.39, 95% CI:1.36–8.46). CKD status did not condition ICU admission or length of in-hospital stay. Conclusions: CKD patients that require hospitalization due to COVID-19 are exposed to higher risk of death and AKI.
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Affiliation(s)
- Armando Coca
- Department of Nephrology, Hospital Clínico Universitario Valladolid, Valladolid, Spain.,Grupo de Trabajo de Jóvenes Nefrólogos de la Sociedad Española de Nefrología (JovSEN), Madrid, Spain
| | - Carla Burballa
- Grupo de Trabajo de Jóvenes Nefrólogos de la Sociedad Española de Nefrología (JovSEN), Madrid, Spain.,Department of Nephrology, Hospital del Mar Barcelona, Barcelona, Spain
| | - Francisco Javier Centellas-Pérez
- Grupo de Trabajo de Jóvenes Nefrólogos de la Sociedad Española de Nefrología (JovSEN), Madrid, Spain.,Department of Nephrology and Renal Transplant, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - María José Pérez-Sáez
- Grupo de Trabajo de Jóvenes Nefrólogos de la Sociedad Española de Nefrología (JovSEN), Madrid, Spain.,Department of Nephrology, Hospital del Mar Barcelona, Barcelona, Spain
| | | | - Agustín Ortega
- Department of Nephrology and Renal Transplant, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Carlos Dueñas
- Department of Internal Medicine, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | | | - Juan Pérez-Martínez
- Department of Nephrology and Renal Transplant, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Guadalupe Ruiz
- Department of Clinical Chemistry, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar Barcelona, Barcelona, Spain
| | - Francisco Llamas
- Department of Nephrology and Renal Transplant, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Julio Pascual
- Department of Nephrology, Hospital del Mar Barcelona, Barcelona, Spain
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30
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Akbarialiabad H, Kavousi S, Ghahramani A, Bastani B, Ghahramani N. COVID-19 and maintenance hemodialysis: a systematic scoping review of practice guidelines. BMC Nephrol 2020; 21:470. [PMID: 33172405 PMCID: PMC7653213 DOI: 10.1186/s12882-020-02143-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/30/2020] [Indexed: 12/23/2022] Open
Abstract
Background Coronavirus Disease 2019 (COVID-19) has substantially impacted the provision of medical services. During the pandemic, many medical services, including facilities providing care to patients with end stage renal disease faced challenges in safeguarding patients and staff while providing clinical care. This study aims to identify the extent, range, and nature of articles related to COVID-19 and maintenance hemodialysis to understand the research gaps and propose recommendations for future research. Methods Using the terms: “Dialysis” OR “RRT” OR “Renal replacement therapy” AND “SARS-COV-2” OR “COVID-19” OR “novel coronavirus” OR “2019-nCov”, we performed a multi-step systematic search of the literature in the English language in Pubmed, Scopus, Embase, and Web of Science published from December 1, 2019, to May 13, 2020. Two authors separately screened the title and abstracts of the documents and ruled out irrelevant articles. We obtained a full report of the papers that met our inclusion criteria and screened the full texts. We conducted a descriptive analysis of the characteristics of the included articles and performed a narrative synthesis of the results. We conducted this scoping review in accordance with the PRISMA-ScR Checklist. Results We included 22 articles in this scoping review. Perspectives (n = 9), editorials (n = 4), and case series (n = 5) were the most common types of articles. Most articles were from Italy and the United States. Seventeen (77.3%) of the articles focused on the topic of recommendation for outpatient hemodialysis units. While many of the recommendations overlapped in several articles, there were also many unique recommendations. Conclusions most of the articles are based on single-center experience, which spontaneously developed best practices. Many of these practices have formed the basis for policies and guidelines that will guide future prevention of infection and management of patients with End Stage Renal Disease (ESRD) and COVID-19.
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Affiliation(s)
- Hossein Akbarialiabad
- Shiraz University of Medical Sciences, Shiraz Medical School, Zand Street, Shiraz, 7134845794, Iran
| | - Shahin Kavousi
- Shiraz University of Medical Sciences, Shiraz Medical School, Zand Street, Shiraz, 7134845794, Iran
| | - Aria Ghahramani
- Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Bahar Bastani
- Medicine-Nephrology, Saint Louis University School of Medicine, 3635 Vista Ave, St Louis, MO, 63110, USA
| | - Nasrollah Ghahramani
- Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
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31
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Mujtaba M, Kueht M, Merwat S, Hussain S, Gamilla-Crudo AK, Kulkarni R, Merwat S, Fair J. Organ transplantation during the COVID-19 pandemic: Making the best patient care decision. Am J Transplant 2020; 20:3259-3260. [PMID: 32506792 PMCID: PMC7301018 DOI: 10.1111/ajt.16116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Muhammad Mujtaba
- University of Texas Medical Branch, Galveston, Texas, USA,Correspondence Muhammad Mujtaba
| | - Michael Kueht
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Shehzad Merwat
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Syed Hussain
- University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Rupak Kulkarni
- University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Jeff Fair
- University of Texas Medical Branch, Galveston, Texas, USA
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32
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Creput C, Fumeron C, Toledano D, Diaconita M, Izzedine H. COVID-19 in Patients Undergoing Hemodialysis: Prevalence and Asymptomatic Screening During a Period of High Community Prevalence in a Large Paris Center. Kidney Med 2020; 2:716-723.e1. [PMID: 33106788 PMCID: PMC7577867 DOI: 10.1016/j.xkme.2020.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rationale & Objective Due to extensive comorbid conditions, coronavirus disease 2019 (COVID-19) has a poor prognosis in people receiving maintenance hemodialysis. In this article, we describe our experience with 200 maintenance hemodialysis patients in a hemodialysis center that used universal reverse transcriptase-polymerase chain reaction testing, including 38 COVID-19–positive patients. Study Design Descriptive observational cohort, including the time line of patient diagnoses along with contextual events including precautions, testing, screening algorithms, clinical diagnostics and therapy, and the clinical course of COVID-19–infected patients and their final outcomes. Setting & Participants 200 patients within a single hemodialysis center with 2 dialysis clinics in Paris. Results Among 200 maintenance hemodialysis patients, 38 (19%) had COVID-19 diagnosed; of these, 15 (39.5%) were admitted to the hospital, including 4 who required intensive care unit (ICU) care. There were 8 (21%) deaths. The most common symptom was fever, followed by dry cough, fatigue, and dyspnea. All COVID-19–infected patients had lymphopenia and an increase in C-reactive protein levels. Median time from the onset of respiratory symptoms to ICU admission was 1 to 2 days. Durations of non-ICU hospitalizations and ICU stays were 7 and 13 days, respectively. Limitations Retrospective study, single hemodialysis center. Conclusions Dialysis patients are a highly susceptible population and hemodialysis centers are a high-risk area in a COVID-19 epidemic. “Unexplained” lymphopenia and/or an increase in C-reactive protein level should lead physicians to the diagnosis of COVID-19 and should, when possible, be followed by diagnostic testing with universal reverse transcriptase-polymerase chain reaction, as well as the reinforcement of contamination barrier measures.
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Affiliation(s)
| | | | | | | | - Hassan Izzedine
- Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France
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33
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Hsu CM, Weiner DE. COVID-19 in dialysis patients: outlasting and outsmarting a pandemic. Kidney Int 2020; 98:1402-1404. [PMID: 33065131 PMCID: PMC7552964 DOI: 10.1016/j.kint.2020.10.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/23/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has affected the care and outcomes of patients treated with dialysis worldwide. In this issue of Kidney International, 3 reports highlight the disproportionately severe impact of COVID-19 on patients on dialysis, noting its high prevalence, particularly among patients receiving in-center dialysis. This likely reflects patients’ limited ability to physically distance as well as community exposures, including residence in areas with high rates of infection. Patients on dialysis are at extremely high risk should they develop COVID-19, with short-term mortality of 20% or higher. Accordingly, it is imperative that the kidney community intervenes to reduce the threat of COVID-19 in this vulnerable population by focusing on modifiable factors, including universal masking of patients and staff and enhanced screening, including testing for COVID-19 in the patients who are asymptomatic during times of high local prevalence.
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Affiliation(s)
- Caroline M Hsu
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Daniel E Weiner
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA.
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34
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Patients’ and healthcare personnel expectations for SARS-CoV-2 screening in dialysis unit during the Covid-19 pandemic. J Nephrol 2020; 33:879-881. [PMID: 32720137 PMCID: PMC7384721 DOI: 10.1007/s40620-020-00811-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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35
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The possibility of SARS-CoV-2 transmission in a haemodialysis unit - report from a large in-hospital centre. Epidemiol Infect 2020; 148:e226. [PMID: 32981558 PMCID: PMC7542315 DOI: 10.1017/s0950268820002277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Data on the possibility of transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) during the provision of chronic haemodialysis, which often entails many person-to-person contacts, are lacking. We report a follow-up of the in-centre contacts of three positive chronic haemodialysis patients. Under strict preventive measures, only one patient out of 21 patient-contacts and 29 personnel-contacts tested positive within 2 weeks after the last contact. This patient, case #3, most likely became infected during unprotected, organised group transportation to the dialysis centre.
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36
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Bigelow BF, Tang O, Toci GR, Stracker N, Sheikh F, Jacobs Slifka KM, Novosad SA, Jernigan JA, Reddy SC, Katz MJ. Transmission of SARS-CoV-2 Involving Residents Receiving Dialysis in a Nursing Home - Maryland, April 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1089-1094. [PMID: 32790661 PMCID: PMC7440122 DOI: 10.15585/mmwr.mm6932e4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly in nursing homes once it is introduced (1,2). To prevent outbreaks, more data are needed to identify sources of introduction and means of transmission within nursing homes. Nursing home residents who receive hemodialysis (dialysis) might be at higher risk for SARS-CoV-2 infections because of their frequent exposures outside the nursing home to both community dialysis patients and staff members at dialysis centers (3). Investigation of a COVID-19 outbreak in a Maryland nursing home (facility A) identified a higher prevalence of infection among residents undergoing dialysis (47%; 15 of 32) than among those not receiving dialysis (16%; 22 of 138) (p<0.001). Among residents with COVID-19, the 30-day hospitalization rate among those receiving dialysis (53%) was higher than that among residents not receiving dialysis (18%) (p = 0.03); the proportion of dialysis patients who died was 40% compared with those who did not receive dialysis (27%) (p = 0.42).Careful consideration of infection control practices throughout the dialysis process (e.g., transportation, time spent in waiting areas, spacing of machines, and cohorting), clear communication between nursing homes and dialysis centers, and coordination of testing practices between these sites are critical to preventing COVID-19 outbreaks in this medically vulnerable population.
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37
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Malberti F, Pecchini P, Marchi G, Foramitti M. When a nephrology ward becomes a COVID-19 ward: the Cremona experience. J Nephrol 2020; 33:625-628. [PMID: 32430898 PMCID: PMC7235973 DOI: 10.1007/s40620-020-00743-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Fabio Malberti
- Divisione Di Nefrologia E Dialisi, Renal Department, ASST-Cremona, Largo Priori 1, 26100, Cremona, Italy.
| | - Paola Pecchini
- Divisione Di Nefrologia E Dialisi, Renal Department, ASST-Cremona, Largo Priori 1, 26100, Cremona, Italy
| | - Gianluca Marchi
- Divisione Di Nefrologia E Dialisi, Renal Department, ASST-Cremona, Largo Priori 1, 26100, Cremona, Italy
| | - Marina Foramitti
- Divisione Di Nefrologia E Dialisi, Renal Department, ASST-Cremona, Largo Priori 1, 26100, Cremona, Italy
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38
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Cozzolino M, Piccoli GB, Ikizler TA, Ronco C. The COVID-19 infection in dialysis: are home-based renal replacement therapies a way to improve patient management? J Nephrol 2020; 33:629-631. [PMID: 32542561 PMCID: PMC7294214 DOI: 10.1007/s40620-020-00784-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mario Cozzolino
- Division of Nephrology and Dialysis, Department of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy.
| | - Giorgina Barbara Piccoli
- Centre Hospitalier Le Mans, France, Le Mans, France
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Talat Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claudio Ronco
- Department of Medicine, University of Padua, Padua, Italy
- Department of Nephrology, Dialysis and Kidney Transplant, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy
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39
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Gagliardi I, Patella G, Michael A, Serra R, Provenzano M, Andreucci M. COVID-19 and the Kidney: From Epidemiology to Clinical Practice. J Clin Med 2020; 9:E2506. [PMID: 32759645 PMCID: PMC7464116 DOI: 10.3390/jcm9082506] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 02/06/2023] Open
Abstract
The new respiratory infectious disease coronavirus disease 2019 (COVID-19) that originated in Wuhan, China, in December 2019 and caused by a new strain of zoonotic coronavirus, named severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), to date has killed over 630,000 people and infected over 15,000,000 worldwide. Most of the deceased patients had pre-existing comorbidities; over 20% had chronic kidney disease (CKD). Furthermore, although SARS-CoV-2 infection is characterized mainly by diffuse alveolar damage and acute respiratory failure, acute kidney injury (AKI) has developed in a high percentage of cases. As AKI has been shown to be associated with worse prognosis, we believe that the impact of SARS-CoV-2 on the kidney should be investigated. This review sets out to describe the main renal aspects of SARS-CoV-2 infection and the role of the virus in the development and progression of kidney damage. In this article, attention is focused on the epidemiology, etiology and pathophysiological mechanisms of kidney damage, histopathology, clinical features in nephropathic patients (CKD, hemodialysis, peritoneal dialysis, AKI, transplantation) and prevention and containment strategies. Although there remains much more to be learned with regards to this disease, nonetheless it is our hope that this review will aid in the understanding and management of SARS-CoV-2 infection.
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Affiliation(s)
- Ida Gagliardi
- Renal Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (G.P.); (A.M.); (M.P.)
| | - Gemma Patella
- Renal Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (G.P.); (A.M.); (M.P.)
| | - Ashour Michael
- Renal Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (G.P.); (A.M.); (M.P.)
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Michele Provenzano
- Renal Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (G.P.); (A.M.); (M.P.)
| | - Michele Andreucci
- Renal Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (G.P.); (A.M.); (M.P.)
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40
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Sbrana F, Dal Pino B, Bigazzi F, Pianelli M, Luciani R, Sampietro T. COVID-19 swab collection and serological screening in lipoprotein apheresis unit. J Clin Apher 2020; 35:382-383. [PMID: 32629544 PMCID: PMC7361289 DOI: 10.1002/jca.21810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Francesco Sbrana
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Pisa, Italy
| | - Beatrice Dal Pino
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Pisa, Italy
| | - Federico Bigazzi
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Pisa, Italy
| | - Mascia Pianelli
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Pisa, Italy
| | - Roberta Luciani
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Pisa, Italy
| | - Tiziana Sampietro
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Pisa, Italy
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41
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Baron DM, Franchini M, Goobie SM, Javidroozi M, Klein AA, Lasocki S, Liumbruno GM, Muñoz M, Shander A, Spahn DR, Zacharowski K, Meybohm P. Patient blood management during the COVID-19 pandemic: a narrative review. Anaesthesia 2020; 75:1105-1113. [PMID: 32339260 PMCID: PMC7497056 DOI: 10.1111/anae.15095] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 01/08/2023]
Abstract
As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient blood management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient blood management during the COVID-19 pandemic. In particular, this review considers the impact of the COVID-19 pandemic on blood supply and specifies important aspects of donor management. We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient blood management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient blood management during the COVID-19 pandemic.
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Affiliation(s)
- D. M. Baron
- Department of Anaesthesia, Intensive Care Medicine and Pain MedicineMedical University of ViennaAustria
| | - M. Franchini
- Department of Hematology and Transfusion MedicineCarlo Poma HospitalMantovaItaly
- Italian National Blood CentreRomeItaly
| | - S. M. Goobie
- Department of Anesthesiology, Critical Care and Pain MedicineHarvard Medical SchoolBoston Children's HospitalBostonMAUSA
| | - M. Javidroozi
- Department of Anesthesiology and Critical Care MedicineEnglewood Hospital and Medical CenterNew JerseyNJUSA
| | - A. A. Klein
- Department of Anaesthesia and Intensive CareRoyal Papworth HospitalCambridgeUK
| | - S. Lasocki
- Département Anesthésie RéanimationCHU AngersUniversité d'AngersFrance
| | | | - M. Muñoz
- Peri‐operative Transfusion MedicineDepartment of Surgical Specialties, Biochemistry and ImmunologySchool of MedicineUniversity of MálagaSpain
| | - A. Shander
- Department of Anesthesiology, Critical Care and Hyperbaric MedicineEnglewood HealthNJUSA
- UF College of MedicineGainesvilleFLUSA
- Icahn School of Medicine at MountSinai New YorkNew YorkNYUSA
- Rutgers UniversityNewarkNJUSA
| | - D. R. Spahn
- Institute of Anesthesiology and Head AnesthesiologyIntensive Care Medicine and OR FacilitiesUniversity of Zurich and University Hospital ZurichSwitzerland
| | - K. Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain TherapyUniversity Hospital FrankfurtGoethe UniversityFrankfurt am MainGermany
| | - P. Meybohm
- Department of AnesthesiologyUniversity Hospital WürzburgGermany
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42
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Rincón A, Moreso F, López-Herradón A, Fernández-Robres MA, Cidraque I, Nin J, Méndez O, López M, Pájaro C, Satorra À, Stuard S, Ramos R. The keys to control a COVID-19 outbreak in a haemodialysis unit. Clin Kidney J 2020; 13:542-549. [PMID: 32885797 PMCID: PMC7454433 DOI: 10.1093/ckj/sfaa119] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The high rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreading represents a challenge to haemodialysis (HD) units. While fast isolation of suspected cases plays an essential role to avoid disease outbreaks, significant rates of asymptomatic cases have recently been described. After detecting an outbreak in one of our HD clinics, wide SARS-CoV-2 screening and segregation of confirmed cases were performed. METHODS The entire clinic population, 192 patients, underwent testing for SARS-CoV-2 detection by real-time reverse-transcriptase polymerase chain reaction . We used univariate and multivariate logistic regression to define variables involved in SARS-CoV-2 infection in our dialysis unit. Later, we analysed differences between symptomatic and asymptomatic SARS-CoV-2-positive patients. RESULTS In total, 22 symptomatic and 14 of the 170 asymptomatic patients had a SARS-CoV-2-positive result. Living in a nursing home/homeless [odds ratio (OR) 3.54; P = 0.026], having been admitted to the reference hospital within the previous 2 weeks (OR 5.19; P = 0.002) and sharing health-care transportation with future symptomatic (OR 3.33; P = 0.013) and asymptomatic (OR 4.73; P = 0.002) positive patients were independent risk factors for a positive test. Nine positive patients (25.7%) remained asymptomatic after a 3-week follow-up. We found no significant differences between symptomatic and asymptomatic SARS-CoV-2-positive patients. CONCLUSIONS Detection of asymptomatic SARS-CoV-2-positive patients is probably one of the key points to controlling an outbreak in an HD unit. Sharing health-care transportation to the dialysis unit, living in a nursing home and having been admitted to the reference hospital within the previous 2 weeks, are major risk factors for SARS-CoV-2 infection.
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Affiliation(s)
- Abraham Rincón
- Medical Department, Fresenius Medical Care Spain, Madrid, Spain
| | - Francesc Moreso
- Medical Department, Fresenius Medical Care Spain, Madrid, Spain
| | | | | | - Ignacio Cidraque
- Tarrasa Dialysis Center, Fresenius Medical Care Spain, Tarrasa, Barcelona, Spain
| | - Jordi Nin
- Hospitalet Dialysis Center, Fresenius Medical Care Spain, Hospitalet de Llobregat, Barcelona, Spain
| | - Orleans Méndez
- Hospitalet Dialysis Center, Fresenius Medical Care Spain, Hospitalet de Llobregat, Barcelona, Spain
| | - Marisol López
- Hospitalet Dialysis Center, Fresenius Medical Care Spain, Hospitalet de Llobregat, Barcelona, Spain
| | - Carlota Pájaro
- Tarrasa Dialysis Center, Fresenius Medical Care Spain, Tarrasa, Barcelona, Spain
| | - Àngels Satorra
- Hospitalet Dialysis Center, Fresenius Medical Care Spain, Hospitalet de Llobregat, Barcelona, Spain
| | - Stefano Stuard
- Global Medical Office - Clinical & Therapeutic Governance EMEA, Fresenius Medical Care, Bad Homburg, Germany
| | - Rosa Ramos
- Medical Department, Fresenius Medical Care Spain, Madrid, Spain
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Taverna G, Di Francesco S, Borroni EM, Yiu D, Toniato E, Milanesi S, Chiriva-Internati M, Bresalier RS, Zanoni M, Vota P, Maffei D, Justich M, Grizzi F. The kidney, COVID-19, and the chemokine network: an intriguing trio. Int Urol Nephrol 2020; 53:97-104. [PMID: 32720031 PMCID: PMC7384276 DOI: 10.1007/s11255-020-02579-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
On December 30th 2019, some patients with pneumonia of unknown etiology were reported in the Program for Monitoring Emerging Diseases (ProMED), a program run by the International Society for Infectious Diseases (ISID), hypothesized to be related to subjects who had had contact with the seafood market in Wuhan, China. Chinese authorities instituted an emergency agency aimed at identifying the source of infection and potential biological pathogens. It was subsequently named by the World Committee on Virus Classification as 2019-nCoV (2019-novel coronavirus) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A number of studies have demonstrated that 2019-nCoV and the SARS-CoV shared the same cell entry receptor named angiotensin-converting enzyme 2 (ACE2). This is expressed in human tissues, not only in the respiratory epithelia, but also in the small intestines, heart, liver, and kidneys. Here, we examine the most recent findings on the effects of SARS-CoV-2 infection on kidney diseases, mainly acute kidney injury, and the potential role of the chemokine network.
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Affiliation(s)
- Gianluigi Taverna
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy.,Urology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Humanitas University, Pieve Emanuele, Milan, Italy
| | - Simona Di Francesco
- Department of Urological Biomedical and Translational Sciences, Federiciana University, Rome, Italy.,Department of Medical and Oral Sciences and Biotechnologies, G. D'Annunzio University, Chieti, Pescara, Italy
| | - Elena Monica Borroni
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy.,Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Daniel Yiu
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Elena Toniato
- Department of Medical and Oral Sciences and Biotechnologies, G. D'Annunzio University, Chieti, Pescara, Italy
| | - Samantha Milanesi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy.,Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Maurizio Chiriva-Internati
- Division of Internal Medicine, Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Kiromic Biopharma, Inc., Houston, TX, USA
| | - Robert S Bresalier
- Division of Internal Medicine, Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matteo Zanoni
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Paolo Vota
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Davide Maffei
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Matteo Justich
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Fabio Grizzi
- Humanitas University, Pieve Emanuele, Milan, Italy. .,Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
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Benedetti C, Waldman M, Zaza G, Riella LV, Cravedi P. COVID-19 and the Kidneys: An Update. Front Med (Lausanne) 2020; 7:423. [PMID: 32793615 PMCID: PMC7385132 DOI: 10.3389/fmed.2020.00423] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023] Open
Abstract
The new coronavirus disease 2019 (COVID-19) has become a world health emergency. The disease predominantly effects individuals between 30 and 79 years of age with 81% of cases being classified as mild. Despite the majority of the general population displaying symptoms similar to the common cold, COVID-19 has also induced alveolar damage resulting in progressive respiratory failure with fatalities noted in 6.4% of cases. Direct viral injury, uncontrolled inflammation, activation of coagulation, and complement cascades are thought to participate in disease pathogenesis. Patients with COVID-19 have displayed kidney damage through acute kidney injury, mild proteinuria, hematuria, or slight elevation in creatinine possibly as consequence of kidney tropism of the virus and multiorgan failure. The impact of COVID-19 on patients with pre-existing kidney impairment, including those with chronic kidney disease, kidney transplant recipients, and individuals on hemodialysis (HD) has not yet been clearly established. No specific treatments for COVID-19 have been found yet. Research has revealed several agents that may have potential efficacy against COVID-19, and many of these molecules have demonstrated preliminary efficacy against COVID-19 and are currently being tested in clinical trials.
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Affiliation(s)
- Claudia Benedetti
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Meryl Waldman
- Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Gianluigi Zaza
- Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Leonardo V. Riella
- Renal Division, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Paolo Cravedi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Quintaliani G, Reboldi G, Di Napoli A, Nordio M, Limido A, Aucella F, Messa P, Brunori G. Exposure to novel coronavirus in patients on renal replacement therapy during the exponential phase of COVID-19 pandemic: survey of the Italian Society of Nephrology. J Nephrol 2020; 33:725-736. [PMID: 32621109 PMCID: PMC7333370 DOI: 10.1007/s40620-020-00794-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023]
Abstract
Background Between February and April 2020, Italy experienced an overwhelming growth of the COVID-19 pandemic. Little is known, at the country level, where and how patients on renal replacement therapy (RRT) have been mostly affected. Methods Survey of the network of Nephrology centers using a simplified 17 items electronic questionnaire designed by Italian Society of Nephrology COVID-19 Research Group. We used spatial epidemiology and geographical information systems to map SARS-CoV-2 spread among RRT patients in Italy. Results On April 9th 2020, all nephrology centers (n = 454) listed in the DialMap database were invited to complete the electronic questionnaire. Within 11 days on average, 365 centers responded (80.4% response rate; 2.3% margin of error) totaling 60,441 RRT patients. The surveyed RRT population included 30,821 hemodialysis (HD), 4139 peritoneal dialysis (PD), and 25,481 transplanted (Tx) patients respectively. The proportion of SARS-CoV-2 positive RRT patients in Italy was 2.26% (95% CI 2.14–2.39) with significant differences according to treatment modality (p < 0.001). The proportion of patients positive for SARS-CoV-2 was significantly higher in HD (3.55% [95% CI 3.34–3.76]) than PD (1.38% [95% CI 1.04–1.78] and Tx (0.86% [95% CI 0.75–0.98]) (p < 0.001), with substantial heterogeneity across regions and along the latitude gradient (p < 0.001). In RRT patients the highest rate was in the north-west (4.39% [95% CI 4.11–4.68], followed by the north-east (IR 2.06% [1.79–2.36]), the center (0.91% [0.75–1.09]), the main islands (0.67% [0.47–0.93]), and the south (0.59% [0.45–0.75]. During the COVID-19 pandemic, among SARS-Cov-2 positive RRT patients the fatality rate was 32.8%, as compared to 13.3% observed in the Italian population as of April 23rd. Conclusions A substantial proportion of the 60,441 surveyed RRT patients in Italy were SARS-Cov-2 positive and subsequently died during the exponential phase of COVID-19 pandemic. Infection risk and rates seems to differ substantially across regions, along geographical latitude, and by treatment modality. Electronic supplementary material The online version of this article (10.1007/s40620-020-00794-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giuseppe Quintaliani
- Italian Society of Nephrology, Viale dell'Università, 11, 00185, Roma, RM, Italy
| | | | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Maurizio Nordio
- Unit of Nephrology, General Hospital, Piazzale Ospedale, 23, 31100, Treviso, Italy
| | - Aurelio Limido
- Nephrology and Dialysis Unit, ASST Fatebenefratelli e Oftalmico, Milan, Italy
| | - Filippo Aucella
- Nephrology and Dialysis Unit, IRCCS "Casa Sollievo Della Sofferenza" Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy
| | - Piergiorgio Messa
- Division of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giuliano Brunori
- Italian Society of Nephrology, Viale dell'Università, 11, 00185, Roma, RM, Italy. .,Nephrology and Dialysis Unit, Hospital of Trento, Trento, Italy.
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46
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Rodrigo E, Piñera VC, Setién MA, Siller M, Pablo D, Tejido R, Ruiz JC. Silent COVID-19 in haemodialysis facilities in Cantabria, Spain: an ecological study. Clin Kidney J 2020; 13:475-476. [PMID: 32695330 PMCID: PMC7337700 DOI: 10.1093/ckj/sfaa106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Emilio Rodrigo
- Department of Nephrology, IDIVAL-Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - Vicente Celestino Piñera
- Department of Nephrology, IDIVAL-Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - Maria Angeles Setién
- Department of Nephrology, IDIVAL-Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - María Siller
- Department of Nephrology, IDIVAL-Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - Daniel Pablo
- Department of Nephrology, IDIVAL-Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - Rafael Tejido
- Department of Nephrology, IDIVAL-Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - Juan Carlos Ruiz
- Department of Nephrology, IDIVAL-Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
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Abstract
Dialysis patients are more vulnerable and susceptible to the severe coronavirus disease 2019 (COVID-19) infection due to multiple comorbidities. Since Taiwan has the highest incidence and prevalence of treated end-stage kidney disease worldwide, it is crucial to act in advance to prevent a potential disaster. In the face of the COVID-19 pandemic, we implement proactive infection control measures to prevent it from spreading without sacrificing the dialysis care quality. In this article, we focused on hemodialysis vascular access (HVA) care in particular. As a life-line of hemodialysis (HD) patients, HVA care has a profound impact on the patient's quality of dialysis and life. Specifically, in our facility, the working and office areas of the HD units are separated to reduce cross-infection. All elective procedures for HVA are postponed, and operating rooms equipped with a negative-pressure anteroom are used for the suspected or confirmed COVID-19 patients. Herein, we share how we modified our HVA care policy not only to prevent our patients from COVID-19 infection but also to maintain the quality of HVA care.
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Affiliation(s)
- Chih-Yu Yang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Stem Cell Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
- Center for Intelligent Drug Systems and Smart Bio-devices (IDSB), Taiwan, ROC
| | - Yi-Fang Wang
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yang Ho
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Hsueh Wu
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chiu-Yang Lee
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Peripheral Vascular Treatment and Research Center and Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Der-Cherng Tarng
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Center for Intelligent Drug Systems and Smart Bio-devices (IDSB), Taiwan, ROC
- Department and Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Address correspondence. Dr. Der-Cherng Tarng, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (D.-C. Tarng)
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48
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Esposito P, Russo R, Conti N, Falqui V, Massarino F, Moriero E, Peloso G, Traverso GB, Garibotto G, Viazzi F. Management of COVID-19 in hemodialysis patients: The Genoa experience. Hemodial Int 2020; 24:423-427. [PMID: 32365278 PMCID: PMC7267634 DOI: 10.1111/hdi.12837] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Pasquale Esposito
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Rodolfo Russo
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Novella Conti
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Valeria Falqui
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Fabio Massarino
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Enzo Moriero
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Giancarlo Peloso
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Giovanni Battista Traverso
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Giacomo Garibotto
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Francesca Viazzi
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
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Impact of renal function on admission in COVID-19 patients: an analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID 19) Registry. J Nephrol 2020; 33:737-745. [PMID: 32602006 PMCID: PMC7322375 DOI: 10.1007/s40620-020-00790-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite its international aggressive extension, with a significant morbidity and mortality, the impact of renal function on its prognosis is uncertain. Methods Analysis from the international HOPE-Registry (NCT04334291). The objective was to evaluate the association between kidney failure severity on admission with the mortality of patients with SARS-CoV-2 infection. Patients were categorized in 3 groups according to the estimated glomerular filtration rate on admission (eGFR > 60 mL/min/1.73 m2, eGFR 30–60 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2). Results 758 patients were included: mean age was 66 ± 18 years, and 58.6% of patient were male. Only 8.5% of patients had a history of chronic kidney disease (CKD); however, 30% of patients had kidney dysfunction upon admission (eGFR < 60 mL/min/1.73 m2). These patients received less frequently pharmacological treatment with hydroxychloroquine or antivirals and had a greater number of complications such as sepsis (11.9% vs 26.4% vs 40.8%, p < 0.001) and respiratory failure (35.4% vs 72.2% vs 62.0%, p < 0.001) as well as a higher in-hospital mortality rate (eGFR > 60 vs eGFR 30-60 vs and eGFR < 30, 18.4% vs 56.5% vs 65.5%, p < 0.001). In multivariate analysis: age, hypertension, renal function, 02 saturation < 92% and lactate dehydrogenase elevation on admission independently predicted all-cause mortality. Conclusions Renal failure on admission in patients with SARS-CoV-2 infection is frequent and is associated with a greater number of complications and in-hospital mortality. Our data comes from a multicenter registry and therefore does not allow to have a precise mortality risk assessment. More studies are needed to confirm these findings. Electronic supplementary material The online version of this article (10.1007/s40620-020-00790-5) contains supplementary material, which is available to authorized users.
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50
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Arslan H, Musabak U, Ayvazoglu Soy EH, Kurt Azap O, Sayin B, Akcay S, Haberal KM, Akdur A, Yildirim S, Haberal M. Incidence and Immunologic Analysis of Coronavirus Disease (COVID-19) in Hemodialysis Patients:A Single-Center Experience. EXP CLIN TRANSPLANT 2020; 18:275-283. [PMID: 32519618 DOI: 10.6002/ect.2020.0194] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES COVID-19 is a great threat to the modern world and significant threat to immunocompromised patients, including patients with chronic renal failure. We evaluated COVID-19 incidence among our hemodialysis patients and investigated the most probable immune mechanisms against COVID-19. MATERIALS AND METHODS Başkent University has 21 dialysis centers across Turkey, with 2420 patients on hemodialysis and 30 on peritoneal dialysis. Among these, we retrospectively evaluated 602 patients (257 female/345 male) with chronic renal failure receiving hemodialysis as renal replacement therapy; 7 patients (1.1%) were infected with SARS-CoV-2. We retrospectively collected patient demographic characteristics, clinical data, and immunological factors affecting the clinical course of the disease. We divided patients into groups and included 2 control groups (individuals with normal renal functions): group I included COVID-19-positive patients with normal renal function, group II included COVID-19-positive hemodialysis patients, group III included COVID-19-negative hemodialysis patients, and group IV included COVID-19-negative patients with normal renal function. Lymphocyte subsets in peripheral blood and typing of human leukocyte antigens were analyzed in all groups, with killer cell immunoglobulin like receptor genes analyzed only in COVID-19-positive patients and healthy controls. RESULTS No deaths occurred among the 7 COVID-19-positive hemodialysis patients. Group I patients were significantly older than patients in groups II and III (P = .039, P = .030, respectively) but not significantly different from group IV (P = .060). Absolute counts of natural killer cells in healthy controls were higherthan in other groups (but not significantly). ActivatedT cells were significantly increased in both COVID-19-positive groups versus COVID-19-negative groups. Groups showed significant differences in C and DQ loci with respect to distribution of alleles in both HLA classes. CONCLUSIONS Although immunocompromised patients are at greater risk for COVID-19, we found lower COVID-19 incidence in our hemodialysis patients, which should be further investigated in in vitro and molecular studies.
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Affiliation(s)
- Hande Arslan
- From the Department of Infectious Diseases, Baskent University, Ankara, Turkey
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