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AKAGUN TULIN, TOMAR OZDEMKAVRAZ, USTA MURAT, BAYLAN SULEYMAN. COVID-19 INFECTION IN KIDNEY TRANSPLANT RECIPIENTS: A SINGLE CENTER EXPERIENCE. Transplant Proc 2022; 54:1424-1428. [PMID: 35649965 PMCID: PMC8995207 DOI: 10.1016/j.transproceed.2022.04.014] [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: 03/18/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/25/2022]
Abstract
Background Methods Results Conclusions
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Palamenghi L, Giudici F, Graffigna G, Generali D. Patients' Engagement in Early Detection of COVID-19 Symptoms: An Observational Study in the Very Early Peak of the Pandemic in Italy in 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053058. [PMID: 35270748 PMCID: PMC8910395 DOI: 10.3390/ijerph19053058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 02/05/2023]
Abstract
COVID-19 exerted a strong impact on the Italian healthcare systems, which in turn resulted in a reduction in the citizens’ trust towards healthcare authorities. Moreover, the focused attention on the typical COVID-19 symptoms (fever, cough) has also impacted the social representation of health priorities, potentially reducing the perceived importance and severity of other symptoms. This study aimed to determine the association of general-practitioner (GP) contact with various symptoms during the COVID-19 pandemic in Cremona, an Italian city at the very epicentre of the pandemic. Between April and June 2020, an anonymous survey was completed by 2161 respondents. Logistic-regression analyses were used to examine the associations of GP contact with sociodemographic characteristics and the presence of symptoms. Of the 2161 respondents (43.5% female, 75.0% aged less than 55 years), 959 (44.4%) reported experiencing various symptoms and 33.3% contacted a GP. GP contact was significantly associated with poor appetite (OR, 2.42; 95% CI 1.63 to 3.62; p < 0.001), taste dysfunctions (OR 1.67; 95% CI 1.20 to 2.34; p < 0.001) and sleepiness during the day (OR 4.15; 95% CI 2.13 to 8.09; p = 0.002). None of the gastrointestinal symptoms resulted in significantly increasing the likelihood of contacting a GP. This study offers a unique observation of citizens’ attitudes and behaviours in early symptom communication/detection during the initial peak of the Italian COVID-19 pandemic.
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Affiliation(s)
- Lorenzo Palamenghi
- Engageminds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, 20123 Milano, Italy;
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
- Faculty of Agriculture, Food and Nutritional Sciences, Università Cattolica del Sacro Cuore, 26100 Cremona, Italy
- Correspondence:
| | - Fabiola Giudici
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Guendalina Graffigna
- Engageminds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, 20123 Milano, Italy;
- Faculty of Agriculture, Food and Nutritional Sciences, Università Cattolica del Sacro Cuore, 26100 Cremona, Italy
| | - Daniele Generali
- Breast Cancer Unit, ASST of Cremona, Viale Concordia 1, 26100 Cremona, Italy;
- Department of Medical Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
- Department of Animal Science, Food and Nutrition–DIANA, Università Cattolica del Sacro Cuore, 29122 Piacenza, Italy
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Jonny, Violetta L, Kartasasmita AS, Amirullah Roesli RM, Rita C. Pharmacological Treatment Options for Coronavirus Disease-19 in Renal Patients. Int J Nephrol 2021; 2021:4078713. [PMID: 34858665 PMCID: PMC8632427 DOI: 10.1155/2021/4078713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/11/2021] [Accepted: 11/10/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with chronic kidney disease (CKD), including dialysis and transplant patients, are at greater risk of contracting SARS-CoV-2 due to kidney dysfunction and preexisting comorbidities. To date, a specific guideline on managing these high-risk patients infected with COVID-19 has not been established. As the current management of COVID-19 comprises mainly experimental drugs, the authors aim to provide information on dosing adjustments at different stages of kidney dysfunction and notable renal side effects. We performed a nonsystematical review of currently available COVID-19 drugs exploring several different clinical trial databases and search browsers. Several antivirals and monoclonal antibodies used in COVID-19 treatment require dosage adjustments in kidney dysfunction. In a global pandemic setting, nephrologists need to consider the appropriate dosage according to the renal function and closely monitor the side effects of different drug combinations to obtain the optimum therapeutic effect while avoiding further renal damage. Further studies are required to determine the safety and efficacy of these drugs in renal patients.
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Affiliation(s)
- Jonny
- Nephrology Division, Department of Internal Medicine, Gatot Soebroto Indonesia Army Central Hospital, Jakarta, Indonesia
| | - Laurencia Violetta
- Nephrology Division, Department of Internal Medicine, Gatot Soebroto Indonesia Army Central Hospital, Jakarta, Indonesia
| | | | | | - Coriejati Rita
- Faculty of Medicine, Universitas Padjajaran, Bandung, West Java, Indonesia
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Jayant K, Reccia I, Bachul PJ, Al-Salmay Y, Pyda JS, Podda M, Perez-Gutierrez A, Dor FJMF, Becker Y, di Sabato D, LaMattina J, Barth R, Fung J, Witkowski P. The Impact of COVID-19 on Kidney Transplant Recipients in Pre-Vaccination and Delta Strain Era: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:4533. [PMID: 34640552 PMCID: PMC8509345 DOI: 10.3390/jcm10194533] [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: 08/15/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 01/08/2023] Open
Abstract
Herein, we performed a meta-analysis of published clinical outcomes of corona virus disease 2019 (COVID-19) in hospitalized kidney transplant recipients. A systematic database search was conducted between December 1, 2019 and April 20, 2020. We analyzed 48 studies comprising 3137 kidney transplant recipients with COVID-19. Fever (77%), cough (65%), dyspnea (48%), and gastrointestinal symptoms (28%) were predominant on hospital admission. The most common comorbidities were hypertension (83%), diabetes mellitus (34%), and cardiac disease (23%). The pooled prevalence of acute respiratory distress syndrome and acute kidney injury were 58% and 48%, respectively. Invasive ventilation and dialysis were required in 24% and 22% patients, respectively. In-hospital mortality rate was as high as 21%, and increased to over 50% for patients in intensive care unit (ICU) or requiring invasive ventilation. Risk of mortality in patients with acute respiratory distress syndrome (ARDS), on mechanical ventilation, and ICU admission was increased: OR = 19.59, OR = 3.80, and OR = 13.39, respectively. Mortality risk in the elderly was OR = 3.90; however, no such association was observed in terms of time since transplantation and gender. Fever, cough, dyspnea, and gastrointestinal symptoms were common on admission for COVID-19 in kidney transplant patients. Mortality was as high as 20% and increased to over 50% in patients in ICU and required invasive ventilation.
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Affiliation(s)
- Kumar Jayant
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
| | - Isabella Reccia
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
| | - Piotr J. Bachul
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Yaser Al-Salmay
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Jordan S. Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA;
| | - Mauro Podda
- Department of Emergency Surgery, Azienda Ospedaliero-Universitaria Di Cagliari, University Hospital Policlinico Duilio Casula, 09124 Cagliari, Italy;
| | - Angelica Perez-Gutierrez
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Frank J. M. F. Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
| | - Yolanda Becker
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Diego di Sabato
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - John LaMattina
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Rolf Barth
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - John Fung
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Piotr Witkowski
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
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Anastasiou G, Hatziagelaki E, Liberopoulos E. Could Dapagliflozin Attenuate COVID-19 Progression in High-Risk Patients With or Without Diabetes? Behind DARE-19 Concept. J Cardiovasc Pharmacol 2021; 78:e12-e19. [PMID: 34001719 PMCID: PMC8253377 DOI: 10.1097/fjc.0000000000001011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/20/2021] [Indexed: 02/06/2023]
Abstract
ABSTRACT Epidemiological studies indicate that diabetes is the second most common comorbidity in COVID-19 (coronavirus disease 2019). Dapagliflozin, a sodium-glucose co-transporter 2 inhibitor, exerts direct cardioprotective and nephroprotective effects. DARE-19 (Dapagliflozin in Respiratory Failure in Patients With COVID-19), an ongoing clinical trial, is designed to investigate the impact of dapagliflozin on COVID-19 progression. This article discusses the potential favorable impact of dapagliflozin on COVID-19 and its complications.
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Affiliation(s)
- Georgia Anastasiou
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece; and
| | - Erifili Hatziagelaki
- Second Department of Internal Medicine, Research Institute and Diabetes Center, “Attikon” University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Liberopoulos
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece; and
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Feng YF, Wang KP, Mo JG, Xu YH, Wang LZ, Jin C, Chen X, Yi B. The spatiotemporal trend of renal involvement in COVID-19: A pooled analysis of 17 134 patients. Int J Infect Dis 2021; 106:281-288. [PMID: 33823283 PMCID: PMC8019246 DOI: 10.1016/j.ijid.2021.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The spatiotemporal trend of renal involvement in coronavirus disease 2019 (COVID-19) patients is still unclear. Therefore, the aim of this study was to reveal the dynamics of renal involvement superimposed COVID-19 according to time and space. METHODS COVID-19 patients reporting renal involvement were included in this study. The following information was collected from relevant articles: first author, patient demographics, patient enrollment period, location, definition of acute kidney injury (AKI), prevalence of AKI, and use of renal replacement therapy (RRT). RESULTS A total of 17 134 patients were finally included. The overall prevalence of AKI in COVID-19 patients was 19%, with 7% of them undergoing RRT. The overall risk of AKI in patients enrolled before March 1, 2020 (9%) was significantly lower than that after March 1, 2020 (36%) (P < 0.00001). Moreover, the overall risk of AKI outside Asia (35%) was significantly higher than that in Asia (10%) (P < 0.00001). Additionally, similar to patients requiring RRT, AKI patients were more likely to become seriously ill or even to die (P < 0.00001). CONCLUSIONS This study found that renal involvement superimposed COVID-19, a comorbidity portending a poor prognosis, has become an increasingly serious problem over time and is more common outside Asia. Thus, more attention should be paid to the management of this specific group of patients.
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Affiliation(s)
- Yi-Fu Feng
- Department of General Surgery, Taizhou Central Hospital, Taizhou 318000, China
| | - Kun-Peng Wang
- Department of General Surgery, Taizhou Central Hospital, Taizhou 318000, China
| | - Jing-Gang Mo
- Department of General Surgery, Taizhou Central Hospital, Taizhou 318000, China
| | - Ying-He Xu
- Department of Intensive Care Unit, Taizhou Central Hospital, Taizhou 318000, China
| | - Lie-Zhi Wang
- Department of General Surgery, Taizhou Central Hospital, Taizhou 318000, China
| | - Chong Jin
- Department of General Surgery, Taizhou Central Hospital, Taizhou 318000, China
| | - Xiang Chen
- Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China; Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha 410008, China; Department of Hepatobiliary and Pancreatic Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Bin Yi
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China; Department of Cardiothoracic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
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Haadi A, Almas T, Nabeel AR, Chan JC, Al-Awaid AH, Niaz MA, Gurmail-Kaufmann G. Damage to the waterworks: COVID-19 and the kidneys. Ann Med Surg (Lond) 2021; 64:102223. [PMID: 33747504 PMCID: PMC7959695 DOI: 10.1016/j.amsu.2021.102223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Abdul Haadi
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Josiah Cy Chan
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Role of blood pressure dysregulation on kidney and mortality outcomes in COVID-19. Kidney, blood pressure and mortality in SARS-CoV-2 infection. J Nephrol 2021; 34:305-314. [PMID: 33656707 PMCID: PMC7926195 DOI: 10.1007/s40620-021-00997-0] [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: 07/04/2020] [Accepted: 02/10/2021] [Indexed: 01/08/2023]
Abstract
Background In February 2020 the corona virus disease 2019 (COVID-19) infection started spreading throughout Italy, hitting the Lombardy region very hard. Despite the high diffusion, only a subset of patients developed severe COVID-19: around 25% of them developed acute kidney injury (AKI) and one-third of them died. Elderly patients and patients with high comorbidities were identified as being at higher risk of severe COVID-19. Methods Our prospective observational cohort study includes 392 consecutive patients hospitalized for COVID-19 in Milan (median age 67 years, 75% male). We evaluated the relationship between blood pressure at presentation, presence of AKI at Emergency Department admission and during hospitalization, and total in-hospital mortality (24%). Results Although 58% of our study patients reported a history of hypertension (HYP) (86% on treatment), 30% presented with low blood pressure levels. Only 5.5% were diagnosed with AKI on admission; 75% of hypertensive patients discontinued therapy during hospitalization (only 20% were on treatment at discharge). Gender and hypertension were strongly associated with AKI at admission (odds ratio 11). Blood pressure was inversely correlated with increased risk of AKI upon admission, regardless of the severity of respiratory distress. Age over 65, history of hypertension, and severity of respiratory distress were the main predictors of AKI, which developed in 34.7% of cases during hospitalization. AKI was associated with increased in-hospital mortality. Hypertension and low blood pressure at presentation were the main predictors of in-hospital mortality, together with age over 65, baseline pulmonary involvement, and severity of illness. Conclusions In patients hospitalized for COVID-19, hypertension and low blood pressure at presentation are important risk factors for AKI and mortality. Early reduction of antihypertensive therapy may improve outcomes in patients with SARS-CoV-2 infection.
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Russo E, Esposito P, Taramasso L, Magnasco L, Saio M, Briano F, Russo C, Dettori S, Vena A, Di Biagio A, Garibotto G, Bassetti M, Viazzi F. Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy. J Nephrol 2021; 34:173-183. [PMID: 33025516 PMCID: PMC7538179 DOI: 10.1007/s40620-020-00875-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of kidney involvement during SARS-CoV-2 infection has been reported to be high. Nevertheless, data are lacking about the determinants of acute kidney injury (AKI) and the combined effect of chronic kidney disease (CKD) and AKI in COVID-19 patients. METHODS We collected data on patient demographics, comorbidities, chronic medications, vital signs, baseline laboratory test results and in-hospital treatment in patients with COVID-19 consecutively admitted to our Institution. Chronic kidney disease was defined as eGFR < 60 mL/min per 1.73 m2 or proteinuria at urinalysis within 180 days prior to hospital admission. AKI was defined according to KDIGO criteria. The primary and secondary outcomes were the development of AKI and death. RESULTS Of 777 patients eligible for the study, acute kidney injury developed in 176 (22.6%). Of these, 79 (45%) showed an acute worsening of a preexisting CKD, and 21 (12%) required kidney replacement therapy. Independent associates of AKI were chronic kidney disease, C-reactive protein (CRP) and ventilation support. Among patients with acute kidney injury, 111 died (63%) and its occurrence increased the risk of death by 60% (HR 1.60 [95% IC 1.21-2.49] p = 0.002) independently of potential confounding factors including hypertension, preexisting kidney damage, and comorbidities. Patients with AKI showed a significantly higher rate of deaths attributed to bleeding compared to CKD and the whole population (7.5 vs 1.5 vs 3.5%, respectively). CONCLUSION Awareness of kidney function, both preexisting CKD and development of acute kidney injury, may help to identify those patients at increased risk of death.
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Affiliation(s)
- Elisa Russo
- Department of Internal Medicine, Clinica Nefrologica Dialisi e Trapianto, University of Genoa, Hospital Policlinico San Martino, IRCCS, Viale Benedetto XV, 16132, Genoa, Italy
| | - Pasquale Esposito
- Department of Internal Medicine, Clinica Nefrologica Dialisi e Trapianto, University of Genoa, Hospital Policlinico San Martino, IRCCS, Viale Benedetto XV, 16132, Genoa, Italy
| | - Lucia Taramasso
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Laura Magnasco
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Michela Saio
- Department of Internal Medicine, Clinica Nefrologica Dialisi e Trapianto, University of Genoa, Hospital Policlinico San Martino, IRCCS, Viale Benedetto XV, 16132, Genoa, Italy
| | - Federica Briano
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Chiara Russo
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Silvia Dettori
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Antonio Di Biagio
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Giacomo Garibotto
- Department of Internal Medicine, Clinica Nefrologica Dialisi e Trapianto, University of Genoa, Hospital Policlinico San Martino, IRCCS, Viale Benedetto XV, 16132, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, Clinica Nefrologica Dialisi e Trapianto, University of Genoa, Hospital Policlinico San Martino, IRCCS, Viale Benedetto XV, 16132, Genoa, Italy.
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Ozturk S, Turgutalp K, Arici M, Odabas AR, Altiparmak MR, Aydin Z, Cebeci E, Basturk T, Soypacaci Z, Sahin G, Elif Ozler T, Kara E, Dheir H, Eren N, Suleymanlar G, Islam M, Ogutmen MB, Sengul E, Ayar Y, Dolarslan ME, Bakirdogen S, Safak S, Gungor O, Sahin I, Mentese IB, Merhametsiz O, Oguz EG, Genek DG, Alpay N, Aktas N, Duranay M, Alagoz S, Colak H, Adibelli Z, Pembegul I, Hur E, Azak A, Taymez DG, Tatar E, Kazancioglu R, Oruc A, Yuksel E, Onan E, Turkmen K, Hasbal NB, Gurel A, Yelken B, Sahutoglu T, Gok M, Seyahi N, Sevinc M, Ozkurt S, Sipahi S, Bek SG, Bora F, Demirelli B, Oto OA, Altunoren O, Tuglular SZ, Demir ME, Ayli MD, Huddam B, Tanrisev M, Bozaci I, Gursu M, Bakar B, Tokgoz B, Tonbul HZ, Yildiz A, Sezer S, Ates K. Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey. Nephrol Dial Transplant 2020; 35:2083-2095. [PMID: 33275763 PMCID: PMC7716804 DOI: 10.1093/ndt/gfaa271] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
Background Chronic kidney disease (CKD) and immunosuppression, such as in renal transplantation (RT), stand as one of the established potential risk factors for severe coronavirus disease 2019 (COVID-19). Case morbidity and mortality rates for any type of infection have always been much higher in CKD, haemodialysis (HD) and RT patients than in the general population. A large study comparing COVID-19 outcome in moderate to advanced CKD (Stages 3–5), HD and RT patients with a control group of patients is still lacking. Methods We conducted a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3–5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. Demographics, comorbidities, medications, laboratory tests, COVID-19 treatments and outcome [in-hospital mortality and combined in-hospital outcome mortality or admission to the intensive care unit (ICU)] were compared. Results A total of 1210 patients were included [median age, 61 (quartile 1–quartile 3 48–71) years, female 551 (45.5%)] composed of four groups: control (n = 450), HD (n = 390), RT (n = 81) and CKD (n = 289). The ICU admission rate was 266/1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group [114/289 (39.4%); 95% confidence interval (CI) 33.9–45.2; and 82/289 (28.4%); 95% CI 23.9–34.5)] were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3–29.9; P < 0.001) and 63/390 (16.2%; 95% CI 13.0–20.4; P < 0.001); RT = 17/81 (21.0%; 95% CI 13.2–30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7–19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8–10.8; P < 0.001) and 18/450 (4%; 95% CI 2.5–6.2; P < 0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group [hazard ratio (HR) (95% CI) CKD: 2.88 (1.52–5.44); P = 0.001; 2.44 (1.35–4.40); P = 0.003; HD: 2.32 (1.21–4.46); P = 0.011; 2.25 (1.23–4.12); P = 0.008), respectively], but these were not significantly different in the RT from in the control group [HR (95% CI) 1.89 (0.76–4.72); P = 0.169; 1.87 (0.81–4.28); P = 0.138, respectively]. Conclusions Hospitalized COVID-19 patients with CKDs, including Stages 3–5 CKD, HD and RT, have significantly higher mortality than patients without kidney disease. Stages 3–5 CKD patients have an in-hospital mortality rate as much as HD patients, which may be in part because of similar age and comorbidity burden. We were unable to assess if RT patients were or were not at increased risk for in-hospital mortality because of the relatively small sample size of the RT patients in this study.
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Affiliation(s)
- Savas Ozturk
- Department of Nephrology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Kenan Turgutalp
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Mersin University Training and Research Hospital, Mersin, Turkey
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Riza Odabas
- Department of Nephrology, University of Health Sciences, Sultan 2.Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- Department of Internal Medicine, Division of Nephrology, Istanbul University - Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Zeki Aydin
- Department of Nephrology, Darica Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Egemen Cebeci
- Department of Nephrology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Taner Basturk
- Department of Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeki Soypacaci
- Department of Internal Medicine, Division of Nephrology, Izmir Katip Celebi University, Atatürk Training and Research Hospital, Izmir, Turkey
| | - Garip Sahin
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tuba Elif Ozler
- Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ekrem Kara
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Hamad Dheir
- Department of Internal Medicine, Division of Nephrology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Necmi Eren
- Department of Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Gultekin Suleymanlar
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mahmud Islam
- Department of Nephrology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey
| | - Melike Betul Ogutmen
- Department of Nephrology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Erkan Sengul
- Department of Nephrology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Yavuz Ayar
- Department of Nephrology, Bursa City Hospital, Bursa, Turkey
| | - Murside Esra Dolarslan
- Department of Nephrology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Serkan Bakirdogen
- Department of Internal Medicine, Division of Nephrology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Seda Safak
- Department of Internal Medicine, Division of Nephrology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Ozkan Gungor
- Department of Nephrology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Idris Sahin
- Department of Internal Medicine, Division of Nephrology, Inonu University Faculty of Medicine, Turgut Ozal Medical Center, Malatya, Turkey
| | - Ilay Berke Mentese
- Department of Internal Medicine, Division of Nephrology, Marmara University Faculty of Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Merhametsiz
- Department of Internal Medicine, Division of Nephrology, Yeni Yuzyil University Faculty of Medicine, Istanbul, Turkey
| | - Ebru Gok Oguz
- Department of Nephrology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Dilek Gibyeli Genek
- Department of Internal Medicine, Division of Nephrology, Mugla Sitki Kocman University Faculty of Medicine, Training and Research Hospital, Mugla, Turkey
| | - Nadir Alpay
- Department of Internal Medicine, Division of Nephrology, Memorial Hizmet Hospital, Istanbul, Turkey
| | - Nimet Aktas
- Department of Nephrology, University of Health Sciences, Bursa Higher Specialization Training and Research Hospital, Bursa, Turkey
| | - Murat Duranay
- Department of Nephrology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Selma Alagoz
- Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Hulya Colak
- Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Training and Research Hospital, Izmir, Turkey
| | - Zelal Adibelli
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Usak University, Usak, Turkey
| | - Irem Pembegul
- Department of Nephrology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Ender Hur
- Department of Nephrology, Manisa Merkezefendi State Hospital, Manisa, Turkey
| | - Alper Azak
- Department of Nephrology, Balıkesir Ataturk City Hospital, Balikesir, Turkey
| | | | - Erhan Tatar
- Department of Nephrology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Rumeyza Kazancioglu
- Department of Internal Medicine, Division of Nephrology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Aysegul Oruc
- Department of Nephrology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Enver Yuksel
- Department of Nephrology, University of Health Sciences, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Engin Onan
- Department of Nephrology, Adana City Training and Research Hospital, Adana, Turkey
| | - Kultigin Turkmen
- Department of Nephrology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | | | - Ali Gurel
- Department of Internal Medicine, Division of Nephrology, Firat University Faculty of Medicine, Elazig, Turkey
| | - Berna Yelken
- Department of Transplantation, Koc University Hospital, Istanbul, Turkey
| | - Tuncay Sahutoglu
- Department of Nephrology, University of Health Sciences, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Mahmut Gok
- Department of Nephrology, University of Health Sciences, Sultan 2.Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Internal Medicine, Division of Nephrology, Istanbul University - Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Sevinc
- Department of Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sultan Ozkurt
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Savas Sipahi
- Department of Internal Medicine, Division of Nephrology, Sakarya University Faculty of Medicine, Training and Research Hospital, Sakarya, Turkey
| | - Sibel Gokcay Bek
- Department of Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Feyza Bora
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Bulent Demirelli
- Department of Nephrology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Akin Oto
- Department of Internal Medicine, Division of Nephrology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Orcun Altunoren
- Department of Nephrology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Serhan Zubeyde Tuglular
- Department of Internal Medicine, Division of Nephrology, Marmara University Faculty of Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Emin Demir
- Department of Internal Medicine, Division of Nephrology, Yeni Yuzyil University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Deniz Ayli
- Department of Nephrology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Bulent Huddam
- Department of Internal Medicine, Division of Nephrology, Mugla Sitki Kocman University Faculty of Medicine, Training and Research Hospital, Mugla, Turkey
| | - Mehmet Tanrisev
- Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ilter Bozaci
- Department of Nephrology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Meltem Gursu
- Department of Internal Medicine, Division of Nephrology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Betul Bakar
- Department of Nephrology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Bulent Tokgoz
- Department of Nephrology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Halil Zeki Tonbul
- Department of Nephrology, Adana City Training and Research Hospital, Adana, Turkey
| | - Alaattin Yildiz
- Department of Internal Medicine, Division of Nephrology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Siren Sezer
- Department of Internal Medicine, Division of Nephrology, Atilim University Faculty of Medicine, Istanbul, Turkey
| | - Kenan Ates
- Department of Internal Medicine, Division of Nephrology, Ankara University Faculty of Medicine Ankara, Turkey
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11
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Farouk SS, Fiaccadori E, Cravedi P, Campbell KN. COVID-19 and the kidney: what we think we know so far and what we don't. J Nephrol 2020; 33:1213-1218. [PMID: 32691342 PMCID: PMC7370875 DOI: 10.1007/s40620-020-00789-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/20/2020] [Indexed: 12/24/2022]
Abstract
The novel coronavirus disease infection (COVID-19) outbreak that was declared a global pandemic in March 2020 had led to an internationally variable but concerning incidence of COVID-associated acute kidney injury (AKI), with prevalence reported as high as 46% in large cohorts of hospitalized patients. Variability in AKI may be explained by differences in traditional risk factors for AKI, heterogeneity among patient cohorts, and differences in racial and ethnic groups. Further, AKI requiring kidney replacement therapies (KRT) has been associated with increased mortality. Proposed mechanisms of kidney injury include direct viral-induced tubular or glomerular injury, sepsis-associated AKI, and thrombotic disease. Kidney pathology include acute tubular injury, glomerular fibrin thrombi, pigmented tubular casts, and collapsing focal segmental glomerulosclerosis. "Viral-like" particles have been observed in renal samples at electron microscopy and viral RNA has been identified in both glomerular and tubular compartments of kidney specimens, but the link between viral presence and injury remain unclear. Though the link between AKI and poor outcomes is clear, prevalence and outcomes of COVID-19 in patients with chronic kidney disease and end stage kidney disease has not yet been reported. In patients on immunosuppression like those with kidney transplants or glomerular disease, COVID-19 has presented a management dilemma. Herein, we review the existing literature on kidney disease in COVID-19 and discuss what remains to be learned.
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Affiliation(s)
- Samira S Farouk
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, Box 1243, One Gustave L. Levy Place, 10029, New York, NY, USA
| | - Enrico Fiaccadori
- Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Paolo Cravedi
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, Box 1243, One Gustave L. Levy Place, 10029, New York, NY, USA
| | - Kirk N Campbell
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, Box 1243, One Gustave L. Levy Place, 10029, New York, NY, USA.
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12
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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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