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Santos AC, Costa VDD, Silva LLD, Miguel JC, Jardim R, Dávila AMR, Paula VSD, Melgaço JG, Lago BVD, Villar LM. SARS-CoV-2 and dialysis: humoral response, clinical and laboratory impacts before vaccination. Braz J Infect Dis 2024; 28:103735. [PMID: 38467386 DOI: 10.1016/j.bjid.2024.103735] [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: 10/06/2023] [Revised: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Patients with kidney disease on Hemodialysis (HD) are susceptible to Coronavirus Disease (COVID-19) due to multiple risk factors. AIM This study aims to report the prevalence of antibodies against SARS-CoV-2 among patients on hemodialysis before vaccination in Brazil and to compare with clinical, demographic, and laboratory data. METHODS Blood samples from 398 Chronic Kidney Disease (CKD) patients treated in three different private institutions in Rio de Janeiro State, Brazil were submitted to the total anti-SARS-CoV-2 testing. Kidney, liver, and hematological markers were also determined. Respiratory samples were tested by real-time PCR for SARS-CoV-2 RNA and positive samples were subjected to high-throughput sequencing on the MinION device. RESULTS Overall, anti-SARS-CoV-2 prevalence was 54.5 % (217/398) and two individuals had SARS-CoV-2 RNA with variant B.1.1. High anti-SARS-CoV-2 seroprevalence was found in male gender and those with hospital admission in the last 3-months before the inclusion in the study. Lower red blood cell count was observed in the anti-SARS-CoV-2 seropositive group. High levels of anti-SARS-CoV-2 were found in those who reported symptoms, had low levels of eosinophils and low hematocrit, and who practiced physical activity. CONCLUSION High prevalence of anti-SARS-CoV-2 was found in CKD patients before the universal immunization in Brazil suggesting that dialysis patients were highly exposed to SARS-CoV-2.
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Affiliation(s)
- Alanna Calheiros Santos
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório Brasileiro de Referência em Hepatites Virais, Rio de Janeiro, RJ, Brazil
| | - Vanessa Duarte da Costa
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório Brasileiro de Referência em Hepatites Virais, Rio de Janeiro, RJ, Brazil
| | - Lucas Lima da Silva
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório Brasileiro de Referência em Hepatites Virais, Rio de Janeiro, RJ, Brazil
| | - Juliana Custódio Miguel
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório Brasileiro de Referência em Hepatites Virais, Rio de Janeiro, RJ, Brazil
| | - Rodrigo Jardim
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório de Biologia Computacional e de Sistemas, Programa de Pós-Graduação em Biodiversidade e Saúde, Rio de Janeiro, RJ, Brazil
| | - Alberto Martín Rivera Dávila
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório de Biologia Computacional e de Sistemas, Programa de Pós-Graduação em Biodiversidade e Saúde, Rio de Janeiro, RJ, Brazil
| | - Vanessa Salete de Paula
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório de Virologia Molecular e Parasitologia, Rio de Janeiro, RJ, Brazil
| | - Juliana Gil Melgaço
- Bio-Manguinhos (FIOCRUZ), Laboratório de Tecnologia Imunológica, Rio de Janeiro, RJ, Brazil
| | - Barbara Vieira do Lago
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório Brasileiro de Referência em Hepatites Virais, Rio de Janeiro, RJ, Brazil
| | - Livia Melo Villar
- Instituto Oswaldo Cruz (FIOCRUZ), Laboratório Brasileiro de Referência em Hepatites Virais, Rio de Janeiro, RJ, Brazil.
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Mohsenzadeh T, Ziaee M, Salehiniya H, Mohsenzadeh H, Mirsani A, Raeesi V. A multicenter study of severity and prognosis of symptomatic COVID-19 in end-stage renal disease and non-dialysis patients in East of Iran. Immun Inflamm Dis 2024; 12:e1188. [PMID: 38456616 PMCID: PMC10921896 DOI: 10.1002/iid3.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES This study aimed to assess the severity and related factors of symptomatic COVID-19 in end-stage renal disease (ESRD) patients from several centers in Eastern Iran. METHODS In this retrospective cohort study, after obtaining ethical approval, 410 patients diagnosed with COVID-19 were included for analysis. Patients were categorized into two groups based on their dialysis status: the dialysis group (ESRD patients undergoing hemodialysis) and the non-dialysis group (those without chronic dialysis). Demographic information, clinical symptoms, laboratory tests at admission, length of hospitalization, ICU admission, need for mechanical ventilation, and mortality data were extracted from their medical records and entered into researcher-developed checklists. RESULTS In this multicenter study, 104 dialysis patients with a mean age of 64.81 ± 16.04 were compared to 316 non-dialysis patients with a mean age of 60.92 ± 17.89. Patients were similar in terms of age and gender, but a higher percentage of the dialysis group was aged over 65 years (p = .008). Altered consciousness, dyspnea, headache, myalgia, anorexia, and cough were statistically significantly more common in the dialysis group when evaluating clinical symptoms (p < .05). The dialysis group had significantly higher levels of white blood cell (WBC), potassium, calcium, urea, creatinine, blood pH, INR, ALT, ESR, and CRP, and lower levels of red blood cell, Hb, platelets, sodium, and LDH compared to the non-dialysis group. Profoundly altered consciousness was more common among deceased patients (p < .001), and this group had higher WBC counts, urea levels, AST, ALT (p < .05), and lower blood pH (p = .001). CONCLUSION Based on the results of this study, it is plausible to suggest a hypothesis of greater severity and worse prognosis of COVID-19 in ESRD patients. Underlying comorbidities, such as liver disorders or more severe clinical symptoms like altered consciousness, may also be indicative of a worse prognosis in dialysis patients with COVID-19.
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Affiliation(s)
- Tara Mohsenzadeh
- Department of MedicineBirjand University of Medical SciencesBirjandIran
| | - Masood Ziaee
- Department of Infectious Diseases, School of Medicine, Infectious Diseases Research CenterBirjand University of Medical SciencesBirjandIran
| | - Hamid Salehiniya
- Department of Epidemiology and Biostatistics, School of Health, Social Determinants of Health Research CenterBirjand University of Medical SciencesBirjandIran
| | | | - Amin Mirsani
- Department of MedicineGonabad University of Medical SciencesGonabadIran
| | - Vajehallah Raeesi
- Department of Internal Medicine, School of MedicineBirjand University of Medical SciencesBirjandIran
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3
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Delgado Ureña A, Hernández García E, Varillas Caso DA. [Humoral response to vaccination against SARS-CoV-2 in patients undergoing maintenance hemodialysis]. Med Clin (Barc) 2023; 160:321-322. [PMID: 36577651 PMCID: PMC9792125 DOI: 10.1016/j.medcli.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Ana Delgado Ureña
- Servicio de Nefrología, Hospital Universitario San Cecilio, Granada, España.
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Harrison TG, Tam TA, Elliott MJ, Ahmed SB, Riehl-Tonn V, Swamy AKR, Benham JL, Peterson J, MacRae JM. Sex differences in COVID-19 symptoms and outcomes in people with kidney failure treated with dialysis: a prospective cohort study. J Nephrol 2023; 36:851-860. [PMID: 36087218 PMCID: PMC9463668 DOI: 10.1007/s40620-022-01448-0] [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: 04/11/2022] [Accepted: 08/20/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND People with kidney failure treated with dialysis are at increased risk of SARS-CoV-2 infection, and severe COVID-19 outcomes such as hospitalization and death. Though there are well-defined sex differences in outcomes for the general population with COVID-19, we do not know whether this translates into kidney failure populations. We aimed to estimate the differences in COVID-19 symptoms and clinical outcomes between males and females treated with maintenance dialysis. METHODS In this prospective observational cohort study, we included adults treated with maintenance dialysis in Southern Alberta, Canada that tested positive for COVID-19 between March 2020 and February 2022. We examined the association between sex (dichotomized as male and female) with COVID-19 symptoms including fever, cough, malaise, shortness of breath, muscle joints/aches, nausea and/or vomiting, loss of appetite, diarrhea, headache, sore throat, and loss of smell/taste using chi-square or Fisher's exact tests. Secondary outcomes included 30-day hospitalization, ICU admission, and death. RESULTS Of 1,329 cohort participants, 246 (18.5%) tested positive for SARS-CoV-2 and were included in our study, including 95 females (39%). Of 207 participants with symptoms assessed, females had less frequent fever (p = 0.003), and more nausea or vomiting (p = 0.003) compared to males, after correction for multiple testing. Males exhibited no symptoms 25% of the time, compared with 10% of females (p = 0.01, not significant when corrected for multiple testing). We did not identify statistically significant differences in clinical outcomes between the sexes, though vaccinated patients had lower odds of hospitalization. CONCLUSIONS Sex differences in COVID-19 symptoms were identified in a cohort of patients treated with maintenance dialysis, which may inform sex-specific screening strategies in dialysis units. Further work is necessary to examine mechanisms for identified sex differences.
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Affiliation(s)
- Tyrone G Harrison
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Trinity A Tam
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Meghan J Elliott
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sofia B Ahmed
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Asha K R Swamy
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jamie L Benham
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Jennifer M MacRae
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Departments of Medicine and Cardiac Sciences, Alberta Kidney Care South, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Zhang X, Chen Q, Xu G. Clinical manifestations of COVID-19 infection in dialysis patients and protective effect of COVID-19 vaccine. Inflamm Res 2023; 72:989-1000. [PMID: 37004547 PMCID: PMC10066982 DOI: 10.1007/s00011-023-01723-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/24/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVE COVID-19 infection poses a special challenge to patients with dialysis patients. The purpose of this study was to evaluate the clinical manifestations of dialysis patients with COVID-19 and the protective effect of the vaccine. METHODS We included 41 studies based on big data, mainly analyzing the clinical symptoms of dialysis patients with COVID-19, the proportion of severe patients before and after vaccination, and the humoral reaction of vaccine in the body. RESULTS 6.1% to 35.7% of dialysis patients with COVID-19 developed respiratory distress symptoms and needed to be admitted to an intensive care unit for mechanical ventilation. The incidence and mortality of COVID-19 in dialysis patients before vaccination were 5.5% and 1.1%, respectively, and decreased to 4.5% and 0.6% in breakthrough infected patients. There was no statistical difference in serum conversion rates between dialysis patients and healthy controls, but the neutralizing antibody titer in the control group was 1922 (IQR 533 to 3186) AU/mL, and the neutralizing antibody titer in dialysis patients significantly decreased to 367 (IQR 171 to 1650) AU/mL (P=0.046). CONCLUSIONS Dialysis is associated with an increased risk of severe COVID-19, and generally has a poor seroconversion response to vaccines. It also confirms the protective effect of vaccines on high-risk populations such as dialysis.
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Affiliation(s)
- Xuehan Zhang
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, People's Republic of China
| | - Qingfeng Chen
- School of Public Health and Management, Nanchang Medical College, No. 1689, Meiling Avenue, Wanli, Nanchang, 330004, People's Republic of China.
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, People's Republic of China.
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Delgado Ureña A, Hernández García E, Varillas Caso DA. Humoral response to vaccination against SARS-CoV-2 in patients undergoing maintenance hemodialysis. MEDICINA CLINICA (ENGLISH ED.) 2023; 160:321-322. [PMID: 37033198 PMCID: PMC10039697 DOI: 10.1016/j.medcle.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Ana Delgado Ureña
- Servicio de Nefrología, Hospital Universitario San Cecilio, Granada, Spain
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7
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Ezzat H, Teama NM, Bichari WA. Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients and the Risk of Hypercoagulability: Should we Consider Routine Screening? Indian J Nephrol 2023; 33:101-107. [PMID: 37234431 PMCID: PMC10208532 DOI: 10.4103/ijn.ijn_142_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/14/2021] [Indexed: 05/28/2023] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) has become a pandemic in late 2019. Its clinical presentation varies from asymptomatic infection to severe respiratory failure. Infection control strategies to minimize the risk of transmission of COVID-19 in end-stage renal disease (ESRD) patients receiving in-center hemodialysis (HD) have been implemented. Development of humoral response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adult patients with ESRD receiving HD has not been sufficiently reported. Methods A total of 179 asymptomatic HD patients undergoing regular HD were screened for COVID-19 infection. Infection with SARS-CoV-2 was confirmed through a real-time reverse transcription polymerase chain reaction assay of nasopharyngeal swab specimens. They were classified into positive and negative groups according to the results of PCR. Results Of the 179 asymptomatic patients, we found that 23 patients (12.8%) were positive for COVID-19. Their mean age was 45.61 ± 13.38 years. There was a significant difference between both groups regarding C-reactive protein, lymphocytes, and platelet counts (P < 0.001). Also, TAT (thrombin-antithrombin complex) and D-dimer levels were significantly increased among the positive group (11.47 ± 1.51 vs. 7.53 ± 1.64 mcq/L, P < 0.001; 1171.52 ± 267.6 vs. 542.76 ± 107.06 ng/mL, P < 0.001, respectively). Conclusion Asymptomatic SARS-CoV-2 infection is detected in HD patients. They carry the risk of hypercoagulability complications. We need more strict infection control measures and proactive diagnosis to limit the spread of the infection and lethal thromboembolic complications.
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Affiliation(s)
- Haitham Ezzat
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nahla Mohamed Teama
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Walid Ahmed Bichari
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Mesic E, Aleckovic-Halilovic M, Paunovic K, Woywodt A, Pjanic M, Paunovic G. COVID - 19 in two dialysis centers situated in two neighbouring states of the Western Balkans. BMC Nephrol 2023; 24:40. [PMID: 36803693 PMCID: PMC9938731 DOI: 10.1186/s12882-023-03080-x] [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: 09/08/2022] [Accepted: 02/06/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Bosnia and Herzegovina (BiH) and Serbia are countries in the Western Balkans that share parts of their social and political legacy from the former Yugoslavia, such as their health care system and the fact that they are not members of European Union. There are very scarce data on COVID - 19 pandemic from this region when compared to other parts of the world and even less is known about its impact on the provision of renal care or differences between countries in the Western Balkans. MATERIALS AND METHODS This observational prospective study was conducted in two regional renal centres in BiH and Serbia, during the COVID - 19 pandemic. We obtained demographic and epidemiological data, clinical course and outcomes of dialysis and transplant patients with COVID - 19 in both units. Data were collected a via questionnaire for two consecutive time periods: February - June 2020 with a total number of 767 dialysis and transplant patients in the two centres, and July - December 2020 with a total number of 749 studied patients, corresponding to two of the largest waves of the pandemic in our region. Departmental policies and infection control measures in both units were also recorded and compared. RESULTS For a period of 11 months, from February to December 2020, 82 patients on in-centre haemodialysis (ICHD), 11 peritoneal dialysis patients and 25 transplant patients who tested positive for COVID-19. In the first study period, the incidence of COVID - 19 positive in Tuzla was 1.3% among ICHD patients, and there were no positive peritoneal dialysis patients, or any transplant patients who tested positive. The incidence of COVID-19 was significantly higher in both centres in the second time period, which corresponds to the incidence in general population. Total deaths of COVID-19 positive patients was 0% in Tuzla and 45.5% in Niš during first, and 16.7% in Tuzla and 23.4% in Niš during the second period. There were notable differences in the national and local/departmental approach to the pandemic between the two centres. CONCLUSION There was poor survival overall when compared to other regions of Europe. We suggest that this reflects the lack of preparedness of both of our medical systems for such situations. In addition, we describe important differences in outcome between the two centres. We emphasize the importance of preventative measures and infection control and highlight the importance of preparedness.
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Affiliation(s)
- Enisa Mesic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Ulica Prof. Dr. Ibre Pašića, 75000 Tuzla, Bosnia and Herzegovina
| | - Mirna Aleckovic-Halilovic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Ulica Prof. Dr. Ibre Pašića, 75000 Tuzla, Bosnia and Herzegovina
| | - Karolina Paunovic
- grid.418653.d0000 0004 0517 2741Nephrology Department, Niš Clinical Centre, Niš, Serbia
| | - Alexander Woywodt
- grid.440181.80000 0004 0456 4815Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire UK
| | - Mirha Pjanic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Ulica Prof. Dr. Ibre Pašića, 75000, Tuzla, Bosnia and Herzegovina.
| | - Goran Paunovic
- grid.418653.d0000 0004 0517 2741Nephrology Department, Niš Clinical Centre, Niš, Serbia
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González-Cuadrado C, Caro-Espada PJ, Chivite-Lacaba M, Utrero-Rico A, Lozano-Yuste C, Gutierrez-Solis E, Morales E, Sandino-Pérez J, Gil-Etayo FJ, Allende-Martínez L, Laguna-Goya R, Paz-Artal E. Hemodialysis-Associated Immune Dysregulation in SARS-CoV-2-Infected End-Stage Renal Disease Patients. Int J Mol Sci 2023; 24:ijms24021712. [PMID: 36675231 PMCID: PMC9865754 DOI: 10.3390/ijms24021712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Patients on hemodialysis show dysregulated immunity, basal hyperinflammation and a marked vulnerability to COVID-19. We evaluated the immune profile in COVID-19 hemodialysis patients and the changes associated with clinical deterioration after the hemodialysis session. Recruited patients included eight hemodialysis subjects with active, PCR-confirmed SARS-CoV-2 infection, five uninfected hemodialysis patients and five healthy controls. In SARS-CoV-2-infected hemodialysis patients TNF-α, IL-6 and IL-8 were particularly increased. Lymphopenia was mostly due to reduction in CD4+ T, B and central memory CD8+ T cells. There was a predominance of classical and intermediate monocytes with reduced HLA-DR expression and enhanced production of pro-inflammatory molecules. Immune parameters were analysed pre- and post-hemodialysis in three patients with COVID-19 symptoms worsening after the hemodialysis session. There was a higher than 2.5-fold increase in GM-CSF, IFN-γ, IL-1β, IL-2, IL-6, IL-17A and IL-21 in serum, and augmentation of monocytes-derived TNF-α, IL-1β and IL-8 and CXCL10 (p < 0.05). In conclusion, COVID-19 in hemodialysis patients associates with alteration of lymphocyte subsets, increasing of pro-inflammatory cytokines and monocyte activation. The observed worsening during the hemodialysis session in some patients was accompanied by augmentation of particular inflammatory cytokines, which might suggest biomarkers and therapeutic targets to prevent or mitigate the hemodialysis-related deterioration during SARS-CoV-2 infection.
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Affiliation(s)
- Cecilia González-Cuadrado
- Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
- Correspondence: (C.G.-C.); (E.P.-A.); Tel.: +34-628-502-629 (C.G.-C.)
| | | | - Marta Chivite-Lacaba
- Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
| | - Alberto Utrero-Rico
- Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
| | - Claudia Lozano-Yuste
- Department of Nephrology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | | | - Enrique Morales
- Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Justo Sandino-Pérez
- Department of Nephrology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Francisco Javier Gil-Etayo
- Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
- Department of Immunology, Hospital Universitario 12 de Octubre, 28009 Madrid, Spain
| | - Luis Allende-Martínez
- Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
- Department of Immunology, Hospital Universitario 12 de Octubre, 28009 Madrid, Spain
| | - Rocio Laguna-Goya
- Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
- Department of Immunology, Hospital Universitario 12 de Octubre, 28009 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Estela Paz-Artal
- Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
- Department of Immunology, Hospital Universitario 12 de Octubre, 28009 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Immunology, Ophthalmology and ENT, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Correspondence: (C.G.-C.); (E.P.-A.); Tel.: +34-628-502-629 (C.G.-C.)
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10
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Bozkir CDC, Ozmemis C, Kurbanzade AK, Balcik B, Gunes ED, Tuglular S. Capacity planning for effective cohorting of hemodialysis patients during the coronavirus pandemic: A case study. EUROPEAN JOURNAL OF OPERATIONAL RESEARCH 2023; 304:276-291. [PMID: 34744293 PMCID: PMC8556688 DOI: 10.1016/j.ejor.2021.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/20/2021] [Indexed: 05/09/2023]
Abstract
Planning treatments of different types of patients have become challenging in hemodialysis clinics during the COVID-19 pandemic due to increased demands and uncertainties. In this study, we address capacity planning decisions of a hemodialysis clinic, located within a major public hospital in Istanbul, which serves both infected and uninfected patients during the COVID-19 pandemic with limited resources (i.e., dialysis machines). The clinic currently applies a 3-unit cohorting strategy to treat different types of patients (i.e., uninfected, infected, suspected) in separate units and at different times to mitigate the risk of infection spread risk. Accordingly, at the beginning of each week, the clinic needs to allocate the available dialysis machines to each unit that serves different patient cohorts. However, given the uncertainties in the number of different types of patients that will need dialysis each day, it is a challenge to determine which capacity configuration would minimize the overlapping treatment sessions of different cohorts over a week. We represent the uncertainties in the number of patients by a set of scenarios and present a stochastic programming approach to support capacity allocation decisions of the clinic. We present a case study based on the real-world patient data obtained from the hemodialysis clinic to illustrate the effectiveness of the proposed model. We also compare the performance of different cohorting strategies with three and two patient cohorts.
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Affiliation(s)
- Cem D C Bozkir
- Industrial Engineering Department, Ozyegin University, Istanbul, Turkey
| | - Cagri Ozmemis
- Industrial Engineering Department, Ozyegin University, Istanbul, Turkey
| | | | - Burcu Balcik
- Industrial Engineering Department, Ozyegin University, Istanbul, Turkey
| | - Evrim D Gunes
- Business Administration, College of Administrative Sciences and Economics, Koc University, Sariyer, Istanbul, Turkey
| | - Serhan Tuglular
- Medical Faculty, Department of Internal Medicine, Marmara University, Istanbul, Turkey
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11
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Esposito P, Garbarino S, Fenoglio D, Cama I, Cipriani L, Campi C, Parodi A, Vigo T, Franciotta D, Altosole T, Grosjean F, Viazzi F, Filaci G, Piana M. Longitudinal Cluster Analysis of Hemodialysis Patients with COVID-19 in the Pre-Vaccination Era. Life (Basel) 2022; 12:1702. [PMID: 36362858 PMCID: PMC9695171 DOI: 10.3390/life12111702] [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: 09/27/2022] [Revised: 10/22/2022] [Accepted: 10/23/2022] [Indexed: 08/29/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) in hemodialysis patients (HD) is characterized by heterogeneity of clinical presentation and outcomes. To stratify patients, we collected clinical and laboratory data in two cohorts of HD patients at COVID-19 diagnosis and during the following 4 weeks. Baseline and longitudinal values were used to build a linear mixed effect model (LME) and define different clusters. The development of the LME model in the derivation cohort of 17 HD patients (66.7 ± 12.3 years, eight males) allowed the characterization of two clusters (cl1 and cl2). Patients in cl1 presented a prevalence of females, higher lymphocyte count, and lower levels of lactate dehydrogenase, C-reactive protein, and CD8 + T memory stem cells as a possible result of a milder inflammation. Then, this model was tested in an independent validation cohort of 30 HD patients (73.3 ± 16.3 years, 16 males) assigned to cl1 or cl2 (16 and 14 patients, respectively). The cluster comparison confirmed that cl1 presented a milder form of COVID-19 associated with reduced disease activity, hospitalization, mortality rate, and oxygen requirement. Clustering analysis on longitudinal data allowed patient stratification and identification of the patients at high risk of complications. This strategy could be suitable in different clinical settings.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine, University of Genoa, 16132 Genova, Italy
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Sara Garbarino
- Dipartimento di Matematica (MIDA), Università di Genova, 16132 Genova, Italy
| | - Daniela Fenoglio
- Biotherapy Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine-Centre of Excellence for Biomedical Research, University of Genova, 16132 Genova, Italy
| | - Isabella Cama
- Dipartimento di Matematica (MIDA), Università di Genova, 16132 Genova, Italy
| | - Leda Cipriani
- Department of Internal Medicine, University of Genoa, 16132 Genova, Italy
| | - Cristina Campi
- Dipartimento di Matematica (MIDA), Università di Genova, 16132 Genova, Italy
| | - Alessia Parodi
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Tiziana Vigo
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | | | - Tiziana Altosole
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Fabrizio Grosjean
- Department of Internal Medicine-Centre of Excellence for Biomedical Research, University of Genova, 16132 Genova, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, 16132 Genova, Italy
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Gilberto Filaci
- Biotherapy Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine-Centre of Excellence for Biomedical Research, University of Genova, 16132 Genova, Italy
| | - Michele Piana
- Dipartimento di Matematica (MIDA), Università di Genova, 16132 Genova, Italy
- Life Science Computational Laboratory (LISCOMP), IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
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12
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Pawłowski M, Fila-Witecka K, Rymaszewska JE, Kamińska D, Poznański P, Augustyniak-Bartosik H, Zielińska D, Krajewska M, Krajewski PK, Stefaniak A, Szepietowski JC, Pokryszko-Dragan A, Chojdak-Łukasiewicz J, Budrewicz S, Pawłowski T, Szcześniak D, Rymaszewska J. Psychopathological Symptoms Among Chronically Ill Patients During SARS-CoV-2 Pandemic in Poland. Psychol Res Behav Manag 2022; 15:2659-2669. [PMID: 36148283 PMCID: PMC9488602 DOI: 10.2147/prbm.s362918] [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: 02/19/2022] [Accepted: 06/19/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction The global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had a drastic psychological and economic impact on the global population. Having a chronic disease during the pandemic is associated with numerous limitations and challenges like regular hospital visits, access to health-care units and getting specialized treatment. In addition, chronically ill patients are at great risk of acquiring the SARS-CoV-2 virus and at experiencing a more severe course of illness, due to comorbid conditions as well as more frequent encounters with health-care workers and other patients in medical facilities. The aim of this study was to examine the psychological disturbances, during the pandemic in chronically ill patients. Methods During the cross-sectional survey conducted between May and October 2020, 398 patients with four different chronic conditions (psoriasis, multiple sclerosis and patients who have undergone a kidney transplant or received dialysis). Study sample was examined regarding the occurrence of psychopathological symptoms (General Health Questionnaire 28) and their perceived stress levels (Perceived Stress Scale). Results The highest scores were found in the MS group and the lowest scores were found in the kidney transplantation group in every subscale of the GHQ-28. Close to half of the studied population (48.74%, n = 193) patients scored above the cut-off for psychopathology. Conclusion As the study was conducted during the SARS-CoV-2 pandemic in Poland, it stands to reason that the pandemic affected the psychological wellbeing of chronically ill patients. A COVID-19 infection, being quarantined and having had contact with a person who was infected, did not significantly affect the outcome measures; however, further research is needed to explore this topic.
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Affiliation(s)
- Marcin Pawłowski
- Psychiatry Department, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - Dorota Kamińska
- Nephrology and Transplantology Department, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Poznański
- Nephrology and Transplantology Department, Wroclaw Medical University, Wroclaw, Poland
| | | | - Dorota Zielińska
- Nephrology and Transplantology Department, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Nephrology and Transplantology Department, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksandra Stefaniak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | | | | | | | - Tomasz Pawłowski
- Psychiatry Department, Wroclaw Medical University, Wroclaw, Poland
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13
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Ponce P, Peralta R, Felix C, Pinto C, Pinto B, Matos JF. Vaccination against SARS-CoV-2 in Haemodialysis Patients: Spike's Ab Response and the Influence of BMI and Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10091. [PMID: 36011725 PMCID: PMC9408116 DOI: 10.3390/ijerph191610091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 05/12/2023]
Abstract
Patients with chronic kidney disease (CKD-5D) in dialysis have been associated with higher rates of SARS-CoV-2 infection. Objective: To identify the CKD-5D patients’ immune system behavior regarding the Pfizer-BioNTech (BNT162b2 mRNA) vaccine (Comirnaty©). This was a multicenter study carried out in 38 dialysis units in NephroCare Portugal. Eligible patients from two cohorts—one composed of completely vaccinated patients with Comirnaty© (vaccinated group) against a second cohort of patients who recovered from SARS-CoV-2 infection (control group)—were selected through representative sampling for each cohort. Humoral response was assessed at 3 (t0) and 6 months (t1) after complete vaccination and, in the control group, 6 months after COVID-19 recovery. In the vaccinated group, at t0, the median anti-Spike IgG level was 1120 AU/mL and, at t1, all participants’ antibody level decreased to a median of 455 AU/mL. In the control group, the median serum SARS-CoV-2 antibodies level was 1836 AU/mL. In the vaccinated group, at t0, patients < 70 years presented a significantly (p = 0.002) higher level of anti-Spike IgG titres. In contrast, older patients from the control group presented a significantly (p = 0.038) higher IgG. No correlation was found between age and anti-Spike IgG antibodies level in any of the studied groups. Patients with a higher body mass index showed a greater immune response in both the vaccinated and control group, although without significance. We concluded that, in the vaccinated group, elderly patients developed a lower immune response than younger patients and the levels of anti-Spike IgG antibodies declined faster between t0 and t1, while in the control group, the oldest and overweight patients developed the best humoral response.
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Affiliation(s)
- Pedro Ponce
- Country Medical, NephroCare Portugal, Fresenius Medical Care Portugal, 1750-233 Lisboa, Portugal
| | - Ricardo Peralta
- Direção de Enfermagem, NephroCare Portugal, Fresenius Medical Care Portugal, 4470-573 Porto, Portugal
| | - Carla Felix
- Direção de Enfermagem, NephroCare Portugal, Fresenius Medical Care Portugal, 4470-573 Porto, Portugal
| | - Carla Pinto
- Country Medical, NephroCare Portugal, Fresenius Medical Care Portugal, 1750-233 Lisboa, Portugal
| | - Bruno Pinto
- Direção de Enfermagem, NephroCare Portugal, Fresenius Medical Care Portugal, 4470-573 Porto, Portugal
| | - João Fazendeiro Matos
- Direção de Enfermagem, NephroCare Portugal, Fresenius Medical Care Portugal, 4470-573 Porto, Portugal
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14
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Presence of specific SARS-COV2 antibodies in hemodialysis patients and their caregivers after the first wave of COVID-19. Sci Rep 2022; 12:11972. [PMID: 35831388 PMCID: PMC9279503 DOI: 10.1038/s41598-022-15913-0] [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: 10/18/2021] [Accepted: 06/30/2022] [Indexed: 12/02/2022] Open
Abstract
Hemodialysis (HD) patients are at risk for severe COVID-19 and cannot comply with social distancing. SARS-COV2 seroprevalence in French patients and caregivers after the first wave of COVID-19 is unknown. SeroCOVIDial is a prospective study conducted between June and December 2020. SARS-COV2 seroprevalence was evaluated by a rapid serological test (BIOSYNEX) in HD patients and caregivers, and the presence or not of anti-SARS-COV2 neutralizing or non-neutralizing antibodies in patients was also determined by ELISA and seroneutralization. In June 2020, 451 HD patients and 238 caregivers were included. Overall SARS-COV2 seroprevalence was 8.4% (patients) and 6.7% (caregivers), and was 87.1% (patients) and 90.0% (caregivers) in participants with a previously documented SARS-COV2 infection. Overall seroprevalence reached 13.8% (patients) and 12.6% (caregivers) following the second epidemic wave. During the follow-up, 38 (8.4%) patients died (9 of COVID-19). Among the 44 (10.6%) patients who became infected, only two were seropositive at M0. The levels of anti-SARS-COV2 antibodies decreased over time in patients and caregivers. The BIOSYNEX test showed 82.9% sensitivity and 97.7% specificity. Prevalence of anti-SARS-COV2 antibodies was low in HD patients and caregivers after the first epidemic wave but rose after the second wave. A rapid serological test showed good performances and could be useful for future monitoring of anti-SARS-COV2 antibodies.
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15
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Tillmann FP, Figiel L, Ricken J, Still H, Korte C, Plaßmann G, Harth A, Jörres A, von Landenberg P. Effect of Third and Fourth mRNA-Based Booster Vaccinations on SARS-CoV-2 Neutralizing Antibody Titer Formation, Risk Factors for Non-Response, and Outcome after SARS-CoV-2 Omicron Breakthrough Infections in Patients on Chronic Hemodialysis: A Prospective Multicenter Cohort Study. J Clin Med 2022; 11:jcm11113187. [PMID: 35683580 PMCID: PMC9181211 DOI: 10.3390/jcm11113187] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023] Open
Abstract
The aim of this study is to determine the effect of repeated vaccinations on neutralizing SARS-CoV-2 IgG antibody titers, evaluate risk factors for immunological non-response, and to report breakthrough infections in chronic hemodialysis patients. Methods: A prospective, multi-center cohort study in 163 chronic hemodialysis patients was conducted. Antibody titers were measured three months after second, third, and fourth (10 pts) booster vaccinations. SARS-CoV-2 neutralizing antibody titers in BAU/mL and % inhibition were divided into three categories (<216, 216–433, >433 and <33, 33–66, and >66%). Somers’s test, paired t-test, and univariable and multivariable logistic regression analysis were applied to evaluate differences in antibody levels and search for risk factors for vaccination failure defined as neutralizing titers <50% and/or need for repeated booster vaccinations. Furthermore, we report on a case series to describe characteristics of patients after four vaccinations (n = 10) and breakthrough infections (n = 20). Results: Third dose boosters resulted in higher proportions of patients with neutralizing antibody levels >66% as compared to after the second dose (64.7% after second dose vs. 88.9% after third dose, p = 0.003), as well as in a respective increase in neutralizing titer levels in % from 68 ± 33% to 89 ± 24 (p < 0.001). The proportion of patients with IgG-titers below 216 BAU/mL decreased from 38.6 to 10.5% (p ≤ 0.001). Age (p = 0.004, OR 1.066, 95% CI 1.020–1.114) and presence of immunosuppressive medications (p = 0.002, OR 8.267, 95% CI 2.206–30.975) were identified as major risk factors for vaccination failure. Repeated booster vaccinations ≥4 times were effective in 8 out of 10 former low-responders (80%) without any side effects or safety concerns. Breakthrough infections showed a clinically mild course but were associated with prolonged viral shedding on PCR-testing ranging 7–29 (mean 13) days. Conclusions: Third and fourth mRNA-based booster vaccinations resulted in higher and longer lasting SARS-CoV-2 antibody levels as compared to after two dosages. The presence of immunosuppressive medication and repeat vaccinations are major potentially modifiable measures to increase antibody levels in non-or low-responders. Breakthrough infections with SARS-CoV-2 Omicron were associated with prolonged viral shedding but clinically mild disease courses.
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Affiliation(s)
- Frank-Peter Tillmann
- Department of Medicine I—Nephrology, Transplantation & Medical Intensive Care, Medical Center Cologne-Merheim, University Witten/Herdecke, Ostmerheimer Str. 200, D-51109 Cologne, Germany; (A.H.); (A.J.)
- Nephrologisches Zentrum Ibbenbüren, Gravenhorsterstr. 1, D-49477 Ibbenbüren, Germany;
- Correspondence:
| | - Lars Figiel
- Nephrologisches Zentrum Emsdetten, Nordwalderstr. 48-50, D-48282 Emsdetten, Germany; (L.F.); (C.K.)
| | - Johannes Ricken
- Nephrologisches Zentrum Rheine, Neuenkirchenerstr. 104, D-48431 Rheine, Germany; (J.R.); (G.P.)
| | - Hermann Still
- Nephrologisches Zentrum Ibbenbüren, Gravenhorsterstr. 1, D-49477 Ibbenbüren, Germany;
| | - Christoph Korte
- Nephrologisches Zentrum Emsdetten, Nordwalderstr. 48-50, D-48282 Emsdetten, Germany; (L.F.); (C.K.)
| | - Grete Plaßmann
- Nephrologisches Zentrum Rheine, Neuenkirchenerstr. 104, D-48431 Rheine, Germany; (J.R.); (G.P.)
| | - Ana Harth
- Department of Medicine I—Nephrology, Transplantation & Medical Intensive Care, Medical Center Cologne-Merheim, University Witten/Herdecke, Ostmerheimer Str. 200, D-51109 Cologne, Germany; (A.H.); (A.J.)
| | - Achim Jörres
- Department of Medicine I—Nephrology, Transplantation & Medical Intensive Care, Medical Center Cologne-Merheim, University Witten/Herdecke, Ostmerheimer Str. 200, D-51109 Cologne, Germany; (A.H.); (A.J.)
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16
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Selvaskandan H, Hull KL, Adenwalla S, Ahmed S, Cusu MC, Graham-Brown M, Gray L, Hall M, Hamer R, Kanbar A, Kanji H, Lambie M, Lee HS, Mahdi K, Major R, Medcalf JF, Natarajan S, Oseya B, Stringer S, Tabinor M, Burton J. Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK. BMJ Open 2022; 12:e054869. [PMID: 35636784 PMCID: PMC9152624 DOI: 10.1136/bmjopen-2021-054869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the applicability of risk factors for severe COVID-19 defined in the general population for patients on haemodialysis. SETTING A retrospective cross-sectional study performed across thirty four haemodialysis units in midlands of the UK. PARTICIPANTS All 274 patients on maintenance haemodialysis who tested positive for SARS-CoV-2 on PCR testing between March and August 2020, in participating haemodialysis centres. EXPOSURE The utility of obesity, diabetes status, ethnicity, Charlson Comorbidity Index (CCI) and socioeconomic deprivation scores were investigated as risk factors for severe COVID-19. MAIN OUTCOMES AND MEASURES Severe COVID-19, defined as requiring supplemental oxygen or respiratory support, or a C reactive protein of ≥75 mg/dL (RECOVERY trial definitions), and its association with obesity, diabetes status, ethnicity, CCI, and socioeconomic deprivation. RESULTS 63.5% (174/274 patients) developed severe disease. Socioeconomic deprivation associated with severity, being most pronounced between the most and least deprived quartiles (OR 2.81, 95% CI 1.22 to 6.47, p=0.015), after adjusting for age, sex and ethnicity. There was no association between obesity, diabetes status, ethnicity or CCI with COVID-19 severity. We found no evidence of temporal evolution of cases (p=0.209) or clustering that would impact our findings. CONCLUSION The incidence of severe COVID-19 is high among patients on haemodialysis; this cohort should be considered high risk. There was strong evidence of an association between socioeconomic deprivation and COVID-19 severity. Other risk factors that apply to the general population may not apply to this cohort.
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Affiliation(s)
- Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Katherine L Hull
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Sherna Adenwalla
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Safa Ahmed
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Maria-Cristina Cusu
- Department of Renal Medicine, Northampton General Hospital NHS Trust, Northampton, UK
| | - Matthew Graham-Brown
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Laura Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Matt Hall
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rizwan Hamer
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ammar Kanbar
- Department of Renal Medicine, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Hemali Kanji
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mark Lambie
- School of Medicine, Keele University, Keele, UK
| | - Han Sean Lee
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Khalid Mahdi
- Department of Renal Medicine, Lincoln County Hospital, Lincoln, UK
| | - Rupert Major
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Health Sciences, University Hospital of Leicester, Leicester, UK
| | - James F Medcalf
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Boavojuvie Oseya
- Department of Renal Medicine, Northampton General Hospital NHS Trust, Northampton, UK
| | - Stephanie Stringer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Matthew Tabinor
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Burton
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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El Karoui K, De Vriese AS. COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment. Kidney Int 2022; 101:883-894. [PMID: 35176326 PMCID: PMC8842412 DOI: 10.1016/j.kint.2022.01.022] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/01/2022] [Accepted: 01/20/2022] [Indexed: 01/07/2023]
Abstract
The COVID-19 pandemic has profound adverse effects on the population on dialysis. Patients requiring dialysis are at an increased risk of SARS-CoV-2 infection and mortality, and many have experienced psychological distress as well as delayed or suboptimal care. COVID-19 survivors have prolonged viral shedding, but generally develop a robust and long-lasting humoral immune response that correlates with initial disease severity. However, protection against reinfection is incomplete. A growing body of evidence reveals delayed and blunted immune responses to SARS-CoV-2 vaccination. Administration of a third dose within 1 to 2 months of prime-boost vaccination significantly increases antibody levels, in particular in patients with poor initial responses. Patients on dialysis have inferior immune responses to adenoviral vector vaccines than to mRNA vaccines. The immunogenicity of the mRNA-1273 vaccine is markedly better than that of the BNT162b2 vaccine, most likely by virtue of its higher mRNA content. Despite suboptimal immune responses in patients on dialysis, preliminary data suggest that vaccination partially protects against infection and severe disease requiring hospitalization. However, progressive waning of immunity and emergence of SARS-CoV-2 variants with a high potential of immune escape call for a booster dose in all patients on dialysis 4 to 6 months after prime-boost vaccination. Patients with persistent poor vaccine responses may be candidates for primary prophylaxis strategies. In the absence of specific data in patients on dialysis, therapeutic strategies in the event of established COVID-19 must be extrapolated from evidence obtained in the population not on dialysis. Neutralizing monoclonal antibodies may be an attractive option after a high-risk exposure or during the early course of infection.
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Affiliation(s)
- Khalil El Karoui
- Department of Nephrology and Transplantation, Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire TRUE, Université Paris Est, Créteil, France
| | - An S De Vriese
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium.
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18
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Steiger S, Rossaint J, Zarbock A, Anders HJ. Secondary Immunodeficiency Related to Kidney Disease (SIDKD)-Definition, Unmet Need, and Mechanisms. J Am Soc Nephrol 2022; 33:259-278. [PMID: 34907031 PMCID: PMC8819985 DOI: 10.1681/asn.2021091257] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Kidney disease is a known risk factor for poor outcomes of COVID-19 and many other serious infections. Conversely, infection is the second most common cause of death in patients with kidney disease. However, little is known about the underlying secondary immunodeficiency related to kidney disease (SIDKD). In contrast to cardiovascular disease related to kidney disease, which has triggered countless epidemiologic, clinical, and experimental research activities or interventional trials, investments in tracing, understanding, and therapeutically targeting SIDKD have been sparse. As a call for more awareness of SIDKD as an imminent unmet medical need that requires rigorous research activities at all levels, we review the epidemiology of SIDKD and the numerous aspects of the abnormal immunophenotype of patients with kidney disease. We propose a definition of SIDKD and discuss the pathogenic mechanisms of SIDKD known thus far, including more recent insights into the unexpected immunoregulatory roles of elevated levels of FGF23 and hyperuricemia and shifts in the secretome of the intestinal microbiota in kidney disease. As an ultimate goal, we should aim to develop therapeutics that can reduce mortality due to infections in patients with kidney disease by normalizing host defense to pathogens and immune responses to vaccines.
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Affiliation(s)
- Stefanie Steiger
- Division of Nephrology, Department of Medicine IV, Ludwig Maximilians University Hospital of Munich, Munich, Germany
| | - Jan Rossaint
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, Ludwig Maximilians University Hospital of Munich, Munich, Germany
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19
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Ben-Dov IZ, Oster Y, Tzukert K, Alster T, Bader R, Israeli R, Asayag H, Aharon M, Burstein I, Pri-Chen H, Imam A, Abel R, Mor-Yosef Levi I, Khalaileh A, Oiknine-Djian E, Bloch A, Wolf DG, Dranitzki Elhalel M. Impact of tozinameran (BNT162b2) mRNA vaccine on kidney transplant and chronic dialysis patients: 3-5 months follow-up. J Nephrol 2022; 35:153-164. [PMID: 34988942 PMCID: PMC8731189 DOI: 10.1007/s40620-021-01210-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Determining the humoral immunogenicity of tozinameran (BNT162b2) in patients requiring chronic renal replacement therapy, and its impact on COVID-19 morbidity several months after vaccination, may guide risk assessment and changes in vaccination policy. METHODS In a prospective post-vaccination cohort study with up to 5 months follow-up we studied outpatient dialysis and kidney transplant patients and respective healthcare teams. Outcomes were anti S1/S2 antibody responses to vaccine or infection, and infection rate during follow-up. RESULTS One hundred seventy-five dialysis patients (40% women, 65 ± 15 years), 252 kidney transplant patients (33% women, 54 ± 14 years) and 71 controls (65% women, 44 ± 14 years) were followed. Three months or longer after vaccination we detected anti S1/S2 IgG antibodies in 79% of dialysis patients, 42% of transplant recipients and 100% of controls, whereas respective rates after infection were 94%, 69% and 100%. Predictors of non-response were older age, diabetes, history of cancer, lower lymphocyte count and lower vitamin-D levels. Factors associated with lower antibody levels in dialysis patients were modality (hemodialysis vs peritoneal) and high serum ferritin levels. In transplant patients, hypertension and higher calcineurin or mTOR inhibitor drug levels were linked with lower antibody response. Vaccination was associated with fewer subsequent infections (HR 0.23, p < 0.05). Moreover, higher antibody levels (particularly above 59 AU/ml) were associated with fewer events, with a HR 0.41 for each unit increased in log10titer (p < 0.05). CONCLUSIONS Dialysis patients, and more strikingly kidney transplant recipients, mounted reduced antibody response to COVID-19 mRNA vaccination. Lesser humoral response was associated with more infections. Measures to identify and protect non-responsive patients are required.
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Affiliation(s)
- Iddo Z Ben-Dov
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel.
| | - Yonatan Oster
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Keren Tzukert
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Talia Alster
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Raneem Bader
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ruth Israeli
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Haya Asayag
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Michal Aharon
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Ido Burstein
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Hadas Pri-Chen
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Ashraf Imam
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roy Abel
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Irit Mor-Yosef Levi
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Abed Khalaileh
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aharon Bloch
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Dana G Wolf
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Dranitzki Elhalel
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
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20
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Parra-Martos L, Cobacho-Salmoral O, Martínez-Urbano J. COVID-19 en el paciente en diálisis. Una revisión sistemática. ENFERMERÍA NEFROLÓGICA 2021. [DOI: 10.37551/s2254-28842021030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introducción: La pandemia por COVID-19 acaecida en 2019 afectó con mayor gravedad a la población de mayor edad y con enfermedades subyacentes, siendo estos factores de riesgo de mortalidad. Estas características son propias del paciente renal en diálisis, por lo que es importante conocer cuál fue el impacto del COVID-19 en este grupo poblacional.Objetivo: El objetivo principal fue conocer y sintetizar la evidencia científica existente sobre las características clínicas de la enfermedad COVID-19 en el paciente con enfermedad renal crónica en diálisis.Metodología: Se realizó una revisión sistemática basada en la declaración PRISMA, en la que se analizaron 23 artículos procedentes de las bases de datos PubMed y Scopus. Se incluyeron artículos originales en inglés y español que excluyeran la población pediátrica.Resultados: Se incluyeron 23 artículos de diseño observacional. Principalmente los resultados se centraron en incidencia, características clínicas, como sintomatología o evolución, mortalidad y medidas preventivas en las unidades de diálisis.Conclusiones: La incidencia de la COVID-19 fue mayor en unidades de diálisis que en los pacientes que recibían diálisis domiciliaria. La sintomatología más leve fue la común a la población general. En los casos más graves, cerca del 50% de los pacientes necesitaron hospitalización y/o ingreso en una Unidad de Cuidados Intensivos. La mortalidad fue bastante elevada y se relacionó con la edad avanzada, comorbilidad, sexo masculino o fragilidad clínica. Además, en las unidades de diálisis se implementaron medidas de prevención de la enfermedad, al ser espacios físicos cerrados donde se concentra un gran número de pacientes.
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Affiliation(s)
- Lucía Parra-Martos
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Olga Cobacho-Salmoral
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Julia Martínez-Urbano
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
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21
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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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22
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Chen MY, Xiao FP, Kuai L, Zhou HB, Jia ZQ, Liu M, He H, Hong M. Outcomes of atrial fibrillation in patients with COVID-19 pneumonia: A systematic review and meta-analysis. Am J Emerg Med 2021; 50:661-669. [PMID: 34879483 PMCID: PMC8483996 DOI: 10.1016/j.ajem.2021.09.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recently, emerging evidence has suggested that atrial fibrillation (AF) has an epidemiological correlation with coronavirus disease 2019 (COVID-19). However, the clinical outcomes of AF in COVID-19 remain inconsistent and inconclusive. The aim of this study was to provide a comprehensive description of the impact of AF on the prognosis of patients with COVID-19 pneumonia. METHODS Three electronic databases (PubMed, Embase, and Web of Science) were searched for eligible studies as of March 1, 2021. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the associations between AF (preexisting and new-onset) and in-hospital mortality, post-discharge mortality, and ventilator use. RESULTS A total of 36 individual studies were incorporated into our meta-analysis. The combined results revealed that preexisting AF was associated with increased in-hospital mortality (pooled OR: 2.07; 95% CI: 1.60-2.67; p < 0.001), post-discharge mortality (pooled OR: 2.69; 95% CI: 1.24-5.83; p < 0.05), and ventilator utilization (pooled OR: 4.53; 95% CI: 1.33-15.38; p < 0.05) in patients with COVID-19. In addition, our data demonstrated that new-onset AF during severe acute respiratory syndrome coronavirus 2 infection was significantly correlated with increased mortality (pooled OR: 2.38; 95% CI: 2.04-2.77; p < 0.001). CONCLUSIONS The presence of AF is correlated with adverse outcomes in patients with COVID-19 pneumonia, which deserves increased attention and should be managed appropriately to prevent adverse outcomes.
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Affiliation(s)
- Ming-Yue Chen
- Department of Geriatrics, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fang-Ping Xiao
- Department of Cardiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lin Kuai
- Department of Geriatrics, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Bo Zhou
- Department of Cardiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhi-Qiang Jia
- Department of Cardiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Liu
- Department of Cardiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao He
- Department of Cardiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mei Hong
- Department of Geriatrics, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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23
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Daoud A, Ali H, Rao V, Rohan V, Soliman K. ACE-inhibitor/angiotensin receptor blockers (ACE-I/ARBs) therapy in COVID-19 infected dialysis patients. Ren Fail 2021; 43:1463-1464. [PMID: 34704916 PMCID: PMC8555537 DOI: 10.1080/0886022x.2021.1994419] [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] [Received: 08/02/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ahmed Daoud
- Department of Internal Medicine, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Hatem Ali
- Department of Internal Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Internal Medicine, Coventry, United Kingdom of Great Britain and Northern Ireland
| | - Vinaya Rao
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Vinayak Rohan
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Karim Soliman
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA
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24
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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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25
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Giot M, Fourié T, Lano G, Villarroel PMS, de Lamballeri X, Gully M, Samson L, Farault J, Bouchouareb D, Jehel O, Brunet P, Jourde-Chiche N, Ninove L, Robert T. Spike and neutralizing antibodies response to COVID-19 vaccination in haemodialysis patients. Clin Kidney J 2021; 14:2239-2245. [PMID: 34603701 PMCID: PMC8344612 DOI: 10.1093/ckj/sfab128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 01/10/2023] Open
Abstract
Background Humoral response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines needs to be evaluated in the fragile population of patients on maintenance haemodialysis (HD). Methods We analysed the antibody response to the spike (S) antigen of SARS-CoV-2 before and after each dose of the messenger RNA (mRNA) Comirnaty vaccine (BNT162b2; BioNTech & Pfizer) in patients from a single dialysis centre and detected the presence of neutralizing antibodies (Nabs). Results Among the 90 vaccinated HD patients (mean age 69 years, 61% male), 19 (21%) had a history of SARS-CoV-2 infection. A seroconversion with anti-S immunoglobulin G antibodies (Sabs) was documented in 20% of patients after the first dose (early responders) and in 77% after the second dose, while 23% were non-responders. Cardiac disease, cirrhosis and gamma globulin levels were independently predictive of the absence of seroconversion. Nabs were detected in 15.4% of early responders after the first dose and in 84.6% of early responders and 57.9% of late responders after the second dose. Sab titres after the second dose were higher in patients with Nab than without Nab {598 [interquartile range (IQR) 246–882]) versus 134 [IQR 61–390]; P < 0.0001}. All patients with a history of SARS-CoV-2 infection developed both Sabs and Nabs and their titres for Sabs and Nabs were higher than in late responders. Conclusions Most HD patients develop a substantial humoral response against SARS-CoV2, with Nabs, following the mRNA vaccine. Whether this immunity persists over time and is able to efficiently protect patients from coronavirus disease 2019 remains to be determined.
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Affiliation(s)
- Matthieu Giot
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France
| | - Toscane Fourié
- Unité des Virus Émergents (UVE: Aix-Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection), Marseille, France
| | - Guillaume Lano
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France.,Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Paola Mariela Saba Villarroel
- Unité des Virus Émergents (UVE: Aix-Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection), Marseille, France
| | - Xavier de Lamballeri
- Unité des Virus Émergents (UVE: Aix-Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection), Marseille, France
| | - Marion Gully
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France
| | - Laurent Samson
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France
| | - Julien Farault
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France
| | - Dammar Bouchouareb
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France
| | - Océane Jehel
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France
| | - Philippe Brunet
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France.,Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Noémie Jourde-Chiche
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France.,Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Laetitia Ninove
- Unité des Virus Émergents (UVE: Aix-Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection), Marseille, France
| | - Thomas Robert
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France.,MMG, Bioinformatics & Genetics, UMR_S910, Aix-Marseille Université, Marseille, France
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26
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Mc Keaveney C, Reid J, Carswell C, Bonner A, de Barbieri I, Johnston W, Maxwell AP, O'Riordan J, Strini V, Walsh I, Noble H. Experiences of renal healthcare practitioners during the COVID-19 pandemic: a multi-methods approach. BMC Nephrol 2021; 22:301. [PMID: 34493246 PMCID: PMC8421457 DOI: 10.1186/s12882-021-02500-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/14/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Globally, renal healthcare practitioners provide intensive and protracted support to a highly complex multi-morbid patient population however knowledge about the impact of COVID-19 on these practitioners is extremely limited. OBJECTIVE This study aimed to explore the experiences of COVID-19 with renal healthcare practitioners during the first global lockdown between June 2020 and September 2020. METHODS A multi-methods approach was carried out including a quantitative survey and qualitative interviews. This was a multinational study of renal healthcare practitioners from 29 countries. Quantitative: A self-designed survey on COVID-19 experiences and standardised questionnaires (General Health Questionnaire-12; Maslach Burnout Inventory). Descriptive statistics were generated for numerical data. Qualitative: Online semi-structured interviews were conducted. Data was subjected to thematic analysis. Renal healthcare practitioners (n = 251) completed an online survey. Thirteen renal healthcare practitioners took part in semi-structured interviews (12 nurses and 1 dietician). RESULTS The majority of participants surveyed were female (86.9 %; n = 218), nurses (86.9 %; n = 218) with an average 21.5 (SD = 11.1) years' experience since professional qualification, and 16.3 years (SD = 9.3) working in renal healthcare. Survey responses indicated a level of preparedness, training and satisfactory personal protective equipment during the pandemic however approximately 40.3 % experienced fear about attending work, and 49.8 % experienced mental health distress. The highest prevalence of burnout was emotional exhaustion (35.9 %). Three themes emerged from the qualitative analysis highlighting the holistic complexities in managing renal healthcare, a neglected specialist workforce, and the need for appropriate support at work during a pandemic. CONCLUSIONS Results have highlighted the psychological impact, in terms of emotional exhaustion and mental health distress in our sample of renal healthcare practitioners. As the pandemic has continued, it is important to consider the long-term impact on an already stretched workforce including the risk of developing mental health disorders. Future research and interventions are required to understand and improve the provision of psychological support for specialist medical and nursing personnel.
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Affiliation(s)
- Clare Mc Keaveney
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Claire Carswell
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK.,Department of Health Sciences, University of York, York, UK
| | - Ann Bonner
- Griffith University, Brisbane, Australia
| | | | - William Johnston
- Kidney Care, Alton, UK.,Northern Ireland Kidney Patient Association, Belfast, UK
| | - Alexander P Maxwell
- Regional Nephrology Unit, Belfast City Hospital, Belfast, UK.,Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Julien O'Riordan
- Galway Hospice Foundation, Galway, Ireland.,National University of Ireland, Galway, Ireland
| | | | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK.
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27
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Giot M, Robert T, Brunet P, Resseguier N, Lano G. Vaccination against COVID-19 in a haemodialysis centre: what is the risk of bleeding complications? Clin Kidney J 2021; 14:1701-1703. [PMID: 34429940 PMCID: PMC7989515 DOI: 10.1093/ckj/sfab059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- Matthieu Giot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception AP-HM, Marseille, France
| | - Thomas Robert
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception AP-HM, Marseille, France
| | - Philippe Brunet
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception AP-HM, Marseille, France
| | - Noémie Resseguier
- Unité de Soutien à la Recherche Clinique et à L'évaluation Économique, AP-HM, Marseille, France.,Centre de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille Université, Marseille, France
| | - Guillaume Lano
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception AP-HM, Marseille, France.,INSERM, INRA, Aix Marseille Univ, C2VN, Marseille, France
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28
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An W, Kang JS, Wang Q, Kim TE. Cardiac biomarkers and COVID-19: A systematic review and meta-analysis. J Infect Public Health 2021; 14:1191-1197. [PMID: 34416596 PMCID: PMC8320426 DOI: 10.1016/j.jiph.2021.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To systematically investigate the relationship between cardiac biomarkers and COVID-19 severity and mortality. METHODS We performed a literature search using PubMed, Web of Science, and Google Scholar. The standardized mean difference (SMD) and 95% confidence interval (CI) were applied to estimate the combined results of 67 studies. A meta-analysis of cardiac biomarkers was used to evaluate disease mortality and severity in COVID-19 patients. RESULTS A meta-analysis of 7812 patients revealed that patients with high levels of cardiac troponin I (SMD = 0.81 U/L, 95% CI = 0.14-1.48, P = 0.017), cardiac troponin T (SMD = 0.78 U/L, 95% CI = 0.07-1.49, P = 0.032), high-sensitive cardiac troponin I (SMD = 0.66 pg/mL, 95% CI = 0.51-0.81, P < 0.001), high-sensitive cardiac troponin T (SMD = 0.93 U/L, 95% CI = 0.21-1.65, P = 0.012), creatine kinase-MB (SMD = 0.54 U/L, 95% CI = 0.39-0.69, P < 0.001), and myoglobin (SMD = 0.80 U/L, 95% CI = 0.57-1.03, P < 0.001) were associated with prominent disease severity in COVID-19 infection. Moreover, 9532 patients with a higher serum level of cardiac troponin I (SMD = 0.51 U/L, 95% CI = 0.37-0.64, P < 0.001), high-sensitive cardiac troponin (SMD = 0.51 ng/L, 95% CI = 0.29-0.73, P < 0.001), high-sensitive cardiac troponin I (SMD = 0.51 pg/mL, 95% CI = 0.38-0.63, P < 0.001), high-sensitive cardiac troponin T (SMD = 0.85 U/L, 95% CI = 0.63-1.07, P < 0.001), creatine kinase-MB (SMD = 0.48 U/L, 95% CI = 0.32-0.65, P < 0.001), and myoglobin (SMD = 0.55 U/L, 95% CI = 0.45-0.65, P < 0.001) exhibited a prominent level of mortality from COVID-19 infection. CONCLUSION Cardiac biomarkers (cardiac troponin I, cardiac troponin T, high-sensitive cardiac troponin, high-sensitive cardiac troponin I, high-sensitive cardiac troponin T, creatine kinase-MB, and myoglobin) should be more frequently applied in identifying high-risk COVID-19 patients so that timely treatment can be implemented to reduce severity and mortality in COVID-19 patients.
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Affiliation(s)
- Wen An
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
| | - Ju-Seop Kang
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
| | - Qiuyang Wang
- Department of Central China Research Institute of Health, Xinxiang Medical University, Xinxiang, China.
| | - Tae-Eun Kim
- Department of Clinical Pharmacology, Konkuk University Hospital, Seoul, Republic of Korea.
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29
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Xu J, Xiao W, Liang X, Shi L, Zhang P, Wang Y, Wang Y, Yang H. A meta-analysis on the risk factors adjusted association between cardiovascular disease and COVID-19 severity. BMC Public Health 2021; 21:1533. [PMID: 34380456 PMCID: PMC8355578 DOI: 10.1186/s12889-021-11051-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 05/12/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD), one of the most common comorbidities of coronavirus disease 2019 (COVID-19), has been suspected to be associated with adverse outcomes in COVID-19 patients, but their correlation remains controversial. METHOD This is a quantitative meta-analysis on the basis of adjusted effect estimates. PubMed, Web of Science, MedRxiv, Scopus, Elsevier ScienceDirect, Cochrane Library and EMBASE were searched comprehensively to obtain a complete data source up to January 7, 2021. Pooled effects (hazard ratio (HR), odds ratio (OR)) and the 95% confidence intervals (CIs) were estimated to evaluate the risk of the adverse outcomes in COVID-19 patients with CVD. Heterogeneity was assessed by Cochran's Q-statistic, I2test, and meta-regression. In addition, we also provided the prediction interval, which was helpful for assessing whether the variation across studies was clinically significant. The robustness of the results was evaluated by sensitivity analysis. Publication bias was assessed by Begg's test, Egger's test, and trim-and-fill method. RESULT Our results revealed that COVID-19 patients with pre-existing CVD tended more to adverse outcomes on the basis of 203 eligible studies with 24,032,712 cases (pooled ORs = 1.41, 95% CIs: 1.32-1.51, prediction interval: 0.84-2.39; pooled HRs = 1.34, 95% CIs: 1.23-1.46, prediction interval: 0.82-2.21). Further subgroup analyses stratified by age, the proportion of males, study design, disease types, sample size, region and disease outcomes also showed that pre-existing CVD was significantly associated with adverse outcomes among COVID-19 patients. CONCLUSION Our findings demonstrated that pre-existing CVD was an independent risk factor associated with adverse outcomes among COVID-19 patients.
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Affiliation(s)
- Jie Xu
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Wenwei Xiao
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Xuan Liang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Li Shi
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Peihua Zhang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Ying Wang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, 450016, China
| | - Haiyan Yang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China.
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Ajaimy M, Liriano-Ward L, Graham JA, Akalin E. Risks and Benefits of Kidney Transplantation during the COVID-19 Pandemic: Transplant or Not Transplant? KIDNEY360 2021; 2:1179-1187. [PMID: 35368354 PMCID: PMC8786107 DOI: 10.34067/kid.0002532021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/12/2021] [Indexed: 02/04/2023]
Abstract
COVID-19 has significantly affected the transplant community, by leading to decreased transplant activity and increased waiting list time. As expected, COVID-19 causes substantial mortality in both ESKD and kidney transplant populations. This is due to underlying CKD and a high prevalence of comorbid conditions, such as diabetes mellitus, hypertension, and cardiovascular disease in this group. Transplant programs have faced the difficult decision of weighing the risks and benefits of transplantation during the pandemic. On one hand, there is a risk of COVID-19 exposure leading to infection while patients are on maximum immunosuppression. Alternatively, there are risks of delaying transplantation, which will increase waitlist times and may lead to waitlist-associated morbidity and mortality. Cautious and thoughtful selection of both the recipient's and donor's post-transplant management has been required during the pandemic, to mitigate the risk of morbidity and mortality associated with COVID-19. In this review article, we aimed to discuss previous publications related to clinical outcomes of COVID-19 disease in kidney transplant recipients, patients with ESKD on dialysis, or on the transplant waiting list, and the precautions transplant centers should take in decision making for recipient and donor selection and immunosuppressive management during the pandemic. Nevertheless, transplantation in this milieu does seem to be the correct decision, with careful patient and donor selection and safeguard protocols for infection prevention. Each center should conduct risk assessment on the basis of the patient's age and medical comorbidities, waitlist time, degree of sensitization, cold ischemia time, status of vaccination, and severity of pandemic in their region.
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Affiliation(s)
- Maria Ajaimy
- Division of Nephrology, Montefiore Einstein Center for Transplantation, Bronx, New York
| | - Luz Liriano-Ward
- Division of Nephrology, Montefiore Einstein Center for Transplantation, Bronx, New York
| | - Jay A. Graham
- Division of Nephrology, Montefiore Einstein Center for Transplantation, Bronx, New York
| | - Enver Akalin
- Division of Nephrology, Montefiore Einstein Center for Transplantation, Bronx, New York
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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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Kazmi S, Alam A, Salman B, Saeed F, Memon S, Chughtai J, Ahmed S, Tariq S, Imtiaz S. Clinical Course and Outcome of ESRD Patients on Maintenance Hemodialysis Infected with COVID-19: A Single-Center Study. Int J Nephrol Renovasc Dis 2021; 14:193-199. [PMID: 34234514 PMCID: PMC8256095 DOI: 10.2147/ijnrd.s310035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/10/2021] [Indexed: 01/12/2023] Open
Abstract
Background In an ESRD subset of patients, COVID-19 infection is associated with increased disease burden and higher mortality rates. Methods We conducted a retrospective single-center cohort study in which 43 ESRD patients had a diagnosis of COVID-19. Association of risk factors with mortality was assessed by chi-square test and logistic regression analysis. Data were collected on a structured performa which included variables like age, gender, comorbid conditions, drug history, clinical presentation, hemodynamic status and laboratory parameters. Outcome variables were recovery and death. All patients received standard treatment for COVID-19 according to hospital protocols, along with hemodialysis and continuous renal replacement therapy (CRRT) when needed. Results Those most affected were found to be male, 25 (58.1%), while the number of females affected was 18 (41.9%). The most frequent comorbid condition was hypertension (HTN), seen in 35 (81.4%) patients; however, thromboembolic complications were very few in these patients. The mortality rate in our study was 25.6%, and the population most susceptible to poor outcomes in the ESRD subgroup was elderly people (45.5%), while younger patients recovered the most from COVID-19 (53.1%). Hypoalbuminemia, leukocytosis, lymphopenia and raised LDH were also found to be associated with death in ESRD patients suffering from COVID-19 (81.8, 72.7, 100 and 100%, respectively). In multivariate logistic regression analysis, we found that the odds ratio of dying from COVID-19 was 19.5 times higher in patients aged >65 years as compared to patients aged 18–50 years (p=0.039). Similarly, patients with a high TLC were 24.1 times more likely to die than patients with a normal TLC (p=0.008). Conclusion In our center, the mortality rate of ESRD patients affected with COVID-19 disease was 25.6%, and older age, leukocytosis, lymphopenia, hypoalbuminemia and high LDH were significantly associated with mortality.
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Affiliation(s)
- Samia Kazmi
- Department of Internal Medicine, The Indus Hospital and Health Network, Karachi, Sindh, Pakistan
| | - Ashar Alam
- Department of Nephrology, The Indus Hospital and Health Network, Karachi, Sindh, Pakistan
| | - Beena Salman
- Department of Nephrology, The Indus Hospital and Health Network, Karachi, Sindh, Pakistan
| | - Faiza Saeed
- Department of Nephrology, The Indus Hospital and Health Network, Karachi, Sindh, Pakistan
| | - Shoukat Memon
- Department of Nephrology, The Indus Hospital and Health Network, Karachi, Sindh, Pakistan
| | - Javeria Chughtai
- Department of Nephrology, The Indus Hospital and Health Network, Karachi, Sindh, Pakistan
| | - Shahzad Ahmed
- Department of Nephrology, The Indus Hospital and Health Network, Karachi, Sindh, Pakistan
| | - Sobia Tariq
- Department of Nephrology, The Indus Hospital and Health Network, Karachi, Sindh, Pakistan
| | - Salman Imtiaz
- Department of Nephrology, The Indus Hospital and Health Network, Karachi, Sindh, Pakistan
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Nithya G, Lamech TM, Arumugam V, Dineshkumar T, Gopalakrishnan N, Aiswarya D, Shaji S, Sastry BVRH, Solomon D, Kannan BS, Sakthirajan R, Rajendran P. A clinical study on the changing dynamics of disease severity, management strategies and outcomes of COVID-19 in patients requiring haemodialysis. J Nephrol 2021; 34:999-1006. [PMID: 34050905 PMCID: PMC8164070 DOI: 10.1007/s40620-021-01072-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/09/2021] [Indexed: 10/26/2022]
Abstract
INTRODUCTION In this observational study, we describe the change in the clinical profile and outcome of Corona Virus Disease 2019 (COVID-19) over the course of the outbreak, among patients requiring dialysis, including chronic haemodialysis therapy. METHODS This is a single-centre prospective observational study of patients with COVID-19 (as confirmed by RT-PCR) and renal failure requiring haemodialysis. Their clinical profiles and outcomes were analysed, vis-à-vis the changing disease severity. FINDINGS A total of 483 patients were included, of whom 416 had end-stage renal disease and were on maintenance haemodialysis. Patients who were symptomatic at presentation had significantly higher levels of Neutrophil-lymphocyte ratio (NLR) (p < 0.001), C-reactive protein (CRP) (p < 0.001), lactate dehydrogenase (LDH) (p < 0.001), higher degrees of lung involvement (p < 0.001) and required more respiratory support (p < 0.001). The overall mortality observed was 18.8%. In the late phases of the outbreak, there was a significant increase in disease severity without a statistically significant increase in mortality. Predictors of mortality on univariate analysis were age, diabetes mellitus, acute on chronic kidney disease, presence of symptoms on admission, NLR, CRP, LDH, computed tomography (CT) chest grades 3 and 4, and need for respiratory support; however, only age and the renal syndrome of acute on chronic kidney disease retained significance on multivariate analysis (p0.003 and p0.019, respectively). CONCLUSION Among patients on haemodialysis, higher mortality was observed in patients who were older, and among those with acute on chronic kidney disease. In the late phase of the outbreak, there was a statistically significant increase in disease severity without a corresponding increase in mortality.
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Affiliation(s)
| | | | | | | | | | | | - Sajmi Shaji
- Institute of Nephrology, Madras Medical College, Chennai, India
| | | | - Dolphin Solomon
- Institute of Nephrology, Madras Medical College, Chennai, India
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Taji L, Thomas D, Oliver MJ, Ip J, Tang Y, Yeung A, Cooper R, House AA, McFarlane P, Blake PG. COVID-19 chez les patients ontariens sous dialyse à long terme. CMAJ 2021; 193:E655-E662. [PMID: 33941528 PMCID: PMC8112626 DOI: 10.1503/cmaj.202601-f] [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] [Accepted: 01/18/2021] [Indexed: 11/16/2022] Open
Abstract
CONTEXTE: Les patients sous dialyse à long terme pourraient avoir un risque accru d’infection par le coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2), et de maladie et de mortalité associées. Nous avons voulu décrire l’incidence, les facteurs de risque et les issues de l’infection chez ces patients en Ontario (Canada). MÉTHODES: Nous avons utilisé des ensembles de données reliées pour comparer les caractéristiques de la maladie et la mortalité chez les patients sous dialyse à long terme en Ontario qui ont testé positif pour le SRAS-CoV-2 et ceux qui n’ont pas développé d’infection, entre le 12 mars et le 20 août 2020. Nous avons recueilli des données sur l’infection par le SRAS-CoV-2 de manière prospective. Nous avons évalué les facteurs de risque d’infection et de mortalité par des analyses de régression logistique multivariées. RÉSULTATS: Pendant la période à l’étude, 187 patients dialysés sur 12 501 (1,5 %) ont reçu un diagnostic d’infection par le SRAS-CoV-2. Parmi eux, 117 (62,6 %) ont été hospitalisés, et le taux de mortalité était de 28,3 %. Les facteurs prédictifs significatifs associés à l’infection incluaient l’hémodialyse dans un centre plutôt que la dialyse à domicile (rapport de cotes [RC] 2,54; intervalle de confiance [IC] à 95 % 1,59–4,05), le fait de vivre dans un établissement de soins de longue durée (RC 7,67; IC à 95 % 5,30–11,11), le fait d’habiter la région du Grand Toronto (RC 3,27; IC à 95 % 2,21–4,80), les ethnicités Noire (RC 3,05; IC à 95 % 1,95–4,77), du sous-continent indien (RC 1,70; IC à 95 % 1,02–2,81) et autres non blanches (RC 2,03; IC à 95 % 1,38–2,97) et les quintiles de revenu inférieurs (RC 1,82; IC à 95 % 1,15–2,89). INTERPRÉTATION: Les patients sous dialyse à long terme sont exposés à un risque accru d’infection par le SRAS-CoV-2 et de mortalité due à la maladie à coronavirus 2019. Il faudra travailler à éliminer les facteurs de risque d’infection et vacciner ces patients en priorité.
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Affiliation(s)
- Leena Taji
- Réseau rénal de l'Ontario (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Santé Ontario; Département de médecine (Oliver), Université de Toronto, Toronto, Ont.; Faculté de médecine et de dentisterie Schulich (House, Blake), Université Western, London, Ont.; Hôpital St. Michael's (McFarlane), Toronto, Ont
| | - Doneal Thomas
- Réseau rénal de l'Ontario (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Santé Ontario; Département de médecine (Oliver), Université de Toronto, Toronto, Ont.; Faculté de médecine et de dentisterie Schulich (House, Blake), Université Western, London, Ont.; Hôpital St. Michael's (McFarlane), Toronto, Ont
| | - Matthew J Oliver
- Réseau rénal de l'Ontario (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Santé Ontario; Département de médecine (Oliver), Université de Toronto, Toronto, Ont.; Faculté de médecine et de dentisterie Schulich (House, Blake), Université Western, London, Ont.; Hôpital St. Michael's (McFarlane), Toronto, Ont
| | - Jane Ip
- Réseau rénal de l'Ontario (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Santé Ontario; Département de médecine (Oliver), Université de Toronto, Toronto, Ont.; Faculté de médecine et de dentisterie Schulich (House, Blake), Université Western, London, Ont.; Hôpital St. Michael's (McFarlane), Toronto, Ont
| | - Yiwen Tang
- Réseau rénal de l'Ontario (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Santé Ontario; Département de médecine (Oliver), Université de Toronto, Toronto, Ont.; Faculté de médecine et de dentisterie Schulich (House, Blake), Université Western, London, Ont.; Hôpital St. Michael's (McFarlane), Toronto, Ont
| | - Angie Yeung
- Réseau rénal de l'Ontario (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Santé Ontario; Département de médecine (Oliver), Université de Toronto, Toronto, Ont.; Faculté de médecine et de dentisterie Schulich (House, Blake), Université Western, London, Ont.; Hôpital St. Michael's (McFarlane), Toronto, Ont
| | - Rebecca Cooper
- Réseau rénal de l'Ontario (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Santé Ontario; Département de médecine (Oliver), Université de Toronto, Toronto, Ont.; Faculté de médecine et de dentisterie Schulich (House, Blake), Université Western, London, Ont.; Hôpital St. Michael's (McFarlane), Toronto, Ont
| | - Andrew A House
- Réseau rénal de l'Ontario (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Santé Ontario; Département de médecine (Oliver), Université de Toronto, Toronto, Ont.; Faculté de médecine et de dentisterie Schulich (House, Blake), Université Western, London, Ont.; Hôpital St. Michael's (McFarlane), Toronto, Ont
| | - Phil McFarlane
- Réseau rénal de l'Ontario (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Santé Ontario; Département de médecine (Oliver), Université de Toronto, Toronto, Ont.; Faculté de médecine et de dentisterie Schulich (House, Blake), Université Western, London, Ont.; Hôpital St. Michael's (McFarlane), Toronto, Ont
| | - Peter G Blake
- Réseau rénal de l'Ontario (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Santé Ontario; Département de médecine (Oliver), Université de Toronto, Toronto, Ont.; Faculté de médecine et de dentisterie Schulich (House, Blake), Université Western, London, Ont.; Hôpital St. Michael's (McFarlane), Toronto, Ont.
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Meta-Analysis of Atrial Fibrillation in Patients With COVID-19. Am J Cardiol 2021; 144:152-156. [PMID: 33508269 PMCID: PMC7839388 DOI: 10.1016/j.amjcard.2021.01.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 02/07/2023]
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Pamplona GM, Sullivan T, Kotanko P. COVID-19 Vaccination Acceptance and Hesitancy in Dialysis Staff: First Results From New York City. Kidney Int Rep 2021; 6:1192-1193. [PMID: 33615048 PMCID: PMC7879030 DOI: 10.1016/j.ekir.2021.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 12/16/2022] Open
Affiliation(s)
| | | | - Peter Kotanko
- Renal Research Institute, New York, New York, USA
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Taji L, Thomas D, Oliver MJ, Ip J, Tang Y, Yeung A, Cooper R, House AA, McFarlane P, Blake PG. COVID-19 in patients undergoing long-term dialysis in Ontario. CMAJ 2021; 193:E278-E284. [PMID: 33542093 PMCID: PMC8034346 DOI: 10.1503/cmaj.202601] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 01/18/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients undergoing long-term dialysis may be at higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and of associated disease and mortality. We aimed to describe the incidence, risk factors and outcomes for infection in these patients in Ontario, Canada. METHODS We used linked data sets to compare disease characteristics and mortality between patients receiving long-term dialysis in Ontario who were diagnosed SARS-CoV-2 positive and those who did not acquire SARS-CoV-2 infection, between Mar. 12 and Aug. 20, 2020. We collected data on SARS-CoV-2 infection prospectively. We evaluated risk factors for infection and death using multivariable logistic regression analyses. RESULTS During the study period, 187 (1.5%) of 12 501 patients undergoing dialysis were diagnosed with SARS-CoV-2 infection. Of those with SARS-CoV-2 infection, 117 (62.6%) were admitted to hospital and the case fatality rate was 28.3%. Significant predictors of infection included in-centre hemodialysis versus home dialysis (odds ratio [OR] 2.54, 95% confidence interval [CI] 1.59-4.05), living in a long-term care residence (OR 7.67, 95% CI 5.30-11.11), living in the Greater Toronto Area (OR 3.27, 95% CI 2.21-4.80), Black ethnicity (OR 3.05, 95% CI 1.95-4.77), Indian subcontinent ethnicity (OR 1.70, 95% CI 1.02-2.81), other non-White ethnicities (OR 2.03, 95% CI 1.38-2.97) and lower income quintiles (OR 1.82, 95% CI 1.15-2.89). INTERPRETATION Patients undergoing long-term dialysis are at increased risk of SARS-CoV-2 infection and death from coronavirus disease 2019. Special attention should be paid to addressing risk factors for infection, and these patients should be prioritized for vaccination.
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Affiliation(s)
- Leena Taji
- Ontario Renal Network (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Ontario Health; Department of Medicine (Oliver), University of Toronto, Toronto, Ont.; Schulich School of Medicine and Dentistry (House, Blake), Western University, London, Ont.; St. Michael's Hospital (McFarlane), Toronto, Ont
| | - Doneal Thomas
- Ontario Renal Network (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Ontario Health; Department of Medicine (Oliver), University of Toronto, Toronto, Ont.; Schulich School of Medicine and Dentistry (House, Blake), Western University, London, Ont.; St. Michael's Hospital (McFarlane), Toronto, Ont
| | - Matthew J Oliver
- Ontario Renal Network (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Ontario Health; Department of Medicine (Oliver), University of Toronto, Toronto, Ont.; Schulich School of Medicine and Dentistry (House, Blake), Western University, London, Ont.; St. Michael's Hospital (McFarlane), Toronto, Ont
| | - Jane Ip
- Ontario Renal Network (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Ontario Health; Department of Medicine (Oliver), University of Toronto, Toronto, Ont.; Schulich School of Medicine and Dentistry (House, Blake), Western University, London, Ont.; St. Michael's Hospital (McFarlane), Toronto, Ont
| | - Yiwen Tang
- Ontario Renal Network (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Ontario Health; Department of Medicine (Oliver), University of Toronto, Toronto, Ont.; Schulich School of Medicine and Dentistry (House, Blake), Western University, London, Ont.; St. Michael's Hospital (McFarlane), Toronto, Ont
| | - Angie Yeung
- Ontario Renal Network (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Ontario Health; Department of Medicine (Oliver), University of Toronto, Toronto, Ont.; Schulich School of Medicine and Dentistry (House, Blake), Western University, London, Ont.; St. Michael's Hospital (McFarlane), Toronto, Ont
| | - Rebecca Cooper
- Ontario Renal Network (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Ontario Health; Department of Medicine (Oliver), University of Toronto, Toronto, Ont.; Schulich School of Medicine and Dentistry (House, Blake), Western University, London, Ont.; St. Michael's Hospital (McFarlane), Toronto, Ont
| | - Andrew A House
- Ontario Renal Network (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Ontario Health; Department of Medicine (Oliver), University of Toronto, Toronto, Ont.; Schulich School of Medicine and Dentistry (House, Blake), Western University, London, Ont.; St. Michael's Hospital (McFarlane), Toronto, Ont
| | - Phil McFarlane
- Ontario Renal Network (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Ontario Health; Department of Medicine (Oliver), University of Toronto, Toronto, Ont.; Schulich School of Medicine and Dentistry (House, Blake), Western University, London, Ont.; St. Michael's Hospital (McFarlane), Toronto, Ont
| | - Peter G Blake
- Ontario Renal Network (Taji, Thomas, Oliver, Ip, Tang, Yeung, Cooper, McFarlane, Blake), Ontario Health; Department of Medicine (Oliver), University of Toronto, Toronto, Ont.; Schulich School of Medicine and Dentistry (House, Blake), Western University, London, Ont.; St. Michael's Hospital (McFarlane), Toronto, Ont.
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Vial R, Gully M, Bobot M, Scarfoglière V, Brunet P, Bouchouareb D, Duval A, Zino HO, Faraut J, Jehel O, Berdad-Haddad Y, Burtey S, Jarrot PA, Lano G, Robert T. Triage of Patients Suspected of COVID-19 in Chronic Hemodialysis: Eosinophil Count Differentiates Low and High Suspicion of COVID-19. J Clin Med 2020; 10:jcm10010004. [PMID: 33375040 PMCID: PMC7792772 DOI: 10.3390/jcm10010004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Daily management to shield chronic dialysis patients from SARS-CoV-2 contamination makes patient care cumbersome. There are no screening methods to date and a molecular biology platform is essential to perform RT-PCR for SARS-CoV-2; however, accessibility remains poor. Our goal was to assess whether the tools routinely used to monitor our hemodialysis patients could represent reliable and quickly accessible diagnostic indicators to improve the management of our hemodialysis patients in this pandemic environment. Methods: In this prospective observational diagnostic study, we recruited patients from La Conception hospital. Patients were eligible for inclusion if suspected of SARS-CoV-2 infection when arriving at our center for a dialysis session between March 12th and April 24th 2020. They were included if both RT-PCR result for SARS-CoV-2 and cell blood count on the day that infection was suspected were available. We calculated the area under the curve (AUC) of the receiver operating characteristic curve. Results: 37 patients were included in the final analysis, of which 16 (43.2%) were COVID-19 positive. For the day of suspected COVID-19, total leukocytes were significantly lower in the COVID-19 positive group (4.1 vs. 7.4 G/L, p = 0.0072) and were characterized by lower neutrophils (2.7 vs. 5.1 G/L, p = 0.021) and eosinophils (0.01 vs. 0.15 G/L, p = 0.0003). Eosinophil count below 0.045 G/L identified SARS-CoV-2 infection with AUC of 0.9 [95% CI 0.81—1] (p < 0.0001), sensitivity of 82%, specificity of 86%, a positive predictive value of 82%, a negative predictive value of 86% and a likelihood ratio of 6.04. Conclusions: Eosinophil count enables rapid routine screening of symptomatic chronic hemodialysis patients suspected of being COVID-19 within a range of low or high probability.
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Affiliation(s)
- Romain Vial
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France; (R.V.); (M.G.); (M.B.); (V.S.); (P.B.); (D.B.); (H.-o.Z.); (J.F.); (O.J.); (S.B.); (G.L.)
| | - Marion Gully
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France; (R.V.); (M.G.); (M.B.); (V.S.); (P.B.); (D.B.); (H.-o.Z.); (J.F.); (O.J.); (S.B.); (G.L.)
| | - Mickael Bobot
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France; (R.V.); (M.G.); (M.B.); (V.S.); (P.B.); (D.B.); (H.-o.Z.); (J.F.); (O.J.); (S.B.); (G.L.)
- C2VN, Aix-Marseille University, INSERM 1263, INRAe, 13005 Marseille, France;
| | - Violaine Scarfoglière
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France; (R.V.); (M.G.); (M.B.); (V.S.); (P.B.); (D.B.); (H.-o.Z.); (J.F.); (O.J.); (S.B.); (G.L.)
| | - Philippe Brunet
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France; (R.V.); (M.G.); (M.B.); (V.S.); (P.B.); (D.B.); (H.-o.Z.); (J.F.); (O.J.); (S.B.); (G.L.)
- C2VN, Aix-Marseille University, INSERM 1263, INRAe, 13005 Marseille, France;
| | - Dammar Bouchouareb
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France; (R.V.); (M.G.); (M.B.); (V.S.); (P.B.); (D.B.); (H.-o.Z.); (J.F.); (O.J.); (S.B.); (G.L.)
| | - Ariane Duval
- Association des Dialysés Provence et Corse, 13009 Marseille, France;
| | - He-oh Zino
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France; (R.V.); (M.G.); (M.B.); (V.S.); (P.B.); (D.B.); (H.-o.Z.); (J.F.); (O.J.); (S.B.); (G.L.)
| | - Julien Faraut
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France; (R.V.); (M.G.); (M.B.); (V.S.); (P.B.); (D.B.); (H.-o.Z.); (J.F.); (O.J.); (S.B.); (G.L.)
| | - Océane Jehel
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France; (R.V.); (M.G.); (M.B.); (V.S.); (P.B.); (D.B.); (H.-o.Z.); (J.F.); (O.J.); (S.B.); (G.L.)
| | - Yaël Berdad-Haddad
- Hematology Laboratory, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France;
| | - Stéphane Burtey
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France; (R.V.); (M.G.); (M.B.); (V.S.); (P.B.); (D.B.); (H.-o.Z.); (J.F.); (O.J.); (S.B.); (G.L.)
- C2VN, Aix-Marseille University, INSERM 1263, INRAe, 13005 Marseille, France;
| | - Pierre-André Jarrot
- C2VN, Aix-Marseille University, INSERM 1263, INRAe, 13005 Marseille, France;
- Department of Internal Medicine and Clinical Immunology, CHU de Marseille, Hôpital de la Conception, 13005 Marseille, France
| | - Guillaume Lano
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France; (R.V.); (M.G.); (M.B.); (V.S.); (P.B.); (D.B.); (H.-o.Z.); (J.F.); (O.J.); (S.B.); (G.L.)
- C2VN, Aix-Marseille University, INSERM 1263, INRAe, 13005 Marseille, France;
| | - Thomas Robert
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, 13005 Marseille, France; (R.V.); (M.G.); (M.B.); (V.S.); (P.B.); (D.B.); (H.-o.Z.); (J.F.); (O.J.); (S.B.); (G.L.)
- MMG, Bioinformatics & Genetics, Aix-Marseille Université, UMR_S910, 13004 Marseille, France
- Correspondence:
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39
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Ortiz A. Complement and protection from tissue injury in COVID-19. Clin Kidney J 2020; 13:734-738. [PMID: 33123353 PMCID: PMC7577760 DOI: 10.1093/ckj/sfaa196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
As the second wave of coronavirus disease 2019 (COVID-19) is well under way around the world, the optimal therapeutic approach that addresses virus replication and hyperinflammation leading to tissue injury remains elusive. This issue of Clinical Kidney Journal provides further evidence of complement activation involvement in COVID-19. Taking advantage of the unique repeat access to chronic haemodialysis patients, the differential time course of C3 and C5 activation in relation to inflammation and severity of disease have been characterized. This further points to complement as a therapeutic target. Indeed, clinical trials targeting diverse components of complement are ongoing. However, a unique case of COVID-19 in a patient with pre-existent atypical haemolytic syndrome on chronic eculizumab therapy suggests that even early eculizumab may fail to prevent disease progression to a severe stage. Finally, preclinical studies in endotoxaemia, another hyperinflammation syndrome characterized by lung and kidney injury, suggest that cilastatin, an inexpensive drug already in clinical use, may provide tissue protection against hyperinflammation in COVID-19.
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Affiliation(s)
- Alberto Ortiz
- IIS-Fundación Jiménez Diaz, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,Red de Investigación Renal, Instituto Carlos III-FEDER, Madrid, Spain
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