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Ashrafi S, Pourahmad Kisomi P, Maroufizadeh S, Jabbari MR, Nafar M, Samavat S, Parvin M, Dalili N. The relationship between CT value and clinical outcomes in renal patients with COVID-19. Int Urol Nephrol 2023; 55:697-709. [PMID: 36121573 PMCID: PMC9483908 DOI: 10.1007/s11255-022-03318-x] [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: 02/11/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Concomitant kidney diseases raise the mortality rate due to the SARS-CoV-2 virus as an independent factor. Although a qualitative PCR test's result is sufficient for diagnosis, Cycle threshold value may present relevant information to the physicians in providing faster treatment in patients with chronic conditions, including kidney diseases, to prevent morbidity and subsequent mortality. Thus, the present study was conducted to determine the relationship between the Cycle threshold value and clinical outcomes in renal patients with the coronavirus 2019. METHODS This retrospective study was conducted on renal patients with the coronavirus 2019 infection admitted to Labbafinejad Hospital in Tehran, the capital of Iran, within a period of one year, from late February 2020 to February 2021. Data were collected per the prepared checklist. Cycle threshold values were measured by performing PCR on nasopharynx and oropharynx swab samples of patients. RESULTS According to the adjusted analysis, having high viral load increased the odds of in-hospital mortality (aOR = 11.65, 95% CI 3.93-34.54), ICU admission (aOR = 5.49, 95% CI 2.16-13.97), and invasive ventilation (aOR = 7.18, 95% CI 2.61-19.74). Having high viral load also increased the odds of O2 therapy (aOR = 3.08, 95% CI 0.79-12.01), although the difference was not statistically significant (P = 0.105). CONCLUSION Cycle threshold value was a significant predictor of mortality in renal patients. Nevertheless, further studies are required on how to render optimal use of the Cycle threshold value, given that the quality of the test sample and the different groups of patients under study affect the effectiveness of this marker in predicting disease severity.
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Affiliation(s)
- Sadra Ashrafi
- Chronic Kidney Disease Research Center, Department of Nephrology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pouya Pourahmad Kisomi
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saman Maroufizadeh
- Department of Biostatistics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Reza Jabbari
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohsen Nafar
- MD, Prof. of Nephrology, Division of Nephrology, Department of Internal Medicine, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,Chronic Kidney Disease Research Center (CKDRC), Department of Nephrology, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shiva Samavat
- Chronic Kidney Disease Research Center (CKDRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Mahmoud Parvin
- Department of Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nooshin Dalili
- Chronic Kidney Disease Research Center, Department of Nephrology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Department of Internal Medicine, Shahid Labbafinejad Medical Center, Department of Nephrology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Boustan 9, Pasdaran Ave, Tehran, Iran.
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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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Fernández-Ruiz M. COVID-19 en receptores de trasplante renal: ¿qué hemos aprendido tras 18 meses de pandemia? ENFERMERÍA NEFROLÓGICA 2021; 24:219-231. [DOI: 10.37551/s2254-28842021020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
La infección por el SARS-CoV-2 (COVID-19) ha supuesto un importante impacto en la actividad trasplantadora en nuestro país. En su condición de paciente inmunodeprimido y con frecuentes comorbilidades, era esperable que la mortalidad y el riesgo de complicaciones asociadas a la COVID-19 en el receptor de trasplante renal (TR) fueran mayores en comparación con la población general, si bien la información al respecto en los primeros meses de la pandemia era muy limitada. Desde marzo de 2020 hemos mejorado rápidamente nuestro conocimiento acerca de la epidemiología, características clínicas y manejo de la COVID-19 post-trasplante. La presente revisión pretende recopilar la información disponible a julio de 2021 en respuesta a una serie de cuestiones relevantes: ¿cómo se manifiesta clínicamente la infección por SARS-CoV-2 en receptores de TR?, ¿cuáles son sus factores pronósticos?, ¿es más grave la COVID-19 en el contexto del TR respecto a los pacientes inmunocompetentes?, ¿de qué opciones de tratamiento antiviral disponemos actualmente para el receptor de TR?, ¿cuál es la experiencia disponible con los tratamientos inmunomoduladores? y, por último, ¿son eficaces las vacunas frente a la COVID-19 basadas en ARN mensajero en esta población?. A pesar de los avances realizados aún son varios los aspectos que debemos mejorar en nuestro abordaje de la infección por SARS-CoV-2 en el ámbito específico del TR.
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Affiliation(s)
- Mario Fernández-Ruiz
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12). Madrid, Departamento de Medicina. Facultad de Medicina. Universidad Complutense. Madrid
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