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Challenges in the Management of Renal Patients in the COVID-19 Era

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (20 December 2022) | Viewed by 26430

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Special Issue Editor

Dr. Guillermo Hidalgo

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Department of Pediatrics, K. Hovnanian Children’s Hospital. Hackensack Meridian Health School of Medicine, Neptune, NJ 07753, USA
Interests: COVID-19; renal transplantation; glomerular diseases; immunosuppression; tubulo interstitial diseases; nephritic syndrome; nephrotic syndrome; acute kidney injury; chronic kidney disease; end-stage renal disease; dialysis

Special Issue Information

Dear Colleagues,

The recognition of the devastating impact of the SARS-CoV-2 virus (cause of the disease COVID-19) changed our world entirely from around the end of November 2019.

Since the start of the COVID-19 pandemic, despite the creation of new worldwide challenges, our scientific community has contributed remarkable advancements in the field of Nephrology. There have been abundant and fast-paced scientific publications on how the virus affects all types of chronic renal patient. Similarly, a significant number of renal effects have been found among non-renal patients who were infected by the virus or had renal complications subsequent to COVID-19 vaccinations. Recent reports now show that renal patients with glomerular diseases may have disease relapses after COVID-19 vaccinations. This new research focus and resulting publications will continue to take multiple different turns as new therapies and basic research comes to fruition. It is within this context that this Special Issue of the journal aims to host topics related to renal diseases and COVID-19. We invite your contributions to help our scientific community clarify many of the outstanding gaps in the knowledge, as well as any new gaps that we may find scientifically relevant as we move forward. Some of these may include the following questions:

Is it safe and effective to use COVID vaccines in post-renal transplant patients?

Which is the best management for renal complications post-COVID vaccination in both non-renal and renal patients?

What is the best management of renal complications after COVID-19 infections in immunocompetent patients?

What are the factors that lead to relapses of glomerular diseases after exposure to COVID-19 vaccinations?

What are the renal effects, adjustments and precautions of new oral drugs (Molnupavir, Paxlovid, Remdesivir, others) for COVID-19?

What are the long-term renal consequences of post-COVID-19 infection in adults and children?

Best strategies to identify SARS-CoV-2 from renal biopsies.

Best practices in COVID-19-related Acute Kidney Injury.

SARS-CoV-2 effects on Angiotensin II, ACE2 receptor, endothelial damage, platelets, complement activation and hypercoagulability among renal disease patients.

The impact of COVID 19 pandemic on health care disparities in kidney care.

Dr. Guillermo Hidalgo
Guest Editor

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Keywords

acute kidney injury
chronic kidney disease
tubuloInterstitial nephritis
glomerulonephritis
COVID-19
SARS-CoV-2
angiotensin II
ACE2 receptor
hypercoagulability
complement activation
platelet aggregation
endothelial damage
vaccine
monoclonal antibodies
protease inhibitors
renal transplant
multisystem inflammatory syndrome (MIS-C)
remdesivir
paxlovid
molnupavir
regeneron

Published Papers (12 papers)

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Research

9 pages, 379 KiB

Open AccessArticle

How COVID-19 Outbreak Influenced Transplantation in Poland

by Jacek Zawierucha, Tomasz Prystacki, Wojciech Marcinkowski, Jacek Stanisław Małyszko, Sławomir Nazarewski and Jolanta Małyszko

J. Clin. Med. 2023, 12(2), 461; https://doi.org/10.3390/jcm12020461 - 6 Jan 2023

Viewed by 1095

Abstract

Announced by the World Health Organization in early 2020, the pandemic caused by SARS-CoV-2 infections has had a huge impact on healthcare systems around the world. Local and international authorities focused on implementing procedures to safeguard the health of the population. All regular daily activities were disrupted. Similar factors related to the global fight against the COVID-19 epidemic also had a large impact on transplantation activity. In this article, the authors present the number of patients qualified for transplantation, transplanted and waiting on the waiting list in Poland during the 2-year period of the pandemic. In the first year of the epidemic (2020), all transplantation figures dropped drastically, by as much as 20–30% compared with 2019. The most disturbing fact is that the number of transplants performed in 2022 is still lower than before the outbreak of the epidemic (2019 and earlier). Full article

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

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14 pages, 284 KiB

Open AccessArticle

Molnupiravir Outpatient Treatment for Adults with COVID-19 in a Real-World Setting—A Single Center Experience

by Kinga Czarnecka, Paulina Czarnecka, Olga Tronina and Magdalena Durlik

J. Clin. Med. 2022, 11(21), 6464; https://doi.org/10.3390/jcm11216464 - 31 Oct 2022

Cited by 7 | Viewed by 1430

Abstract

Background: Molnupiravir is approved for the treatment of adult patients with mild to moderate COVID-19. The main goal of the treatment is to reduce hospitalization and mortality rate. This study aimed at the all-cause hospitalization and all-cause death assessment in patients at high risk of severe COVID-19 treated with molnupiravir. Methods: This was a prospective, observational single center study. Non-hospitalized patients with SARS-CoV-2 infection, COVID-19 symptoms with the onset of up to 5 days, and at high risk of severe COVID-19 illness received molnupiravir based on attending physician decisions. Results: In total, 107 patients were enrolled. Adverse events were reported in 28.0% of patients, with nausea and abdominal pain being the most commonly observed. No treatment-emergent AEs resulted in therapy discontinuation. Overall, 15 patients required hospitalization. During the observation, 2.8% (n = 3) of patients subsequently died. All deaths were considered to be related to COVID-19 complications. Age over 65 years, heart failure, and ischemic heart disease showed a significant correlation with the severe course of COVID-19. Conclusion: Molnupiravir may be perceived as an alternative treatment for patients with immunosuppression and advanced chronic kidney disease. Nevertheless, further studies are required to conclusively establish a role for molnupiravir in future COVID-19 treatment recommendations. Full article

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

8 pages, 532 KiB

Open AccessArticle

Humoral Immune Response to a Timely Booster mRNA Vaccination in Non-Responders to a Standard Vaccination Schedule against COVID-19 in Kidney Transplant Recipients

by Julia Stigler, Lukas Buchwinkler, Claire Anne Solagna, Michael Rudnicki, Markus Pirklbauer, Gert Mayer and Julia Kerschbaum

J. Clin. Med. 2022, 11(21), 6439; https://doi.org/10.3390/jcm11216439 - 30 Oct 2022

Cited by 1 | Viewed by 1101

Abstract

Kidney transplant recipients who are at increased risk for COVID-19 infection and associated morbidity and mortality have been shown to be prone to an impaired humoral immune response to a standard vaccination schedule against COVID-19 with two doses of SARS-CoV-2 mRNA vaccines. In this study, response rate of 94 kidney transplant recipients without detectable seroconversion after two doses of a mRNA vaccine who were offered a timely third mRNA vaccine after completion of the standard vaccination schedule was retrospectively analyzed. After a median of 28 days, antibody titers against the S1 spike protein showed a non-response rate of 53%. No significant risk factors for non-response could be identified. The responders showed a high variation in antibody titers (median 73.9 BAU/mL, IQR 221.5). In conclusion, a third booster mRNA vaccine in non-responding kidney transplant recipients leads to a detectable humoral immune response in approximately half of the patients. In the seroconversion group, antibody titers were highly variable, indicating that even non-responders to the standard vaccination schedule might develop a significant humoral immune response after a timely booster vaccine. Full article

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

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15 pages, 1166 KiB

Open AccessArticle

Association between Renal Function at Admission and COVID-19 in-Hospital Mortality in Southern Italy: Findings from the Prospective Multicenter Italian COVOCA Study

by Raffaele Galiero, Vittorio Simeon, Giuseppe Loffredo, Alfredo Caturano, Luca Rinaldi, Erica Vetrano, Giulia Medicamento, Maria Alfano, Domenico Beccia, Chiara Brin, Sara Colantuoni, Jessica Di Salvo, Raffaella Epifani, Riccardo Nevola, Raffaele Marfella, Celestino Sardu, Carmine Coppola, Ferdinando Scarano, Paolo Maggi, Cecilia Calabrese, Pellegrino De Lucia Sposito, Carolina Rescigno, Costanza Sbreglia, Fiorentino Fraganza, Roberto Parrella, Annamaria Romano, Giosuele Calabria, Benedetto Polverino, Antonio Pagano, Fabio Giuliano Numis, Carolina Bologna, Mariagrazia Nunziata, Vincenzo Esposito, Nicola Coppola, Nicola Maturo, Rodolfo Nasti, Pierpaolo Di Micco, Alessandro Perrella, Miriam Lettieri, Luigi Elio Adinolfi, Paolo Chiodini, Ferdinando Carlo Sasso and on behalf of COVOCA Study Group Show full author list Hide full author list

J. Clin. Med. 2022, 11(20), 6121; https://doi.org/10.3390/jcm11206121 - 17 Oct 2022

Cited by 7 | Viewed by 1899

Abstract

Background. Evidence has shown a close association between COVID-19 infection and renal complications in both individuals with previously normal renal function and those with chronic kidney disease (CKD). Methods. The aim of this study is to evaluate the in-hospital mortality of SARS-CoV-2 patients according to their clinical history of CKD or estimated glomerular filtration rate (eGFR). This is a prospective multicenter observational cohort study which involved adult patients (≥18 years old) who tested positive with SARS-CoV-2 infection and completed their hospitalization in the period between November 2020 and June 2021. Results. 1246 patients were included in the study, with a mean age of 64 years (SD 14.6) and a median duration of hospitalization of 15 days (IQR 9–22 days). Cox’s multivariable regression model revealed that mortality risk was strongly associated with the stage of renal impairment and the Kaplan–Meier survival analysis showed a progressive and statistically significant difference (p < 0.0001) in mortality according to the stage of CKD. Conclusion. This study further validates the association between CKD stage at admission and mortality in patients hospitalized for COVID-19. The risk stratification based on eGFR allows clinicians to identify the subjects with the highest risk of intra-hospital mortality despite the duration of hospitalization. Full article

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

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12 pages, 1111 KiB

Open AccessArticle

Factors Influencing Longevity of Humoral Response to SARS-CoV-2 Vaccination in Patients with End Stage Kidney Disease Receiving Renal Replacement Therapy

by Irena Glowinska, Barbara Labij-Reduta, Jerzy Juzwiuk, Magdalena Lukaszewicz, Adam Pietruczuk, Agata Poplawska, Anna Daniluk-Jamro, Katarzyna Kakareko, Alicja Rydzewska-Rosolowska, Beata Naumnik, Ewa Koc-Zorawska, Marcin Zorawski and Tomasz Hryszko

J. Clin. Med. 2022, 11(17), 4984; https://doi.org/10.3390/jcm11174984 - 25 Aug 2022

Cited by 7 | Viewed by 1302

Abstract

COVID-19 has severely affected the population of patients with end stage renal disease. Current data have proved a two-dose vaccination schedule against SARS-CoV-2 to be effective among dialyzed patients. There are limited data on the longevity and modulating factors of humoral response after vaccination. We performed a prospective longitudinal cohort study to determine longevity of the humoral response after SARS-CoV-2 vaccine. The study included 191 adult patients on hemodialysis and peritoneal dialysis. All participants had been vaccinated with three doses, either with BNT162b2 (Pfizer-BioNTech) (n = 109) or mRNA-1273 (Moderna) (n = 82). Anti-spike protein receptor-binding domain antibodies (anti-S IgG) were assessed using SARS-CoV-2 (RBD) IgG ELISA EIA-6150 IVD assay at baseline, on the 21st day and 43rd day, before a booster dose and two weeks thereafter. We found that before vaccination, 37.7% of the cohort had anti-S IgG titres concordant with seroconversion. After two-dose vaccination, seroconversion occurred in 97% of patients. The booster dose evoked a ~12-fold increase in antibody level. Obesity increased more than two-fold the odds for a decrease in anti-S IgG. Previous COVID-19 infection enhanced longevity of the humoral response following vaccination. In patients with previous COVID-19 infection, the BNT162b2 vaccine was associated with a higher odds of anti-S IgG waning compared to the mRNA-1273 vaccine. In conclusion, we report that obesity predisposes patients to protective antibody waning, hybrid immunity enhances odds for higher anti-S IgG concentrations and vaccine efficacy may be influenced by previous SARS-CoV-2 infection. The results might provide a rationale for vaccination protocol design. Full article

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

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13 pages, 863 KiB

Open AccessArticle

The Higher the CKD Stage, the Higher the Psychological Stress in Patients with CKD during COVID-19 Pandemic

by Kyung-Mi Lee, Ji-Sun Kim, Sungjo Hwang, Nam Jun Cho, Samel Park, Hyo Wook Gil and Eun Young Lee

J. Clin. Med. 2022, 11(16), 4776; https://doi.org/10.3390/jcm11164776 - 16 Aug 2022

Cited by 4 | Viewed by 1381

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is related to psychological distress. Such distress depends on various factors. We previously reported that hemodialysis patients have more psychological distress than peritoneal dialysis patients among patients on dialysis in the COVID-19 pandemic era. However, no study has reported how psychological distress related to the COVID-19 pandemic depends on renal function in the entire group of chronic kidney disease (CKD) patients. Therefore, the objective of this study was to investigate psychological distress and concerns related to COVID-19 according to CKD stage. This was a cross-sectional study that included 397 CKD patients who visited a hospital from August 2020 to November 2020. Patients responded to questionnaires covering depression (9-item Patient Health Questionnaire, PHQ-9), anxiety (7-item Generalized Anxiety Disorder, GAD-7), psychological impact of event (22-item Impact of Event Scale-Revised, IES-R), insomnia (7-item Insomnia severity Index, ISI), concerns, and precautionary measures about COVID-19. According to eGFR and dialysis status, patients were divided into three groups: (1) patients with CKD stage 1~2, (2) patients with CKD stage 3~5 without dialysis, and (3) dialysis patients. The higher the CKD stage, the higher the GAD-7 (p = 0.009) and the ISI score (p = 0.001). When patients with CKD stage 1~2 and CKD stage 3~5 (with or without dialysis) were compared, PHQ-9 (p = 0.026), GAD-7 (p = 0.010), and ISI score (p = 0.002) were higher in the CKD stage 3~5 group. However, when comparing those with and without dialysis, only the ISI score (p = 0.008) showed a significant difference. More severe kidney dysfunction in CKD patients was associated with more psychological distress during the COVID-19 pandemic. Therefore, as CKD stage increases, more attention should be paid to the mental care of these patients. Full article

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

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8 pages, 471 KiB

Open AccessArticle

Renal Tubular Acidosis in Pregnant Critically Ill COVID-19 Patients: A Secondary Analysis of a Prospective Cohort

by Simona Humbel, Pedro David Wendel-Garcia, Simone Unseld, Fabienne Noll, Reto Andreas Schuepbach, Christoph Camille Ganter, Harald Seeger, Sascha David and Rea Andermatt

J. Clin. Med. 2022, 11(15), 4273; https://doi.org/10.3390/jcm11154273 - 22 Jul 2022

Viewed by 1292

Abstract

Background: Renal tubular acidosis (RTA) is an extremely rare cause of metabolic acidosis (10 in 100,000). RTA has been linked neither to pregnancy nor to severe coronavirus disease 2019 (COVID-19). The purpose of this study was to analyze the prevalence and clinical course of normal anion gap metabolic acidosis in critically ill pregnant COVID-19 patients and to compare them to an age-matched nonpregnant female patient cohort. Methods: Secondary analysis was conducted on a prospective observational cohort of critically ill patients suffering from COVID-19 consecutively admitted to a tertiary intensive care unit (ICU) between February 2020 and April 2021. Results: A total of 321 COVID-19 patients required admission to the ICU; 95 (30%) were female, and 18 (19%) were of childbearing age. Seven of eight (88%) pregnant women (all in the last trimester) required advanced respiratory support due to COVID-19. The estimated glomerular filtration rate was 135 (123–158) mL/min/m² body surface area, and six pregnant women (86%) were diagnosed with a normal, respiratory compensated, anion gap metabolic acidosis (pH_min 7.3 (7.18–7.31), HCO₃⁻_min 14.8 (12.8–18.6) mmol/L, and paCO₂ 3.4 (3.3–4.5) kPa). Three (43%) acidotic pregnant women fulfilled diagnostic criteria for RTA. All women recovered spontaneously within less 7 days. Conclusions: Metabolic acidosis seems to be very common (85%) in pregnant critically ill COVID-19 patients, and the prevalence of RTA might be higher than normal. It remains to be demonstrated if this observation is an indirect epiphenomenon or due to a direct viral effect on the tubular epithelium. Full article

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

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10 pages, 931 KiB

Open AccessArticle

Changes of Acute Kidney Injury Epidemiology during the COVID-19 Pandemic: A Retrospective Cohort Study

by Pasquale Esposito, Elisa Russo, Daniela Picciotto, Francesca Cappadona, Yuri Battaglia, Giovanni Battista Traverso and Francesca Viazzi

J. Clin. Med. 2022, 11(12), 3349; https://doi.org/10.3390/jcm11123349 - 10 Jun 2022

Cited by 9 | Viewed by 1558

Abstract

To evaluate the impact of the Coronavirus Disease-19 (COVID-19) pandemic on the epidemiology of acute kidney injury (AKI) in hospitalized patients, we performed a retrospective cohort study comparing data of patients hospitalized from January 2016 to December 2019 (pre-COVID-19 period) and from January to December 2020 (COVID-19 period, including both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative and positive patients). AKI was classified by evaluating the kinetics of creatinine levels. A total of 51,681 patients during the pre-COVID-19 period and 10,062 during the COVID-19 period (9026 SARS-CoV-2-negative and 1036 SARS-CoV-2-positive) were analyzed. Patients admitted in the COVID-19 period were significantly older, with a higher prevalence of males. In-hospital AKI incidence was 31.7% during the COVID-19 period (30.5% in SARS-CoV-2-negative patients and 42.2% in SARS-CoV-2-positive ones) as compared to 25.9% during the pre-COVID-19 period (p < 0.0001). In the multivariate analysis, AKI development was independently associated with both SARS-CoV-2 infection and admission period. Moreover, evaluating the pre-admission estimated glomerular filtration rate (eGFR) we found that during the COVID-19 period, there was an increase in AKI stage 2–3 incidence both in patients with pre-admission eGFR < 60 mL/min/1.73 m² and in those with eGFR ≥ 60 mL/min/1.73 m² (“de novo” AKI). Similarly, clinical outcomes evaluated as intensive care unit admission, length of hospital stay, and mortality were significantly worse in patients admitted in the COVID-19 period. Additionally, in this case, the mortality was independently correlated with the admission during the COVID-19 period and SARS-CoV-2 infection. In conclusion, we found that during the COVID-19 pandemic, in-hospital AKI epidemiology has changed, not only for patients affected by COVID-19. These modifications underline the necessity to rethink AKI management during health emergencies. Full article

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

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16 pages, 1205 KiB

Open AccessArticle

Time-Limited Therapy with Belatacept in Kidney Transplant Recipients

by Thibault Letellier, Delphine Kervella, Abderrahmane Sadek, Christophe Masset, Claire Garandeau, Cynthia Fourgeux, Victor Gourain, Jeremie Poschmann, Gilles Blancho, Simon Ville and on behalf of the Divat Consortium

J. Clin. Med. 2022, 11(11), 3229; https://doi.org/10.3390/jcm11113229 - 6 Jun 2022

Viewed by 1683

Abstract

Introduction: In kidney transplant recipients, belatacept is usually pursued indefinitely after it has been started. In the setting of the belatacept shortage and after having evaluated the benefit–risk ratio, we established a strategy consisting of time-limited belatacept therapy/transient calcineurin inhibitor withdrawal, whose results are analyzed in that study. Methods: We considered all the kidney transplant recipients that had been switched from conventional immunosuppressive therapy to belatacept and then for whom belatacept has been withdrawn intentionally. Furthermore, in the first 8 patients, we assessed changes in peripheral blood mononuclear cells (PBMC) transcriptome using RNAseq before and 3 months after belatacept withdrawal. Results: Over the study period, 28 out of 94 patients had belatacept intentionally withdrawn including 25 (89%) switched to low-dose CNI. One rejection due to poor compliance occurred. The eGFR after 12 months remained stable from 48 ± 19 mL.1.73 m⁻² to 46 ± 17 mL.1.73 m⁻² (p = 0.68). However, patients that resumed belatacept/withdrew CNIs (n = 10) had a trend towards a better eGFR comparing with the others (n = 15): 54 ± 20 mL.1.73 m⁻² vs. eGFR 43 ± 16 mL.1.73 m⁻², respectively (p = 0.15). The only factor associated with belatacept resumption was when the withdrawal took place during the COVID-19 outbreak. Transcriptome analysis of PBMCs, did not support rebound in alloimmune response. Conclusions: These findings underpin the use of belatacept as part of a time-limited therapy, in selected kidney transplant recipients, possibly as an approach to allow efficient vaccination against SARS-CoV-2. Full article

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

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10 pages, 264 KiB

Open AccessArticle

Does COVID-19 Vaccination Cause Storage Lower Urinary Tract Symptoms?

by Yu-Chen Chen, Yin-Chi Liang, Shuo-Jung Ho, Hao-Wei Chen, Yung-Shun Juan, Wei-Chung Tsai, Shu-Pin Huang, Jung-Ting Lee, Yu-Peng Liu, Chung-Yao Kao, Yen-Ko Lin, Cheng-Yu Long, Meng-Ni Wu, Chao-Ju Chen and Wen-Jeng Wu

J. Clin. Med. 2022, 11(10), 2736; https://doi.org/10.3390/jcm11102736 - 12 May 2022

Cited by 3 | Viewed by 9272

Abstract

We investigated the storage lower urinary tract symptoms (LUTS) before and after the first dose of coronavirus disease 2019 (COVID-19) vaccine and the association between pre-vaccinated overactive bladder (OAB) and the worsening of storage LUTS following COVID-19 vaccination. This cross-sectional study in a third-level hospital in Taiwan used the validated pre- and post-vaccinated Overactive Bladder Symptom Score (OABSS). Diagnosis of OAB was made using pre-vaccinated OABSS. The deterioration of storage LUTS was assessed as the increased score of OABSS following vaccination. Of 889 subjects, up to 13.4% experienced worsened storage LUTS after vaccination. OAB was significantly associated with an increased risk of worsening urinary urgency (p = 0.030), frequency (p = 0.027), and seeking medical assistance due to urinary adverse events (p < 0.001) after vaccination. The OAB group faced significantly greater changes in OABSS-urgency (p = 0.003), OABSS-frequency (p = 0.025), and total OABSS (p = 0.014) after vaccination compared to those observed in the non-OAB group. Multivariate regression revealed that pre-vaccinated OAB (p = 0.003) was a risk for the deterioration of storage LUTS. In conclusion, storage LUTS may deteriorate after vaccination. OAB was significantly associated with higher risk and greater changes in worsening storage LUTS. Storage LUTS should be closely monitored after COVID-19 vaccination, especially in those OAB patients. Full article

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

9 pages, 508 KiB

Open AccessArticle

Negative Impact of the COVID-19 Pandemic on Kidney Disease Management—A Single-Center Experience in Romania

by Adrian Vasile Mureșan, Eliza Russu, Emil Marian Arbănași, Réka Kaller, Ioan Hosu, Eliza Mihaela Arbănași and Septimiu Toader Voidăzan

J. Clin. Med. 2022, 11(9), 2452; https://doi.org/10.3390/jcm11092452 - 27 Apr 2022

Cited by 14 | Viewed by 1769

Abstract

Background: The evolution of the COVID-19 pandemic affected healthcare systems worldwide. The patients with chronic kidney disease (CKD), diabetes, and cardiovascular disease were most affected and had an unfavorable outcome. Methods: We examined the activity of the Nephrology Department from Târgu-Mureș County Emergency Hospital retrospectively, comparing two periods: June 2020–November 2021 (COVID-19 period) and June 2018–November 2019 (non-COVID-19 period). Results: In the COVID-19 period, there were fewer one-day hospitalizations registered, 77.27% more dialysis catheters were installed, and 43.75% more arteriovenous fistulas were performed. An overall increase in the number of patients requiring dialysis during the pandemic was recorded, as of the number of dialysis sessions performed. Moreover, we observed a statistically significant increase in the number of dialysis sessions per patient and a statistically significant increase in the number of hospitalization days in the pandemic interval. Acute kidney injury (AKI) and urosepsis were the diagnoses that increased the most among in-patients during the pandemic, while all other nephrology diagnoses decreased. Conclusions: The COVID-19 pandemic accelerated kidney pathology and worsened the outcomes of nephrology patients in our center. The number of chronic and patient’s access to one-day hospitalization decreased in order to minimalize the exposure and the risk of infection. In contrast, the need for emergency dialysis increased significantly. Full article

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

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13 pages, 522 KiB

Open AccessArticle

Acute Kidney Injury in Critically-Ill COVID-19 Patients

by Romain Arrestier, Ségolène Gendreau, David Mokrani, Jean-Philippe Bastard, Soraya Fellahi, François Bagate, Paul Masi, Thomas d’Humières, Keyvan Razazi, Guillaume Carteaux, Nicolas De Prost, Vincent Audard and Armand Mekontso-Dessap

J. Clin. Med. 2022, 11(7), 2029; https://doi.org/10.3390/jcm11072029 - 5 Apr 2022

Cited by 7 | Viewed by 1918

Abstract

Purpose: Acute kidney injury (AKI) is common in patients with COVID-19, however, its mechanism is still controversial, particularly in ICU settings. Urinary proteinuria profile could be a non-invasive tool of interest to scrutinize the pathophysiological process underlying AKI in COVID-19 patients. Material and Methods: We conducted a retrospective study between March 2020 and April 2020. All patients with laboratory-confirmed COVID-19 and without end-stage kidney disease requiring renal replacement therapy before ICU admission were included. Our objectives were to assess the incidence and risk factors for AKI and to describe its clinical and biological characteristics, particularly its urinary protein profile. Results: Seventy patients were included; 87% needed mechanical ventilation and 61% needed vasopressor during their ICU stay; 64.3% of patients developed AKI and half of them needed dialysis. Total and tubular proteinuria on day 1 were higher in patients with AKI, whereas glomerular proteinuria was similar in both groups. The main risk factor for AKI was shock at admission (OR = 5.47 (1.74–17.2), p < 0.01). Mortality on day 28 was higher in AKI (23/45, 51.1%) than in no-AKI patients (1/25, 4%), p < 0.001. Risk factors for 28-days mortality were AKI with need for renal replacement therapy, non-renal SOFA score and history of congestive heart failure. Conclusions: AKI is common in COVID-19 patients hospitalized in ICU; it seems to be related to tubular lesions rather than glomerular injury and is related to shock at ICU admission. Full article

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

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