The aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed.
Rationale & Objective. Chronic kidney disease (CKD) characterized by decreased glomerular filtration rate (GFR) is often accompanied by various degrees of impaired tubular function in the cortex and medulla. Assessment of tubular function may, therefore, be useful in establishing the severity of kidney disease and in identifying those at greater risk of CKD progression. We explored reductions in urinary concentrating ability, a well-known feature of CKD, as a risk factor for GFR decline and end-stage kidney disease (ESRD).
StudyDesign. Prospective longitudinal cohort study. Setting and participants. 2,084 adult patients with CKD stages 1 to 4 from the French NephroTest Cohort Study. Predictor. Fasting urinary osmolality (Uosm) measured by delta cryoscopy. Outcomes. End-stage renal disease (ESRD), mortality prior to ESRD, and measured GFR (mGFR) assessed by 51 Cr-EDTA renal clearance. Analytical Approach. Cause-specific hazards models were fit to estimate crude and adjusted associations of urinary osmolality with ESRD and death prior to ESRD. Linear mixed models with random intercepts were fit to evaluate the association of urinary osmolality with slope of decline in mGFR. Results. At baseline, mean age was 58.7±15.2 (SD) years with a median mGFR of 40.2 [IQR, 29.1-54.5] ml/min and a median fasting Uosm of 502.7 ± 151.7 mOsm/kg H2O. Baseline fasting Uosm was strongly associated with mGFR (R=0.54, p<0.001). 380 ESRD events and 225 deaths prior to ESRD occurred during a median follow-up of 5.9 years [3.8-8.2]. Patients with lower baseline fasting Uosm had a higher adjusted risk of 4ESRD but not of mortality (HRs of 1.9 [95% CI, 1.2-3.0] and 0.99 [95% CI, 0.68-1.44], respectively, for the lowest versus highest tertile). Based on a mixed linear model, adjusted for baseline mGFR and clinical characteristics, patients in the lowest tertile of baseline Uosm had a steeper decline in kidney function (-4.9% ± 0.9% per year, p<0.001) compared to patients in the highest tertile.Limitations. Fasting was self-reported.Conclusions. Fasting Uosm may be a useful tool, in addition to GFR and albuminuria, for assessing non-glomerular damage in patients with CKD who are at higher risk of CKD progression.
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