Background COVID-19 has exposed hemodialysis patients and kidney transplant recipients to an unprecedented life-threatening infectious disease raising concerns about kidney replacement therapy (KRT) strategy during the pandemic. The present study investigated the association of type of KRT with COVID-19 severity adjusting for differences in individual characteristics. Methods Data on kidney transplant recipients and hemodialysis patients diagnosed with COVID-19 between February 1st and December 1st 2020 were retrieved from ERACODA. Cox regression models adjusted for age, sex, frailty and comorbidities were used to estimate hazard ratios (HR) for 28-day mortality risk in all patients and in the subsets who were tested because of symptoms Results In total, 1,670 patients (496 functional kidney transplant and 1,174 hemodialysis) were included. 16.9% of kidney transplant and 23.9% of hemodialysis patients died within 28 days of presentation. The unadjusted 28-day mortality risk was 33% lower in kidney transplant recipients compared with hemodialysis patients (HR: 0.67, 95%CI: 0.52-0.85). In a fully adjusted model, the risk was 78% higher in kidney transplant recipients (HR: 1.78, 95%CI: 1.22-2.61) compared with hemodialysis patients. This association was similar in patients tested because of symptoms (fully adjusted model HR: 2.00, 95%CI: 1.31-3.06). This risk was dramatically increased during the first post-transplant year. Results were similar for other endpoints (e.g. hospitalization, ICU admission, mortality beyond 28 days) and across subgroups. Conclusions Kidney transplant recipients had a greater risk of a more severe course of COVID-19 compared with hemodialysis patients; they therefore require specific infection mitigation strategies.
Background Modifications in social habits together with the increase of emigration have contributed not only to increased dermatophytoses but also to an altered etiology. During the last few years, Braga has suffered a radical change from a rural to a cosmopolitan life-style.Methods A statistical study of dermatophytoses and the etiology of their causative agents was performed by a retrospective survey carried out among patients of Hospital de São Marcos, Braga, Portugal, from 1983-2002. In this study, a total of 10 003 patients were analyzed.Results Over this period the frequency of dermatophytoses, as defined by the recovery of a dermatophyte in culture, was found to be 23.6%, whereas nondermatophytic infections accounted for 7.0%. Analysis of the clinical forms and the isolated fungi supports that the dermatophyte species have a predilection for certain body areas ( P ≤ 0.01). Age is a very important factor regarding the occurrence of dermatophytoses ( P ≤ 0.0001), with a correlation between increasing age and infection, positive for Trichophyton rubrum and negative for Microsporum canis . Overall the gender of the patients is not an association factor for the development of dermatophytoses; however, significant differences were detected in the distribution of some etiologic agents ( P ≤ 0.05). ConclusionsThe results showed the main etiologic agent of dermatophytoses to be Trichophyton rubrum (37.4%). Moreover, dermatophytoses are both decreasing and showing a new profile in Braga, and a pronounced decrease of Trichophyton megninii was observed throughout the study.
Hyperuricemia is commonly found in the general population, with a prevalence of about 20 to 25% in adult men and slightly lower prevalence in pre-menopausal women. In both genders, incidence increases with age 1. The prevalence of chronic kidney disease (CKD) has been increasing in the past few years, with its morbidity and mortality not only related to the end-stage renal disease (ESRD), but also with cardiovascular disease. As such, every effort must be made to slow its progression. Emerging evidence suggests that the relationship between hyperuricemia and CKD is more than just a marker of renal dysfunction, playing a much more important role in its pathogenesis and progression, and cardiovascular morbidity-mortality as well. If that association proves to be true, the next question would be when to treat hyperuricemia, and which drugs should be used. Allopurinol has been used for a long time, but febuxostat has been showing growing evidence not only regarding the control of hyperuricemia, but also on slowing CKD progression. In this review, we will try to answer those questions, while describing the most recent evidence on hyperuricemia as a risk factor for CKD and its management in those patients. BIOLOGICAL BASES Uric Acid Homeostasis Uric acid (UA) is a compound endogenously produced by the purine metabolism. These purines, generated in the liver (either from dietary or from endogenous synthesis), are first metabolized into guanine and hypoxanthine, and then into xanthine, which is oxidized into UA by xanthine oxidase 2. Although the reason is not entirely understood, contrary to other mammals, hominids have lost the enzyme uricase, responsible for converting UA into a more soluble molecule 3,4. As such, UA is excreted unmetabolized, mainly by the kidney (about twothirds), and about one-third through the intestinal tract 5,6. Several genes encoding membrane transporters responsible for UA excretion have been identified, such as Abcg2 (ATP-binding cassette subfamily G membrane 2) in the enterocytes and proximal renal tubular epithelium; and others associated with UA reabsorption in the renal tubule, such as URAT1 (urate anion exchanger 1) and GLUT9 (glucose transporter type 9) 7. Physiological Functions UA has two main functions in the human body. The first is related to its role in the elimination of nitrogenous compounds, such as ammonia and urea. The second is derived from its potent antioxidant activity, which is so important that more than half of normal human's free-radical scavenging capacity in the serum is related to UA 8,9. This ability is of great importance to the microvascular endothelium, where UA prevents oxidative inactivation of endothelial enzymes, maintaining its ability to mediate vascular dilation in situations of oxidative stress 10. Apart from its beneficial biological effects, higher levels of UA have been linked to a higher risk of cardiovascular disease, with several studies describing it as an independent risk predictor of cardiovascular mortality 10,11. This duality has been named ...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.