Kidney diseases and COVID-19 infection: causes and effect, supportive therapeutics and nutritional perspectives

Abstract

Recently, the novel coronavirus disease 2019 , has attracted the attention of scientists where it has a high mortality rate among older adults and individuals suffering from chronic diseases, such as chronic kidney diseases (CKD). It is important to elucidate molecular mechanisms by which COVID-19 affects the kidneys and accordingly develop proper nutritional and pharmacological strategies. Although numerous studies have recently recommended several approaches for the management of COVID-19 in CKD, its impact on patients with renal diseases remains the biggest challenge worldwide. In this paper, we review the most recent evidence regarding causality, potential nutritional supplements, therapeutic options, and management of COVID-19 infection in vulnerable individuals and patients with CKD. To date, there is no effective treatment for COVID-19-induced kidney dysfunction, and current treatments are yet limited to anti-inflammatory (e.g. ibuprofen) and anti-viral medications (e.g. Remdesivir, and Chloroquine/Hydroxychloroquine) that may increase the chance of treatment. In conclusion, the knowledge about kidney damage in COVID-19 is very limited, and this review improves our ability to introduce novel approaches for future clinical trials for this contiguous disease.

Impact of Kidney Failure on the Severity of COVID-19

“…Patients with CKD are highly susceptible to COVID-19 and are at an increased risk of progression to a severe or critical form of the disease because of impaired immunity; additionally, they are at enhanced risk of SARS-CoV-2 infection due to frequent hospital attendance [ 2 , 13 , 14 , 15 , 16 , 17 , 18 ]. The prevalence of CKD in patients with COVID-19 has been reported in a wide range of approximately 1–47%; however, it is suggested that the lowest values result from underestimation [ 16 , 19 , 20 , 21 ]. Among patients with COVID-19 hospitalized in 30 Polish centers included in the current analysis, nearly 20% were diagnosed with CKD, of which 18% presented severe renal failure.…”

Medical nutritional therapy for renal transplantation in the COVID-19 pandemic

“…Vitamin D, which is also important for renal transplantation patients, is also prominent in the COVID-19 pandemic due to its anti-inflammatory effects[ 6 , 30 ]. In response to COVID-19 infection, vitamin D can prevent disease progression through the production of antimicrobial peptides in the respiratory epithelium and help reduce inflammatory response[ 31 ]. Vitamin D deficiency has been reported to increase the rate of hospitalization and mortality due to COVID-19[ 32 ].…”

“…Vitamin C contributes to immunity by supporting both the innate and adaptive immune system, modulating inflammatory mediators, and influencing epithelial barriers. It has important benefits such as preventing common cold and upper respiratory tract infections, reducing the duration and severity of the disease and supporting respiratory defense mechanisms[ 31 ]. In addition, it is thought that vitamin C may have a positive effect against COVID-19, as many upper respiratory tract infections are caused by endemic coronaviruses[ 33 ].…”

“…In excessive intake of Vitamin C, accumulation of oxalose, which is a metabolic byproduct of ascorbic acid, can be seen in kidney patients. Therefore, dietary vitamin C intake appears to be safer than supplementation[ 31 ]. Consumption of fresh vegetables and fruits with high vitamin C contributes to increasing the intake of not only vitamin C but also other antioxidant vitamins.…”

“…Because of the immune-modulating effects of nutraceuticals such as beta-glucans, melatonin and probiotics, it might be valuable for efficient clinical outcomes for COVID-19 patients. However, there are insufficient data and strong evidence for these components[ 31 , 36 ].…”