Clinical course and predictive risk factors for fatal outcome of SARS-CoV-2 infection in patients with chronic kidney disease

Pilgram, Lisa; Eberwein, Lukas; Wille, Kai; Koehler, Felix C.; Stecher, Melanie; Rieg, Siegbert; Kielstein, Jan T.; Jakob, Carolin E. M.; Rüthrich, Maria Madeleine; Burst, Volker; Praßer, Fabian; Borgmann, Stefan; Lanznaster, Julia; Isberner, Nora; Tometten, Lukas; Dolff, Sebastian

doi:10.1007/s15010-021-01597-7

Cited by 14 publications

(16 citation statements)

References 29 publications

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“…The high risk of COVID-19 mortality in CKD patients was confirmed by several comparisons carried out in this study. The crude mortality rate of 44.6% was of similar magnitude to that observed in hemodialysis patients treated in the dialysis units of the Emilia-Romagna region [17] and higher than the 25-30% range reported for people older than 70 years in Italy [23,24] and the 32.9% reported for CKD patients in the German Lean European Open Survey [25].…”

Section: Plos Onesupporting

confidence: 64%

COVID-19 incidence and mortality in non-dialysis chronic kidney disease patients

et al. 2021

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Many studies reported a higher risk of COVID-19 disease among patients on dialysis or with kidney transplantation, and the poor outcome of COVID-19 in these patients. Patients in conservative management for chronic kidney disease (CKD) have received attention only recently, therefore less is known about how COVID-19 affects this population. The aim of this study was to provide evidence on COVID-19 incidence and mortality in CKD patients followed up in an integrated healthcare program and in the population living in the same catchment area. The study population included CKD patients recruited in the Emilia-Romagna Prevention of Progressive Renal Insufficiency (PIRP) project, followed up in the 4 nephrology units (Ravenna, Forlì, Cesena and Rimini) of the Romagna Local Health Authority (Italy) and alive at 1.01.2020. We estimated the incidence of COVID-19, its related mortality and the excess mortality within this PIRP cohort as of 31.07.2020. COVID-19 incidence in CKD patients was 4.09% (193/4,716 patients), while in the general population it was 0.46% (5,195/1,125,574). The crude mortality rate among CKD patients with COVID-19 was 44.6% (86/193), compared to 4.7% (215/4,523) in CKD patients without COVID-19. The excess mortality of March-April 2020 was +69.8% than the average mortality of March-April 2015–19 in the PIRP cohort. In a cohort mostly including regularly followed up CKD patients, the incidence of COVID-19 among CKD patients was strongly related to the spread of the infection in the community, while its lethality is associated with the underlying kidney condition and comorbidities. COVID-19 related mortality was about ten times higher than that of CKD patients without COVID. For this reason, it is urgent to offer a direct protection to CKD patients by prioritizing their vaccination.

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Section: Plos Onesupporting

confidence: 64%

COVID-19 incidence and mortality in non-dialysis chronic kidney disease patients

et al. 2021

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“…A total of 2527 articles were obtained by our search strategy. After excluding duplicates and preliminary screening, 1243 full-text articles were assessed for eligibility and 984 studies were excluded for not meeting the inclusion criteria while 254 for unavailable outcome, leaving 5 investigations fulfilling the inclusion criteria [ 6 , 7 , 16 , 17 , 18 ]. A flow diagram of the literature search and related screening process is shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…For the primary outcome of the study, the prevalence of anemia among COVID-19 patients ranged between 8.0% and 59.8% [ 6 , 7 , 16 , 17 , 18 ]. A random effect model revealed a pooled prevalence of anemia in 25.6% of cases (95% CI: 8.3–56.5%).…”

Section: Resultsmentioning

confidence: 99%

“…Over the last two years, several analyses have demonstrated that the prognosis of patients with COVID-19 infection is closely related to the burden of associated comorbidities, such as arterial hypertension (HT), atrial arrhythmias, diabetes mellitus (DM) and more generally to cardiovascular disease (CVDs) [ 1 , 2 , 3 , 4 , 5 ]. However, few investigations, often achieving conflicting results, have focused their attention on the association between anemia in COVID-19 patients and the related risk of short-term mortality [ 6 , 7 ]. Conversely, recent studies have demonstrated that pre-existing anemia represents a risk factor for severe COVID-19 infection [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Role of Anemia in COVID-19 Patients: A Meta-Analysis

Zuin

Rigatelli

Quadretti³

et al. 2021

Infectious Disease Reports

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Introduction. The prevalence and prognostic implications of anemia in patients infected by the SARS-CoV-2 remains unclear. We performed a systematic review and meta-analysis to assess the prevalence and mortality risk in COVID-19 patients with anemia. Methods. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to 1 September 2021, reporting data on the adjusted OR (aOR) for mortality among COVID-19 patients with anemia. The pooled prevalence of anemia among COVID-19 patients was calculated using a random effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random effects models with odds ratio (aOR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I2 statistic. Results. Five studies, enrolling 9.623 COVID-19 patients [3.707 males (38.5%)], met the inclusion criteria and were included in the final analysis. The pooled prevalence of anemia was 25.6% of cases (95% CI: 8.3–56.5%), with high heterogeneity (I2 = 98.9%). Meta-regression showed that the anemia prevalence was influenced by a direct correlation with age (p = 0.007) and chronic kidney disease (p = 0.004) as moderating variables. Conversely, an inverse relationship was observed with male gender (p < 0.0001). Anemia was significantly associated with higher risk of short-term mortality (aOR: 1.69, 95% CI: 1.28–2.24, p < 0.001), with low heterogeneity (I2 = 0%). Conclusions. Anemia represents a major comorbidity in about 25% of COVID-19 patients and it is associated with about 70% higher risk of short-term mortality.

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“…Additional risk factors for severe disease progression such as diabetes, higher age, cardiovascular diseases, or hypertension are common in these patients. Dialysis dependence is another important independent risk factor [2,[4][5][6]. Moreover, it is recognized that these patients are particularly at risk for SARS-CoV-2 infection due to the difficulty of implementing hygienic concepts and quarantine restrictions in dialysis centers.…”

Section: Introductionmentioning

confidence: 99%

Decline of Humoral Responses 6 Months after Vaccination with BNT162b2 (Pfizer–BioNTech) in Patients on Hemodialysis

et al. 2022

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This study analyzed binding and neutralizing antibody titers up to 6 months after standard vaccination with BNT162b2 (two doses of 30 µg each) in SARS-CoV-2 naïve patients (n = 59) on hemodialysis. Humoral vaccine responses were measured before and 6, 12, and 24 weeks after the first vaccination. A chemiluminescent immunoassay (CLIA) was used to quantify SARS-CoV-2 IgG against the spike glycoprotein. SARS-CoV-2 neutralizing activity was tested against the wild-type virus. A multivariable binary regression model was used to identify risk factors for the absence of humoral immune responses at 6 months. At week 6, vaccine-specific seroconversion was detected in 96.6% of all patients with median anti-SARS-CoV-2 IgGs of 918 BAU/mL. At weeks 12 and 24, seroconversion rates decreased to 91.5% and 79.7%, and corresponding median binding antibody titers declined to 298 BAU/mL and 89 BAU/mL, respectively. Neutralizing antibodies showed a decay from 79.6% at week 6 to 32.8% at week 24. The risk factor with the strongest association for vanishing immune responses was low serum albumin (p = 0.018). Regarding vaccine-specific humoral responses 6 months after the standard BNT162b2 vaccination schedule, SARS-CoV-2 naïve patients receiving hemodialysis must be considered at risk of becoming infected with SARS-CoV-2 and being infectious.

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Clinical course and predictive risk factors for fatal outcome of SARS-CoV-2 infection in patients with chronic kidney disease

Cited by 14 publications

References 29 publications

COVID-19 incidence and mortality in non-dialysis chronic kidney disease patients

COVID-19 incidence and mortality in non-dialysis chronic kidney disease patients

Prognostic Role of Anemia in COVID-19 Patients: A Meta-Analysis

Decline of Humoral Responses 6 Months after Vaccination with BNT162b2 (Pfizer–BioNTech) in Patients on Hemodialysis

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