COVID-19 and cardiovascular disease in patients with chronic kidney disease

Abstract

Millions of people worldwide have chronic kidney disease (CKD). Affected patients are at high risk for cardiovascular disease for several reasons. Among various comorbidities, CKD is associated with the more severe forms of SARS-Cov-2 infection. This is particularly true for patients receiving dialysis or for kidney recipients. From the start of the SARS-Cov-2 pandemic, several cardiovascular complications have been observed in affected subjects, spanning through acute inflammatory manifestations, cardiovascular events, thrombotic episodes and arrythmias. Several pathogenetic mechanisms have been hypothesized, including direct cytopathic viral effects on the myocardium, endothelial damage, and hypercoagulability. This spectrum of disease can occur during the acute phase of the infection, but also after months from recovery. This review is focussed on the cardiovascular complications of COVID-19 with particular interest to their implications for the CKD population.

The Importance of Natural and Acquired Immunity to SARS-CoV-2 Infection in Patients on Peritoneal Dialysis

“…That is significant for the healthcare system, which is completely focused on COVID-19 patients. Elderly patients are at greater risk of an adverse outcome from COVID-19 [ 8 ]. Given that life expectancy has increased and that the frequency of ESKD has increasingly shifted towards the geriatric population, this is another piece of information that is important for starting dialysis treatment with PD.…”

“…During the immunization period, different vaccines against SARS-CoV-2 (neutralizing, vector and m RNK) were available in the Republic of Serbia: inactivated virus vaccine (Sinopharm, Beijing, China), m RNA vaccine (Pfizer/BioNTech, New York, NY, USA) and adenovirus vector vaccines (Sputnik-V (Moscow, Russia) and Oxford-AstraZeneca (Cambridge, England, UK)) [ 6 ]. According to the World Health Organization, immunization was not mandatory but highly recommended for vulnerable groups, such as patients with different stages of chronic kidney disease (CKD), and particularly the dialysis population (HD and PD) and kidney transplant recipients (KTRs) [ 7 , 8 , 9 ]. The official recommendation was that the dialysis population should be immunized against SARS-CoV-2, except in situations where less than three months have passed since the previous COVID-19 infection [ 10 ].…”

Early Detection of Inflammation and Malnutrition and Prediction of Acute Events in Hemodialysis Patients through PINI (Prognostic Inflammatory and Nutritional Index)

“…Although the initial research on cardiovascular disease and COVID-19 primarily focused on concerns about the increased risk of severe short-term outcomes and difficulties in managing these conditions, attention is increasingly shifting towards long-term consequences. The coexistence of cardiovascular impairments in the hemodialysis population, such as coronary artery disease, heart failure, and cerebrovascular disease, along with cardiovascular risk factors such as the male gender, aging, high blood pressure, and diabetes, can exacerbate pre-existing cardiovascular conditions in the post-COVID-19 period and lead to new heart-function consequences [ 37 ].…”

Pathogenic mechanisms of cardiovascular damage in COVID-19

“…At present, the prevalence of COVID-19 has slightly improved with viral mutation and population vaccination, but the number of infections and deaths is still rising. Although COVID-19 has been initially associated with respiratory system, it has become rapidly clear that it may affect multiple important organs including the heart (Tomasoni et al 2020 ; Del Vecchio et al 2024 ). COVID-19 may directly exacerbate pre-existing heart disease and frequently induce new cardiovascular complications (Burger et al 2021 ).…”