COVID-19 in Kidney Transplant Recipients With Diabetes Mellitus: A Propensity Score Matching Analysis

Rangel, Érika Bevilaqua; Lucena, Débora D. de; Aguiar-Brito, Isabella; Andrade, Luís Gustavo Modelli de; Veronese-Araújo, Alexandre; Cristelli, Marina Pontello; Tedesco‐Silva, Hélio; Medina‐Pestana, José Osmar

doi:10.3389/ti.2022.10375

Cited by 7 publications

(12 citation statements)

References 51 publications

(75 reference statements)

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“…In a study of 3,854 patients, glycemic levels greater than >170 mg/dL were also associated with worse outcomes in COVID-19, including an increase in intubation rate (OR = 15.6) and mortality (OR = 3.6), longer hospitalization time, and increased risk for developing ARDS (OR = 9.3) [28]. Using propensity-score matching, our group also documented that higher previous fasting blood glucose was associated with worse outcomes on KTRs independently of DM status [29]. As SARS-CoV-2 induces adipose tissue dysfunction by binding to ACE2 receptor [8], the reduction of adiponectin and adiponectin/leptin ratio is associated with the increase in type I interferon signaling pathway and activation of the innate immune response, which leads to insulin resistance and, consequently, hyperglycemia [28].…”

Section: Discussionmentioning

confidence: 51%

Impact of Hypertension on COVID-19 Burden in Kidney Transplant Recipients: An Observational Cohort Study

Aguiar-Brito

Lucena

Veronese-Araújo

et al. 2022

Viruses

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Background: COVID-19 severity is determined by cardiometabolic risk factors, which can be further aggravated by chronic immunosuppression in kidney transplant recipients (KTRs). We aimed to verify the main risk factors related to hypertension (HTN) that contribute to COVID-19 progression and mortality in that population. Methods: Retrospective analysis of 300 KTRs from March 2020 to August 2020 in a single center. We compared the main outcomes between HTN (n = 225) and non-HTN (n = 75), including admission to the intensive care unit (ICU), development of acute kidney injury (AKI), need for invasive mechanical ventilation or oxygen, and mortality. Results: Of the patients in the study, 57.3% were male, 61.3% were white, the mean age was 52.5 years, and 75% had HTN. Pre-existing HTN was independently associated with higher rates of mortality (32.9%, OR = 1.96, p = 0.036), transfer to the ICU (50.7%, OR = 1.94, p = 0.017), and AKI with hemodialysis (HD) requirement (40.4%, OR = 2.15, p = 0.011). In the hypertensive group, age, diabetes mellitus, heart disease, smoking, glycemic control before admission, C-reactive protein, lactate dehydrogenase, lymphocytes, and D-dimer were significantly associated with COVID-19 progression and mortality. Both lower basal and previous estimated glomerular filtration rates posed KTRs with HTN at greater risk for HD requirement. Conclusions: Therefore, the early identification of factors that predict COVID-19 progression and mortality in KTRs affected by COVID-19 contributes to therapeutic decisions, patient flow management, and allocation of resources.

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Section: Discussionmentioning

confidence: 51%

Impact of Hypertension on COVID-19 Burden in Kidney Transplant Recipients: An Observational Cohort Study

Aguiar-Brito

Lucena

Veronese-Araújo

et al. 2022

Viruses

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“…Tighter blood glucose control (≤140 mg/dL) might improve outcomes in COVID‐19 critically ill patients 28,29 . Poor glycaemic control was also indicative of COVID‐19 burden in kidney transplant recipients 30 . However, it is unclear whether COVID‐19 can affect the human pancreas.…”

Section: Discussionmentioning

confidence: 99%

“…28,29 Poor glycaemic control was also indicative of COVID-19 burden in kidney transplant recipients. 30 However, it is unclear whether COVID-19 can affect the human pancreas.…”

Section: Clinical Perspectivementioning

confidence: 99%

Lymphocytes regulate expression of the SARS‐CoV‐2 cell entry factor ACE2 in the pancreas of T2DM patients

et al. 2023

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AimsCOVID‐19 patients with type 2 diabetes mellitus (T2DM) show both poorer clinical outcomes and have an increased risk of death. SARS‐CoV‐2 virus infection requires simultaneous expression of the SARS‐CoV‐2 cell entry factors angiotensin‐converting enzyme 2 (ACE2) and transmembrane protease serine type 2 (TMPRSS2) in the same cell. The aim of the study was to explore the underlying mechanisms of a COVID‐19 infection in patients with T2DM.MethodsThe distribution and expression of AEC2 and TMPRSS2 in different pancreatic cell types in clinical samples of T2DM patients and diabetic mouse models were analysed by single‐cell sequencing, bioinformatics analysis and basic experiments.ResultsThe results showed that ACE2 and TMPRSS2 are expressed in the ducts of the human pancreas. These findings suggest that SARS‐CoV‐2 can infect ductal cells in vivo through ACE2 and TMPRSS2. T2DM can promote the co‐expression of ACE2 and TMPRSS2 in exocrine ducts, including in the human pancreas. We hypothesize that ACE2 expression levels are associated with increased numbers of lymphocytes in vivo.ConclusionsIncreased blood glucose levels are associated with increased ACE2 expression and an increased number of lymphocytes. At the same time, lymphocytes can promote ACE2 expression.

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“…Even if diabetes is a major comorbid condition in patients hospitalized with COVID-19, the effect of the pandemic on the number and outcome of KT recipients with diabetes requires further investigations 10–12. A recent meta-analysis concluded that KT recipients are at higher risk of severe complications and death from COVID-19 than the general population 11.…”

Section: Introductionmentioning

confidence: 99%

“…A recent meta-analysis concluded that KT recipients are at higher risk of severe complications and death from COVID-19 than the general population 11. Furthermore, KT recipients with diabetes have been reported to have a higher risk of mortality from COVID-19 than those without diabetes (24% vs 13%, p=0.02) 12…”

Section: Introductionmentioning

confidence: 99%

Influence of diabetes and other risk factors on in-hospital mortality following kidney transplantation: an analysis of the Spanish National Hospital Discharge Database from 2016 to 2020

Lopez-de-Andres,

Jimenez-Garcia,

Lopez-Herranz

et al. 2024

BMJ Open Diab Res Care

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IntroductionTo assess time trends in incidence, clinical characteristics, complications, and hospital outcomes among patients with type 1 diabetes (T1D), with type 2 diabetes (T2D), and patients without diabetes who underwent kidney transplant (KT); to identify variables associated with in-hospital mortality (IHM); and to determine the impact of the COVID-19 pandemic.Research design and methodsWe used a nationwide discharge database to select KT recipients admitted to Spanish hospitals from 2016 to 2020. We stratified patients according to diabetes status. We used multivariable logistic regression to identify the variables associated with IHM.ResultsA total of 14 594 KTs were performed in Spain (T2D, 22.28%; T1D, 3.72%). The number of KTs rose between 2016 and 2019 and and decreased from 2019 to 2020 in all groups. In patients with T2D, the frequency of KT complications increased from 21.08% in 2016 to 34.17% in 2020 (p<0.001). Patients with T2D had significantly more comorbidity than patients with T1D and patients without diabetes (p<0.001). Patients with T1D experienced KT rejection significantly more frequently (8.09%) than patients with T2D (5.57%).COVID-19 was recorded in 26 out of the 2444 KTs performed in 2020, being found in 6 of the 39 patients deceased that year (15.38%) and in 0.83% of the survivors.The variables associated with IHM were comorbidity and complications of KT. The presence of T1D was associated with IHM (OR 2.6; 95% CI 1.36 to 5.16) when patients without diabetes were the reference category. However, T2D was not associated with a higher IHM (OR 0.86; 95% CI 0.61 to 1.2).ConclusionsThe COVID-19 pandemic led to a decrease in the number of transplants. Patients with T1D have more rejection of the transplanted organ than patients with T2D. Fewer women with T2D undergo KT. The presence of T1D is a risk factor for IHM.

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COVID-19 in Kidney Transplant Recipients With Diabetes Mellitus: A Propensity Score Matching Analysis

Cited by 7 publications

References 51 publications

Impact of Hypertension on COVID-19 Burden in Kidney Transplant Recipients: An Observational Cohort Study

Impact of Hypertension on COVID-19 Burden in Kidney Transplant Recipients: An Observational Cohort Study

Lymphocytes regulate expression of the SARS‐CoV‐2 cell entry factor ACE2 in the pancreas of T2DM patients

Influence of diabetes and other risk factors on in-hospital mortality following kidney transplantation: an analysis of the Spanish National Hospital Discharge Database from 2016 to 2020

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