Increased vulnerability to COVID‐19 in chronic kidney disease

Carlson, Nicholas; Nelveg-Kristensen, K-E; Ballegaard, E Freese; Feldt‐Rasmussen, Bo; Hornum, Mads; Kamper, A. D.; Gislason, Gunnar; Torp‐Pedersen, Christian

doi:10.1111/joim.13239

Cited by 48 publications

(51 citation statements)

References 48 publications

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“…Mortality among hospitalized patients with COVID-19-associated AKI (COVID-19 AKI) is higher than for those without kidney involvement 8 , 9 . As with all instances of AKI in the context of multi-organ failure requiring ICU admission, mortality among patients admitted to the ICU with COVID-19 AKI requiring KRT is especially high 10 . Anecdotal reports of a lack of renal recovery in those who survive relative to that reported for other forms of AKI is of particular concern 7 , 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

“…As with all instances of AKI in the context of multi-organ failure requiring ICU admission, mortality among patients admitted to the ICU with COVID-19 AKI requiring KRT is especially high 10 . Anecdotal reports of a lack of renal recovery in those who survive relative to that reported for other forms of AKI is of particular concern 7 , 9 , 10 . However, long-term patient outcomes are not yet fully understood as they are complicated by prolonged hospital admissions and lack of reported follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Pathophysiology of COVID-19-associated acute kidney injury

et al. 2021

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Although respiratory failure and hypoxaemia are the main manifestations of COVID-19, kidney involvement is also common. Available evidence supports a number of potential pathophysiological pathways through which acute kidney injury (AKI) can develop in the context of SARS-CoV-2 infection. Histopathological findings have highlighted both similarities and differences between AKI in patients with COVID-19 and in those with AKI in non-COVID-related sepsis. Acute tubular injury is common, although it is often mild, despite markedly reduced kidney function. Systemic haemodynamic instability very likely contributes to tubular injury. Despite descriptions of COVID-19 as a cytokine storm syndrome, levels of circulating cytokines are often lower in patients with COVID-19 than in patients with acute respiratory distress syndrome with causes other than COVID-19. Tissue inflammation and local immune cell infiltration have been repeatedly observed and might have a critical role in kidney injury, as might endothelial injury and microvascular thrombi. Findings of high viral load in patients who have died with AKI suggest a contribution of viral invasion in the kidneys, although the issue of renal tropism remains controversial. An impaired type I interferon response has also been reported in patients with severe COVID-19. In light of these observations, the potential pathophysiological mechanisms of COVID-19-associated AKI may provide insights into therapeutic strategies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pathophysiology of COVID-19-associated acute kidney injury

et al. 2021

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“…A recent study performed on the Danish population [5], which differentiated between pre-existing CKD and AKI through national healthcare registries, showed an increasing risk for severe disease in CKD population. Although these ndings appear in contrast with our data, the mean age in this study was signi cantly lower compared to our sample (57.6 y vs. 69.1 y), which shows this could be due to demographic differences of the populations studied.…”

Section: Discussionmentioning

confidence: 99%

“…Although these ndings appear in contrast with our data, the mean age in this study was signi cantly lower compared to our sample (57.6 y vs. 69.1 y), which shows this could be due to demographic differences of the populations studied. However, the risk for severe disease or death was weak for early stages of CKD and when the variable "age" was included in the regressive model [5].…”

Section: Discussionmentioning

confidence: 99%

“…However, despite a variety of evidence from observational studies and metanalysis, the real impact of Acute Kidney Injury (AKI) as a clinical risk factor is still lacking [4]. The incidence of Chronic Kidney Disease (CKD) in COVID-19 hospitalized patients is also not clearly de ned, and it is probably in uenced by demographic and epidemiologic characteristics [5]. The role of CKD in COVID-19 severity is even more debated, probably as a result of the di culty in differentiating CKD from AKI in patients hospitalized during a pandemic outbreak [6].…”

Section: Introductionmentioning

confidence: 99%

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Kidney Dysfunction And COVID-19: Characteristics, Predictive Factors, And Influence Of Age

Porta

Baiardi

Fassina

et al. 2021

Preprint

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Background COVID-19 severity and mortality are strongly influenced by age and comorbidities. Among comorbidities, kidney dysfunction seems to play a crucial role. Indeed, acute kidney injury (AKI) is a frequent finding in hospitalized COVID-19 patients and seems to be associated to mortality and severity. On the other hand, the role of chronic kidney disease (CKD) in COVID-19 is more debated. Aims and Methods We performed a retrospective study in a cohort of 174 hospitalized COVID-19 patients in Italy from March 3rd to May 21st 2020, to investigate the role of kidney dysfunction on COVID-19 severity and mortality. Moreover, we examined in depth the relationship between kidney function, age, and progression of COVID-19, also using different equations to estimate the glomerular filtration rate (GFR). Hazard ratios (HR) and odds ratios (OR) were obtained by logistic regression, while a predictive analysis was made through a machine learning approach.Results AKI and death occurred in 10.2 % and 19.5% respectively, in our population. Serum creatinine, blood urea nitrogen, neutrophils, lymphocytes, c-reactive protein and procalcitonin were significantly correlated to mortality and severity of the disease. The major risk factors for mortality in our cohort were age [adjusted HR, 6.2; 95% confidence interval (CI) 1.8-21.4] and AKI [3.36 (1.44-7.87)], while, in these relationships, GFR at the baseline mitigated the role of age. The occurrence of AKI was influenced by baseline kidney function, D-dimer and procalcitonin and hypertension. Our predictive analysis for AKI and mortality reached an accuracy ≥ of 94% and 91%, respectively. In patients ≥ 70 years, MDRD and CKD-EPI showed a better performance in the prediction of AKI and mortality, compared to BIS-1 formula.Discussion Our study confirms the importance of AKI as a risk factor in COVID-19 disease, while it scales down the role of CKD, especially in elderly patients. BIS-1 formula demonstrated a worse performance to predict the outcomes in COVID-19 patients when compared to MDRD and CKD-EPI.

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Clinical manifestations of COVID-19 infection in dialysis patients and protective effect of COVID-19 vaccine

Zhang

Chen

2023

Inflamm. Res.

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Background and objective COVID-19 infection poses a special challenge to patients with dialysis patients. The purpose of this study was to evaluate the clinical manifestations of dialysis patients with COVID-19 and the protective effect of the vaccine. Methods We included 41 studies based on big data, mainly analyzing the clinical symptoms of dialysis patients with COVID-19, the proportion of severe patients before and after vaccination, and the humoral reaction of vaccine in the body. Results 6.1% to 35.7% of dialysis patients with COVID-19 developed respiratory distress symptoms and needed to be admitted to an intensive care unit for mechanical ventilation. The incidence and mortality of COVID-19 in dialysis patients before vaccination were 5.5% and 1.1%, respectively, and decreased to 4.5% and 0.6% in breakthrough infected patients. There was no statistical difference in serum conversion rates between dialysis patients and healthy controls, but the neutralizing antibody titer in the control group was 1922 (IQR 533 to 3186) AU/mL, and the neutralizing antibody titer in dialysis patients significantly decreased to 367 (IQR 171 to 1650) AU/mL ( P =0.046). Conclusions Dialysis is associated with an increased risk of severe COVID-19, and generally has a poor seroconversion response to vaccines. It also confirms the protective effect of vaccines on high-risk populations such as dialysis.

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Increased vulnerability to COVID‐19 in chronic kidney disease

Cited by 48 publications

References 48 publications

Pathophysiology of COVID-19-associated acute kidney injury

Pathophysiology of COVID-19-associated acute kidney injury

Kidney Dysfunction And COVID-19: Characteristics, Predictive Factors, And Influence Of Age

Clinical manifestations of COVID-19 infection in dialysis patients and protective effect of COVID-19 vaccine

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