Initial Effects of COVID-19 on Patients with ESKD

Weinhandl, Eric D.; Wetmore, James B.; Peng, Yi; Liu, Jiannong; Gilbertson, David T.; Johansen, Kirsten L.

doi:10.1681/asn.2021010009

Cited by 52 publications

(65 citation statements)

References 23 publications

(37 reference statements)

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“…Lastly, recent national studies on hospitalization and mortality rates among patients with ESKD in the first wave of the pandemic similarly found significant differences in adjusted relative rates with respect to patient age, sex, race, and ethnicity. 64 , 65 …”

Section: Discussionmentioning

confidence: 99%

COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis

et al. 2021

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Key Points Question What are the characteristics and mortality outcomes associated with COVID-19 among Medicare patients undergoing long-term dialysis? Findings This cohort study among 498 169 patients receiving regular maintenance dialysis found several risk factors for COVID-19 that persisted as risk factors for mortality: nursing home status, time on dialysis, congestive heart failure, diabetes, and comorbidity burden. Higher COVID-19 rates were observed among Black patients, while attenuated survival differences were observed between Black and non-Black patients, and although male sex was not associated with a higher COVID-19 rate, it was associated with higher mortality among patients with COVID-19. Meaning These findings suggest that among patients undergoing long-term dialysis, Black race, male sex, nursing home status, and having comorbidities, such as diabetes and cardiac diseases, were associated with higher risk of COVID-19 and higher post–COVID-19 mortality.

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Section: Discussionmentioning

confidence: 99%

COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis

et al. 2021

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“…11 Indeed, the number of patients initiating treatment for kidney failure during the first quarter of 2021 fell to levels not seen since 2011, which is likely because nephrologists were avoiding initiating patients on dialysis as the pandemic raged. 12 Avoidance of care owing to fear of infection, difficulty with or concerns about using transportation (especially public transportation or services in which rides were shared with other patients), and the acute economic hardship that often strikes people with a heavy burden of chronic disease may contribute to an undercount of the number of both infections and deaths related to COVID-19.…”

Section: Editorialmentioning

confidence: 99%

Understanding the Burden of the COVID-19 Pandemic for People With Kidney Disease

Wetmore

2021

American Journal of Kidney Diseases

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H ealth authorities worldwide began to recognize the enormity of the coronavirus disease 2019 pandemic late in the first quarter of 2020. The daunting public health implications of the pandemic for people with kidney disease has since become increasingly clear. Indeed, reports on the impact of COVID-19 in people with kidney disease have appeared at a rate unprecedented in the history of nephrology.In this issue of AJKD, the report by Chung et al 1 provides important insights into 2 questions of supreme importance: What is the incidence of COVID-19 in people with kidney disease? and What is the association between COVID-19 and death in people with kidney disease? The investigators found that the incidence of COVID-19 in patients with chronic kidney disease (CKD) treated with dialysis was 105 per 10,000 person-weeks; in patients with CKD not requiring kidney replacement therapy (KRT), 16 per 10,000 person-weeks; and in kidney transplant recipients (KTRs), 23 per 10,000 person-weeks. Compared with patients with CKD without KRT, therefore, incidence of COVID-19 is roughly 6 times higher in maintenance dialysis patients and roughly oneand-a-half times higher in KTRs. Regarding the issue of risk of death associated with COVID-19 among people with kidney disease, the authors report that, compared with patients receiving dialysis who did not have COVID-19, the incidence rate ratio (IRR) for death in affected dialysis patients was approximately 8. Analogously, KTRs with COVID-19 had an IRR for death of 42 compared with KTRs who did not have COVID-19. (Owing to a lack of suitable studies, IRRs for CKD without KRT could not be estimated.)Quantifying the incidence of COVID-19 and COVID-19-related death is obviously of crucial importance, yet generating insights into the relationship between kidney disease and risk of these outcomes is more complex than it first appears. If the goal is to determine the additional risks for COVID-19 and COVID-19-related death associated with kidney disease, merely comparing rates among people with kidney disease to rates in the general population may be inadequate. This is because people with kidney disease have high rates of accompanying comorbid conditions such as diabetes, atherosclerotic vascular disease, heart failure, and others that are themselves likely to confer increased risk for COVID-19 and COVID-19-related death. An early indication that kidney disease is a risk factor for COVID-19-related death emerged from the UK's National Health Service

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“… 5 Race/ethnicity (non‐Hispanic Black, Hispanic and Asian), age >60 years, obesity and type‐2‐diabetes increase the risk of adverse outcomes. 6 , 7 In addition, kidney transplant patients with COVID‐19 are 1.28 times more likely to die than matched‐haemodialysis patients. 5 …”

Section: Introductionmentioning

confidence: 99%

Humoral and cellular immune response to severe acute respiratory syndrome coronavirus‐2 vaccination in haemodialysis and kidney transplant patients

et al. 2021

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End‐stage renal disease (ESRD) patients are amongst the vulnerable groups and thus prioritized in the Coronavirus disease‐2019 vaccination programmes. However, this cohort was excluded from vaccine‐trials and yet shares the same vaccination scheme with the general population. Here, we explore trends of immune response‐proportions amongst ESRD patients on renal replacement therapy for up to 4 weeks post‐vaccination completion with Pfizer/Moderna vaccines. From inception to 10 July 2021, we searched six online‐databases for articles reporting humoral and cellular immune response proportions for up to 4 weeks post booster‐vaccination. We pooled the responders' proportions by meta‐analysis and conducted a meta‐regression stratifying outcomes by significant confounders. Twenty‐seven eligible studies reported 2789 ESRD patients. 1337, 1452 and 477 were on haemodialysis, received kidney transplantation, and healthy controls, respectively. Haemodialysis patients' proportions of humoral and cellular immune responses varied from 87.29% (80.77–93.81)–88.78% (86.76–90.80) and 62.86% (56.56, 69.17)–85.78% (78.99, 92.57), respectively, between first‐ and fourth‐weeks. Kidney transplant patients' proportions of humoral and cellular immune responses ranged from 2.6% (0.06–13.48)–29.87% (27.68, 32.07) and 5.13% (0.63–17.3)–59.84% (54.57–65.10), respectively, between first‐ and fourth‐weeks. All healthy controls maintained ≥93% proportions of both responses throughout the follow‐up. Study design and country of study influenced the pooled response proportions. Conclusively, haemodialysis and kidney transplant patients have lower proportions of humoral and cellular immune responses than healthy controls. However, haemodialysis patients' response proportions improve, reaching near healthy‐control levels by the fourth week. Kidney transplant patients' lower responses' proportions also improve but remain significantly lower than healthy controls throughout four‐weeks. The “ one‐size‐fits‐all ” vaccination scheme might be inadequate for kidney transplant patients.

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Initial Effects of COVID-19 on Patients with ESKD

Cited by 52 publications

References 23 publications

COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis

COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis

Understanding the Burden of the COVID-19 Pandemic for People With Kidney Disease

Humoral and cellular immune response to severe acute respiratory syndrome coronavirus‐2 vaccination in haemodialysis and kidney transplant patients

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