Study of Disease Severity and Outcomes in COVID-19 Patients With Chronic Kidney Disease at a Tertiary Care Hospital in South India

Ramamurthy, Pranav; Rajashekhar, Rashmi P.; Kulkarni, Ashwin; Prabhu, Divya; Kumar, Anil; Ravindra, Rahul; Ramamurthy, Prakriti

doi:10.7759/cureus.21413

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…SARS-CoV-2 використовує саме рецептор АПФ-2 для входу в клітину і агресивніший варіант Delta, що містить багато мутацій в субодиниці S 1 , поліпшує його здатність зв'язуватися з АПФ-2 [11]. Можливо, це пояснює різ-ницю у більшій частоті захворюваності на SARS-CoV-2 у світі у чоловіків, так само як і їхньої смертності [12] Встановлений у дослідженні BIRCOV феномен зниження АТ, можливо, через «ефект БРА» від SARS-CoV-2, важливо розглянути в аспекті летальності при SARS-CoV-2. Показово, що SARS-CoV-2, забезпечуючи ефект подвійної блокади РААС у людей, які отримують іАПФ або ПІР, не посилює гіпотензивного ефекту у тих, хто приймає БРА.…”

Section: обговоренняunclassified

Renal function in patients with chronic kidney disease and hypertension degree 1–2 against the background of SARS-CoV-2

Zavalna

2023

KIDNEYS

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Background. SARS-CoV-2 infection in patients with chronic kidney disease (CKD) and hypertension degree 1–2 worsens the state of the cardiovascular system and may contribute to cardiovascular events and adverse renal risks. The presence of CKD in combination with hypertension degree 1–2 and its medical correction with renin-angiotensin-aldosterone system (RAAS) inhibitors causes a significant impact on the health of patients infected with SARS-CoV-2. SARS-CoV-2 uses RAAS, namely the receptor for angiotensin-converting enzyme (ACE) 2, as a tool to enter the cell. To choose further approaches and treatment, this combination of three pathological conditions requires careful analysis and research. Objective: to study the functional state of the kidneys in patients with CKD and hypertension infected with SARS-CoV-2. Materials and methods. The article is a fragment of the BIRCOV (ARB, ACE inhibitors, DRi in COVID-19) trial, which was designed according to the POEM (Patient-Oriented Evidence that Matters). The BIRCOV (two-center, open-label, initiative-randomized, in three parallel arms) prospective study enrolled 120 patients with CKD and hypertension degree 1–2, it lasted for 1 year and was registered at ClinicalTrials.gov (NCT03336203). One hundred and twelve outpatients with degree 1–2 hypertension, 83 with combination with CKD, were selected. At the end of the study, 108 patients remained, their results are presented in the article with subsequent statistical processing. Division into groups occurred depending on the drugs received (ACE inhibitors, angiotensin receptor blockers (ARBs) or direct renin inhibitor (DRIs)). Endpoints were: estimated glomerular filtration rate (eGFR), average blood pressure, albuminuria level. In 24 patients, the urine albumin to creatinine ratio was analyzed at the beginning of SARS-CoV-2, then 2, 4, 12, 24 weeks after the onset of the disease. Mathematical processing and statistical evaluation of the research results was done in the medical statistics package. Results. All patients were divided into 3 groups depending on the drug: 35 (32 %) of them received ARBs, 42 (39 %) ACE inhibitors, 31 (29 %) DRIs. At the manifestation of SARS-CoV-2, a decrease in blood pressure was recorded during the first two weeks, with the subsequent return to baseline on week 12 in the group of people who received ACE inhibitors, the lowest indicator was in the DRI group. The use of ACE inhibitors (risk ratio (RR) 1.648, 95% confidence interval (CI) 0.772–3.519, number needed to treat (NNT) 7.0) and ARBs (RR 13.023, 95% CI 1.815–93.426, NNT 19) in the treatment of hypertension significantly increased the risk of withdrawal compared to DRIs. Patients with CKD had similar dynamics of blood pressure during 24 weeks of observation. In CKD, higher mean blood pressure values were obtained compared to other participants of the BIRCOV trial. A simultaneous decrease in eGFR and systolic blood pressure was documented, it was most pronounced in patients with CKD. The lowest results were in people who took ACE inhibitors for 0–24 weeks: the correlation coefficient was 0.815. A decrease in eGFR correlated with the degree of CKD. There was a decrease in eGFR of less than 60 ml/min during the first 4 weeks from the onset of SARS-CoV-2 in 28 people who took ACE inhibitors versus 22 who used ARBs or DRIs: absolute risk was 0.667 (RR 2.00, 95% CI 1.337–2.92, NNT 3.0). The relative risk of eGFR reduction was 16.6 (95% CI 5.263–52.360, NNT 1.774) for people receiving ACE inhibitors versus all patients with CKD, 2.049 for ARBs (95% CI 0.361–11.22, NNT 1.774) and 1.064 for DRIs versus the entire sample of people with CKD (95% CI 0.116–9.797, NNT 431.6). After 12 weeks of follow-up, eGFR almost returned to baseline in CKD stage 2–3a. An increase in the urine albumin to creatinine ratio (which did not reach the baseline within 24 weeks from the onset of the disease) was recorded in CKD patients with stable renal function during the first 12 weeks from the onset of SARS-CoV-2 (the mean values of eGFR were not statistically different within 2–24 weeks). Males had a higher risk of CKD progression to end-stage renal disease. In people with SARS-CoV-2, on the second week from the onset of the disease, a decrease in eGFR was observed with a reciprocal increase in the level of blood uric acid, which differed significantly from the baseline values. The use of dexamethasone was accompanied by a decrease in eGFR (Р ≤ 0.05) and the preservation of these disorders in people with CKD stage 3b-4 up to 24 weeks of observation (RR 0.686, 95% CI 0.264–1.780, NNT 7.636). Conclusions. The course of SARS-CoV-2 in people with hypertension degree 1–2 was characterized by the development of significant hypotension among those taking ACE inhibitors, and in patients with CKD and hypertension taking ACE inhibitors — by a decrease in GFR, hypotension, an increase in albuminuria and in the urine albumin to creatinine ratio, which was transient in most cases. Albuminuria increased less significantly in patients taking ARBs and was practically unchanged when using DRIs. Patients with CKD stage 4 and hypertension degree 2 had the greatest risks of an unfavorable prognosis. The authors hypothesized about the mechanism of SARS-CoV-2 effect when using ACE inhibitors that was similar to that of ARBs (ARB effect), i.e., in people who took ACE inhibitors, the effect of reducing blood pressure was comparable to that of the dual RAAS blockade with ACE inhibitors and ARBs.

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Section: обговоренняunclassified

Renal function in patients with chronic kidney disease and hypertension degree 1–2 against the background of SARS-CoV-2

Zavalna

2023

KIDNEYS

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“…15 A retrospective study from India indicated that 47.5 severity of COVID-19 in the non-kidney transplant patient group (47.5%) had severe COVID-19. 16 These differences could be due to sample size, study area, and study design.…”

Section: Factors Associated With Covid-19 Severitymentioning

confidence: 99%

Factors Associated with COVID-19 Severity Among Kidney Transplant and Non-Kidney Transplant Patients at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Kidane,

Alemu,

Biratu

et al. 2023

IJGM

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“…Diverse factors contribute to thyroid problems in patients with CKD. CKD patients have a greater prevalence of hypothyroidism than the overall population [5] . Through the action of isoform D1 of the enzyme T4-5′-deiodinase, the kidney contributes to the synthesis of serum free triiodothyronine (FT3) by deiodinating free thyroxine (FT4).…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Thyroid Hormones in Patient with Chronic Renal Failure Undergoing Maintenance Haemodialysis in Hospital Cross Section Study

2024

The Egyptian Journal of Hospital Medicine

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Background: A significant alteration in thyroid hormone function tests occurred in chronic kidney disease (CKD) patients especially if they are on dialysis. Objective: The purpose of our study was to determine the prevalence of thyroid hormone abnormalities among chronic renal failure patients undergoing maintenance haemodialysis, and to assess the connection between thyroid hormones dysfunction, duration of dialysis, complication of chronic renal failure and other comorbidities. Patients and Methods: This cross-section study was executed on 200 patients exceeding the age of 18, with confirmed end-stage renal disease (ESRD. Patients were split into 4 groups based on status of thyroid dysfunction into hypothyroidism group, hyperthyroidism group, normal thyroid or sick euthyroid group. Results: There was overt hypothyroidism in 20 (64.51%) patients and subclinical hypothyroidism in 11(5.5 %) patients. However, overt hyperthyroidism was in 9 (4.5%) patients and subclinical hyperthyroidism was in 10 (5 %) patients. Sick euthyroid was found in 83 (41.50%) patients and finally, euthyroid patients was in 67 (33.50%) patients. Conclusions: Thyroid hormone dysfunction is common in chronic renal failure patients undergoing maintenance hemodialysis, even in those who are clinically euthyroid.

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Study of Disease Severity and Outcomes in COVID-19 Patients With Chronic Kidney Disease at a Tertiary Care Hospital in South India

Cited by 3 publications

References 15 publications

Renal function in patients with chronic kidney disease and hypertension degree 1–2 against the background of SARS-CoV-2

Renal function in patients with chronic kidney disease and hypertension degree 1–2 against the background of SARS-CoV-2

Factors Associated with COVID-19 Severity Among Kidney Transplant and Non-Kidney Transplant Patients at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Assessment of the Thyroid Hormones in Patient with Chronic Renal Failure Undergoing Maintenance Haemodialysis in Hospital Cross Section Study

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