The effectiveness of dexamethasone on the prognosis of dialysis patients with severe COVID-19

Toçoğlu, Aysel; Dheir, Hamad; Demirci, Taner; Kurt, Rumeysa; Salihi, Salih; Yaylacı, Selçuk; Çakar, Gözde Çakırsoy; Toptan, Hande; Karabay, Oğuz; Sipahi, Savaş

doi:10.1590/1806-9282.20210600

Cited by 5 publications

(7 citation statements)

References 23 publications

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“…In addition, evidence of steroid administration in patients receiving dialysis therapy is limited. Toçoglu et al studied the efficacy of dexamethasone in dialysis patients with moderate II COVID-19 and found that the duration of hospital stay in the dexamethasone-treated group was significantly longer than that in the non-dexamethasone-treated group and that the 28-day survival rate was insignificant [ 14 ]. Although it is difficult to conduct a prospective RCT, further studies are required to determine whether patients on dialysis therapy have a better prognosis by treating with steroids.…”

Section: Discussionmentioning

confidence: 99%

Committee report: Questionnaire survey on the treatment of COVID-19 in patients receiving dialysis therapy

et al. 2022

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Background Patients with coronavirus disease 2019 (COVID-19) who receive dialysis therapy develop more severe disease and have a poorer prognosis than patients who do not. Although various data on the treatment of patients not receiving dialysis therapy have been reported, clinical practice for patients on dialysis is challenging as data is limited. The Infection Control Committee of the Japanese Society for Dialysis Therapy decided to clarify the status of treatment in COVID-19 patients on dialysis. Methods A questionnaire survey of 105 centers that had treated at least five COVID-19 patients on dialysis was conducted in August 2021. Results Sixty-six centers (62.9%) responded to the questionnaire. Antivirals were administered in 27.7% of facilities treating mild disease (most patients received favipiravir) and 66.7% of facilities treating moderate disease (most patients with moderate or more severe conditions received remdesivir). Whether and how remdesivir is administered varies between centers. Steroids were initiated most frequently in moderate II disease (50.8%), while 43.1% of the facilities initiated steroids in mild or moderate I disease. The type of steroid, dose, and the duration of administration were generally consistent, with most facilities administering dexamethasone 6 mg orally or 6.6 mg intravenously for 10 days. Steroid pulse therapy was administered in 48.5% of the facilities, and tocilizumab was administered in 25.8% of the facilities, mainly to patients on ventilators or equivalent medications, or to the cases of exacerbations. Furthermore, some facilities used a polymethylmethacrylate membrane during dialysis, nafamostat as an anticoagulant, and continuous hemodiafiltration in severe cases. There was limited experience of polymyxin B-immobilized fiber column-direct hemoperfusion and extracorporeal membrane oxygenation. The discharge criteria for patients receiving dialysis therapy were longer than those set by the Ministry of Health, Labor and Welfare in 22.7% of the facilities. Conclusions Our survey revealed a variety of treatment practices in each facility. Further evidence and innovations are required to improve the prognosis of patients with COVID-19 receiving dialysis therapy.

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Section: Discussionmentioning

confidence: 99%

Committee report: Questionnaire survey on the treatment of COVID-19 in patients receiving dialysis therapy

et al. 2022

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“…Patients undergoing haemodialysis were excluded from the RECOVERY trial, although 8% had an eGFR <30 mL/min/1.73 m 2 . Another retrospective analysis of haemodialysis patients with COVID-19 infection receiving dexamethasone did not demonstrate a clear clinical benefit [ 101 ]. However, this retrospective study was limited by its methodology, and it remains in current recommendations that haemodialysis patients with COVID-19 infection requiring oxygen support should receive steroid treatment.…”

Section: Treatment Strategies For Elderly Haemodialysis Patients Infe...mentioning

confidence: 99%

COVID-19 in Elderly Patients Receiving Haemodialysis: A Current Review

McDonnell

Kalra

et al. 2023

Biomedicines

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There is an increased incidence of elderly adults diagnosed with kidney failure as our global aging population continues to expand. Hence, the number of elderly adults indicated for kidney replacement therapy is also increasing simultaneously. Haemodialysis initiation is more commonly observed in comparison to kidney transplantation and peritoneal dialysis for the elderly. The onset of the coronavirus 2019 (COVID-19) pandemic brought new paradigms and insights for the care of this patient population. Elderly patients receiving haemodialysis have been identified as high-risk groups for poor COVID-19 outcomes. Age, immunosenescence, impaired response to COVID-19 vaccination, increased exposure to sources of COVID-19 infection and thrombotic risks during dialysis are key factors which demonstrated significant associations with COVID-19 incidence, severity and mortality for this patient group. Recent findings suggest that preventative measures such as regular screening and, if needed, isolation in COVID-19-positive cases, alongside the fulfillment of COVID-19 vaccination programs is an integral strategy to reduce the number of COVID-19 cases and consequential complications from COVID-19, particularly for high-risk groups such as elderly haemodialysis patients. The COVID-19 pandemic brought about the rapid development and repurposing of a number of medications to treat patients in the viral and inflammatory stages of their disease. However, elderly haemodialysis patients were grossly unrepresented in many of these trials. We review the evidence for contemporary treatments for COVID-19 in this population to provide clinicians with an up-to-date guide. We hope our article increases awareness on the associations and impact of COVID-19 for the elderly haemodialysis population, and encourage research efforts to address knowledge gaps in this topical area.

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“…Normal populasyonda steroid tedavisi dışında kesinleşen ve tam anlamıyla COVID-19 ilişkili mortalite azaltıcı etkisi olan tedavi rejimi yoktur. Ancak, diyaliz populasyonunda steroid dahil hiçbir medikal tedavi etkinliği kanıtlanmamıştır (Toçoglu et al, 2021). Antikoagülan tedavisi emboli profilaksisinde ve pron pozisyon metodu hastalık progresiyonu ve mekanik ventilatör gereksinimi azaltması bakımından önemli tedavi yaklaşımları arasında yer almaktadır (Gautret et al, 2020).…”

Section: Hemodiyaliz Hastalarında Covid-19 Tedavisiunclassified

“…kalitatif ve yarı kantitatif reseptör bağlama alanı ile ilgili yapılan bir çalışmada; tam aşılı 2367 hastadan %65'i (no=51527) mRNA1273 (Moderna mRNA), %19'u (no= 5440) BNT162b2 (Pfizer mRNA) ve %17'si (no=5400) Ad26.COV2.S (Johnson ve Johnson, atenüe adenovirüs) aşıları uygulanmış. Hastalardaki aşı tipine ve diyaliz yöntemine göre antikor yanıtları değerlendirildiğinde; CO-VID-19 aşısına "yanıt yok" veya "yanıt azalması" prevalansı aşı tipine göre değişiyordu, hastaların üçte birinde zayıflatılmış adenovirüs Ad26.COV2.S aşı sonrası yanıt alınırken, hastaların üçte birinde 29-60 günde bile saptanabilir veya azalmış IgG yanıtı yoktu (Garcia et al, 2021;Toçoglu et al, 2021). Yakın zamanda yapılan büyük bir kohort çalışmasının bir ara analizi, mRNA bazlı BNT162b2 aşısının (no = 55) veya adenovirüsün (AZD1222) (no = 53) iki dozundan sonra ve sağlıklı kontrol katılımcıları (no = 162) SARS-CoV-2-nötralize edici antikorların indüksiyonunu karşılaştırdı.…”

Section: Hemodiyaliz Hastalarında Covid-19 Tedavisiunclassified

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COVID-19 ve Böbrek

Dheir¹,

Sipahi²

2023

Temelden Kliniğe COVID-19

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The coronavirus disease , caused by severe acute respiratory syndrome (ARDS) new type of coronavirus (SARS-CoV-2), is a serious public health emergency that has become a pandemic all over the world. Although initially identified as a respiratory targeted virus, the SARS-CoV-2 has now been shown to have multi-organ involvement other than lung involvement. Renal dysfunction (eGFR <60 ml/ min/1.73 m2) and proteinuria and microscopic hematuria in around 40% were detected in >30% of COVID-19 patients at hospitalization. In postmortem studies, the virus was isolated in different structures of the kidney. It has been shown histopathologically that the COVID-19 may cause acute kidney injury (AKI), acute tubular injury, acute glomerular injury and thrombotic microangiopathy as kidney involvement. In the first months of the pandemic, the incidence of COVID-19-related kidney complications was reported to be extremely low. However, large-scale studies on kidney involvement in the later months of the pandemic have shown the opposite. The most important risk factors

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The effectiveness of dexamethasone on the prognosis of dialysis patients with severe COVID-19

Cited by 5 publications

References 23 publications

Committee report: Questionnaire survey on the treatment of COVID-19 in patients receiving dialysis therapy

Committee report: Questionnaire survey on the treatment of COVID-19 in patients receiving dialysis therapy

COVID-19 in Elderly Patients Receiving Haemodialysis: A Current Review

COVID-19 ve Böbrek

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