When a nephrology ward becomes a COVID-19 ward: the Cremona experience

Malberti, Fabio; Pecchini, Paola; Marchi, Gianluca; Foramitti, Marina

doi:10.1007/s40620-020-00743-y

Cited by 20 publications

(24 citation statements)

References 8 publications

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“…Nevertheless, the Authors raised some doubts about the reliability of data collection and speculated that their summary estimates may represent an underestimation of actual incidence. Interestingly, in a highly selected cohort, excluding the 20 patients on dialysis, 25 (40.3%) out of 62 patients hospitalized in a Nephrology ward in Cremona (Lombardy) developed AKI [20]. Among our study population, we observed an incidence of AKI of 22%.…”

Section: Discussionmentioning

confidence: 63%

Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy

et al. 2020

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Background The prevalence of kidney involvement during SARS-CoV-2 infection has been reported to be high. Nevertheless, data are lacking about the determinants of acute kidney injury (AKI) and the combined effect of chronic kidney disease (CKD) and AKI in COVID-19 patients. Methods We collected data on patient demographics, comorbidities, chronic medications, vital signs, baseline laboratory test results and in-hospital treatment in patients with COVID-19 consecutively admitted to our Institution. Chronic kidney disease was defined as eGFR < 60 mL/min per 1.73 m2 or proteinuria at urinalysis within 180 days prior to hospital admission. AKI was defined according to KDIGO criteria. The primary and secondary outcomes were the development of AKI and death. Results Of 777 patients eligible for the study, acute kidney injury developed in 176 (22.6%). Of these, 79 (45%) showed an acute worsening of a preexisting CKD, and 21 (12%) required kidney replacement therapy. Independent associates of AKI were chronic kidney disease, C-reactive protein (CRP) and ventilation support. Among patients with acute kidney injury, 111 died (63%) and its occurrence increased the risk of death by 60% (HR 1.60 [95% IC 1.21–2.49] p = 0.002) independently of potential confounding factors including hypertension, preexisting kidney damage, and comorbidities. Patients with AKI showed a significantly higher rate of deaths attributed to bleeding compared to CKD and the whole population (7.5 vs 1.5 vs 3.5%, respectively). Conclusion Awareness of kidney function, both preexisting CKD and development of acute kidney injury, may help to identify those patients at increased risk of death.

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Section: Discussionmentioning

confidence: 63%

Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy

et al. 2020

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“…Few European data are currently available on this topic. In a cohort of 62 patients not on maintenance dialysis in Lombardy, Italy, 40% developed AKI and 10% required KRT [18]. In this cohort, a mortality rate of 88% was reported in patients with advanced chronic kidney disease (CKD).…”

Section: The True Incidence Of Acute Kidney Injury?mentioning

confidence: 88%

“…Though immune dysfunction (both immunosuppression and overactivation) have been described in this population [41], it is possible that ESKD patients do not mount the same cytokine storm response implicated in multiorgan dysfunction noted in critically ill patients. Mortality data on this patient populations remains limited, though a 30% mortality rate was reported in a cohort of 20 hemodialysis patients with COVID-19 [18]. In a large cohort of patients in New York City, patients with CKD and either atrial fibrillation, heart failure, or ischemic heart disease had a higher mortality rate.…”

Section: Chronic Kidney Disease (Ckd) and End-stage Kidney Disease (Ementioning

confidence: 97%

“…Existing data, while heterogenous with respect to population size, location, severity of illness, and definitions of AKI, show a wide range of rates of AKI occurrence in patients with COVID-19 from 1 to 46% ( Fig. 1 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]). At our institution, the incidence of AKI in 3325 patients with COVID-19 was 46%-with 20% requiring KRT [19].…”

Section: The True Incidence Of Acute Kidney Injury?mentioning

confidence: 99%

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COVID-19 and the kidney: what we think we know so far and what we don’t

et al. 2020

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The novel coronavirus disease infection (COVID-19) outbreak that was declared a global pandemic in March 2020 had led to an internationally variable but concerning incidence of COVID-associated acute kidney injury (AKI), with prevalence reported as high as 46% in large cohorts of hospitalized patients. Variability in AKI may be explained by differences in traditional risk factors for AKI, heterogeneity among patient cohorts, and differences in racial and ethnic groups. Further, AKI requiring kidney replacement therapies (KRT) has been associated with increased mortality. Proposed mechanisms of kidney injury include direct viral-induced tubular or glomerular injury, sepsis-associated AKI, and thrombotic disease. Kidney pathology include acute tubular injury, glomerular fibrin thrombi, pigmented tubular casts, and collapsing focal segmental glomerulosclerosis. "Viral-like" particles have been observed in renal samples at electron microscopy and viral RNA has been identified in both glomerular and tubular compartments of kidney specimens, but the link between viral presence and injury remain unclear. Though the link between AKI and poor outcomes is clear, prevalence and outcomes of COVID-19 in patients with chronic kidney disease and end stage kidney disease has not yet been reported. In patients on immunosuppression like those with kidney transplants or glomerular disease, COVID-19 has presented a management dilemma. Herein, we review the existing literature on kidney disease in COVID-19 and discuss what remains to be learned.

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“…In Italy, preliminary studies confirmed that patients on renal replacement therapy (RRT), especially those on hemodialysis (HD), are particularly vulnerable for severe and fatal COVID-19 [11][12][13][14][15]. Thus far, while several reports and editorials focused on this fragile population [8,[11][12][13][14][15], no large-scale country level study addressed the COVID-19 epidemiology in RRT patients. The urgent need for a better understanding of the epidemic in RRT patients was immediately evident, and therefore we designed a survey of the Nephrology centers in Italy, aimed to capture the main features, impact and geographical distribution of SARS-CoV-2 spread in over 60,000 prevalent RRT patients during the exponential phase of the COVID-19 pandemic in Italy.…”

Section: Introductionmentioning

confidence: 99%

Exposure to novel coronavirus in patients on renal replacement therapy during the exponential phase of COVID-19 pandemic: survey of the Italian Society of Nephrology

Quintaliani

Reboldi

Napoli³

et al. 2020

J Nephrol

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Background Between February and April 2020, Italy experienced an overwhelming growth of the COVID-19 pandemic. Little is known, at the country level, where and how patients on renal replacement therapy (RRT) have been mostly affected. Methods Survey of the network of Nephrology centers using a simplified 17 items electronic questionnaire designed by Italian Society of Nephrology COVID-19 Research Group. We used spatial epidemiology and geographical information systems to map SARS-CoV-2 spread among RRT patients in Italy. Results On April 9th 2020, all nephrology centers (n = 454) listed in the DialMap database were invited to complete the electronic questionnaire. Within 11 days on average, 365 centers responded (80.4% response rate; 2.3% margin of error) totaling 60,441 RRT patients. The surveyed RRT population included 30,821 hemodialysis (HD), 4139 peritoneal dialysis (PD), and 25,481 transplanted (Tx) patients respectively. The proportion of SARS-CoV-2 positive RRT patients in Italy was 2.26% (95% CI 2.14-2.39) with significant differences according to treatment modality (p < 0.001). The proportion of patients positive for SARS-CoV-2 was significantly higher in HD (3.55% [95% CI 3.34-3.76]) than PD (1.38% [95% CI 1.04-1.78] and Tx (0.86% [95% CI 0.75-0.98]) (p < 0.001), with substantial heterogeneity across regions and along the latitude gradient (p < 0.001). In RRT patients the highest rate was in the northwest (4.39% [95% CI 4.11-4.68], followed by the northeast (IR 2.06% [1.79-2.36]), the center (0.91% [0.75-1.09]), the main islands (0.67% [0.47-0.93]), and the south (0.59% [0.45-0.75]. During the COVID-19 pandemic, among SARS-Cov-2 positive RRT patients the fatality rate was 32.8%, as compared to 13.3% observed in the Italian population as of April 23rd. Conclusions A substantial proportion of the 60,441 surveyed RRT patients in Italy were SARS-Cov-2 positive and subsequently died during the exponential phase of COVID-19 pandemic. Infection risk and rates seems to differ substantially across regions, along geographical latitude, and by treatment modality.

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When a nephrology ward becomes a COVID-19 ward: the Cremona experience

Cited by 20 publications

References 8 publications

Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy

Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy

COVID-19 and the kidney: what we think we know so far and what we don’t

Exposure to novel coronavirus in patients on renal replacement therapy during the exponential phase of COVID-19 pandemic: survey of the Italian Society of Nephrology

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