COVID-19 Ricochets on Kidney Transplant and Hemodialysis Patients
Year 2023,
Volume: 33 Issue: 3, 309 - 315, 30.06.2023
Mevlüt Hakan Göktepe
,
Hilal Akay Çizmecioglu
,
Ali Kürşat Tuna
,
Ahmet Cizmecioglu
Abstract
Background/Aims: An impaired immune response affects Coronavirus 2019 (COVID-19) disease progression. Immunities of both hemodialysis (HD) and Kidney Transplant (KTx) patients have already been suppressed. This study evaluated the prognostic laboratory results in HD and KTx patients with COVID-19.
Methods: This retrospective, case-control study was conducted with PCR (+) COVID-19 HD and KTx patients and a control group. All patients were divided into two subgroups according to disease severity. Patients' demographic records and laboratory results were obtained from the follow-up files.
Results: A total of 30 HD, 20 KTx patients, and 40 control groups were involved in the study. Gender and hospitalization duration did not differ between the groups. There was a 10% mortality rate in the KTx group and 27% in the HD group. Lung involvement in Computed Tomography (CT) was higher in HD patients (47%) than in KTx (25%). In subgroup evaluations, the most prominent laboratory values were fibrinogen in HD patients and LDH and Ferritin in KTx patients in determining disease severity.
Conclusions: Early hospitalization and treatment implementations will be associated with a good prognosis in HD and KTx patients since CT and laboratory results are not predictive in these groups of patients during the COVID-19 pandemic.
Supporting Institution
None
References
- Mahase E. Covid-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction. BMJ 2020;368:m1036
- WHO (2022) Coronavirus Disease (COVID-19) Dashboard. https://covid19.who.int/. Accessed 19 April 2022
- Weiss P, Murdoch DR. Clinical course and mortality risk of severe COVID-19. Lancet 2020;395(10229):1014-1015
- Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R, Costa F, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med 2020;288(2):192-206
- Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, et al. A single center observational study of the clinical characteristics and short-term outcome of 20 kidney transplant patients admitted for SARS-CoV2 pneumonia. Kidney Int 2020;97(6):1083-1088
- W. Guan, Z. Ni, Yu Hu, W. Liang, C. Ou, J. He, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382(18):1708-1720
- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020;323(11):1061-1069
- Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19). J Gen Intern Med 2020;35(5):1545-1549
- Azzi Y, Bartash R, Scalea J, Loarte-Campos P, Akalin E. COVID-19 and Solid Organ Transplantation: A Review Article. Transplantation 2021;105(1):37-55
- Vaziri ND, Pahl MV, Crum A, Norris K. Effect of uremia on structure and function of immune system. J Ren Nutr 2012;22(1):149-56
- Lee IC, Huo TI, Huang YH. Gastrointestinal and liver manifestations in patients with COVID-19. J Chin Med Assoc. 2020;83(6):521-523
- Mao R, Qiu Y, He JS, Tan JY, Li XH, Liang J, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020;5(7):667-678
- Dashti-Khavidaki S, Khalili H, Nourian A. Pharmacotherapy Considerations in CKD Patients With COVID-19, A Narrative Review. Iran J Kidney Dis 2020;14(4):247-255.
- Coulter CV. The role of the suspicious renal pharmacist in identifying unusual adverse drug reactions-why this is not a small problem. Int J Clin Pharm 2018;40(4):775-777
- https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum/
- Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395(10223):507-13.
- Huang I, Pranata R. Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis. J Intensive Care 2020;8:36.
- Tang HM, Tang HL. Anastasis: recovery from the brink of cell death. R Soc Open Sci 2018;5(9):180442.
- Łabuś A, Niemczyk M, Kulesza A, Fliszkiewicz M, Pączek L. Costs of Post-Renal Transplant Care in the Final Period of Graft Function. Transplant Proc 2020;52(8):2368-2370
- Turgutalp K, Ozturk S, Arici M, Eren N, Gorgulu N, Islam M, et al. Determinants of mortality in a large group of hemodialysis patients hospitalized for COVID-19. BMC Nephrol 2021;22(1):29
- Goicoechea M, Sánchez Cámara LA, Macías N, Muñoz de Morales A, Rojas ÁG, Bascuñana A, et al. COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain. Kidney Int 2020;98(1):27-34
- Yiqiong Ma, Bo Diao, Xifeng Lv, Wei Liang, Jili Zhu, Lei Liu, et al. 2019 novel coronavirus disease in hemodialysis (HD) patients: report from one HD center in Wuhan, China. medRxiv 2020
- Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, et al. Hematological findings and complications of COVID-19. Am J Hematol 2020;95(7):834-847
- Pujani M, Raychaudhuri S, Singh M, Kaur H, Agarwal S, Jain M, et al. An analysis of hematological, coagulation and biochemical markers in COVID-19 disease and their association with clinical severity and mortality: an Indian outlook. Am J Blood Res 2021;11(6):580-591. Published 2021 Dec 15.
- Gubensek, J., Lolic, M., Ponikvar, R., & Buturovic-Ponikvar, J. D-dimer levels in maintenance hemodialysis patients: High prevalence of positive values also in the group without predisposing diseases. Hemodialysis international. International Symposium on Home Hemodialysis 2016; 20(2), 198–203
- Diris JH, Hackeng CM, Kooman JP, Pinto YM, Hermens WT, van Dieijen-Visser MP. Impaired renal clearance explains elevated troponin T fragments in hemodialysis patients. Circulation 2004;109(1):23-5
- Giannitsis E, Katus HA. Troponin T release in hemodialysis patients. Circulation 2004;110(3):e25-6; author reply e25-6
- Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest 2020;130(5):2620-9
- Boonnak K, Vogel L, Feldmann F, Feldmann H, Legge KL, Subbarao K. Lymphopenia associated with highly virulent H5N1 virus infection due to plasmacytoid dendritic cell-mediated apoptosis of T cells. J Immunol 2014;192(12):5906-12.
- Cizmecioglu A, Akay Cizmecioglu H, Goktepe MH, Emsen A, Korkmaz C, Esenkaya Tasbent F, et al. Apoptosis-induced T-cell lymphopenia is related to COVID-19 severity. J Med Virol. 2021 May;93(5):2867-2874
- Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020; 71(15):762-768
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054-1062
- Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020;323(20):2052-2059
- Akalin E, Azzi Y, Bartash R, Seethamraju H, Parides M, Hemmige V, et al. Covid-19 and Kidney Transplantation. N Engl J Med 2020;382(25):2475-2477
- Scarpioni R, Manini A, Valsania T, De Amicis S, Albertazzi V, Melfa L, et al. Covid-19 and its impact on nephropathic patients: the experience at Ospedale "Guglielmo da Saliceto" in Piacenza. G Ital Nefrol 2020;37(2):2020-vol2
- Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, et al. Management of Patients on Dialysis and With Kidney Transplantation During the SARS-CoV-2 (COVID-19) Pandemic in Brescia, Italy. Kidney Int Rep 2020;5(5):580-585
Böbrek Nakli ve Hemodiyaliz Hastalarında COVID-19 Rikoşeleri
Year 2023,
Volume: 33 Issue: 3, 309 - 315, 30.06.2023
Mevlüt Hakan Göktepe
,
Hilal Akay Çizmecioglu
,
Ali Kürşat Tuna
,
Ahmet Cizmecioglu
Abstract
Arka Plan/Amaçlar: Bozulmuş bir bağışıklık cevabı, Coronavirüs 2019 (COVID-19) hastalığının prognozunu etkiler. Hem hemodiyaliz (HD) hem de Böbrek Nakli (BN) hastalarının bağışıklıkları zaten baskılıdır. Bu çalışma COVID-19'lu HD ve BN hastalarında prognostik laboratuvar sonuçlarını değerlendirmiştir.
Yöntemler: Bu retrospektif, vaka kontrol çalışması, PCR (+) COVID-19 HD ve BN hastaları ve kontrol grubu ile gerçekleştirildi. Tüm hastalar hastalık şiddetine göre iki alt gruba ayrıldı. Hastaların demografik kayıtları ve laboratuvar sonuçları takip dosyalarından elde edildi.
Bulgular: Çalışmaya toplam 30 HD, 20 BN hastası ve 40 kontrol grubu dahil edildi. Cinsiyet ve hastanede yatış süresi gruplar arasında farklılık göstermedi. BN grubunda %10, HD grubunda %27 ölüm oranı vardı. Bilgisayarlı Tomografide (BT) akciğer tutulumu HD hastalarında (%47) BN'ye (%25) göre daha yüksekti. Alt grup değerlendirmelerinde hastalık şiddetinin belirlenmesinde HD hastalarında fibrinojen, BN hastalarında ise LDH ve Ferritin öne çıkan laboratuvar değerleriydi.
Sonuç: BT ve laboratuvar sonuçları COVID-19 pandemisinde bu tarz hasta gruplarında prediktif olmadığı için erken yatış ve tedavi uygulamaları HD ve BN hastalarında iyi bir prognoz ile ilişkili olacaktır.
References
- Mahase E. Covid-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction. BMJ 2020;368:m1036
- WHO (2022) Coronavirus Disease (COVID-19) Dashboard. https://covid19.who.int/. Accessed 19 April 2022
- Weiss P, Murdoch DR. Clinical course and mortality risk of severe COVID-19. Lancet 2020;395(10229):1014-1015
- Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R, Costa F, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med 2020;288(2):192-206
- Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, et al. A single center observational study of the clinical characteristics and short-term outcome of 20 kidney transplant patients admitted for SARS-CoV2 pneumonia. Kidney Int 2020;97(6):1083-1088
- W. Guan, Z. Ni, Yu Hu, W. Liang, C. Ou, J. He, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382(18):1708-1720
- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020;323(11):1061-1069
- Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19). J Gen Intern Med 2020;35(5):1545-1549
- Azzi Y, Bartash R, Scalea J, Loarte-Campos P, Akalin E. COVID-19 and Solid Organ Transplantation: A Review Article. Transplantation 2021;105(1):37-55
- Vaziri ND, Pahl MV, Crum A, Norris K. Effect of uremia on structure and function of immune system. J Ren Nutr 2012;22(1):149-56
- Lee IC, Huo TI, Huang YH. Gastrointestinal and liver manifestations in patients with COVID-19. J Chin Med Assoc. 2020;83(6):521-523
- Mao R, Qiu Y, He JS, Tan JY, Li XH, Liang J, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020;5(7):667-678
- Dashti-Khavidaki S, Khalili H, Nourian A. Pharmacotherapy Considerations in CKD Patients With COVID-19, A Narrative Review. Iran J Kidney Dis 2020;14(4):247-255.
- Coulter CV. The role of the suspicious renal pharmacist in identifying unusual adverse drug reactions-why this is not a small problem. Int J Clin Pharm 2018;40(4):775-777
- https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum/
- Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395(10223):507-13.
- Huang I, Pranata R. Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis. J Intensive Care 2020;8:36.
- Tang HM, Tang HL. Anastasis: recovery from the brink of cell death. R Soc Open Sci 2018;5(9):180442.
- Łabuś A, Niemczyk M, Kulesza A, Fliszkiewicz M, Pączek L. Costs of Post-Renal Transplant Care in the Final Period of Graft Function. Transplant Proc 2020;52(8):2368-2370
- Turgutalp K, Ozturk S, Arici M, Eren N, Gorgulu N, Islam M, et al. Determinants of mortality in a large group of hemodialysis patients hospitalized for COVID-19. BMC Nephrol 2021;22(1):29
- Goicoechea M, Sánchez Cámara LA, Macías N, Muñoz de Morales A, Rojas ÁG, Bascuñana A, et al. COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain. Kidney Int 2020;98(1):27-34
- Yiqiong Ma, Bo Diao, Xifeng Lv, Wei Liang, Jili Zhu, Lei Liu, et al. 2019 novel coronavirus disease in hemodialysis (HD) patients: report from one HD center in Wuhan, China. medRxiv 2020
- Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, et al. Hematological findings and complications of COVID-19. Am J Hematol 2020;95(7):834-847
- Pujani M, Raychaudhuri S, Singh M, Kaur H, Agarwal S, Jain M, et al. An analysis of hematological, coagulation and biochemical markers in COVID-19 disease and their association with clinical severity and mortality: an Indian outlook. Am J Blood Res 2021;11(6):580-591. Published 2021 Dec 15.
- Gubensek, J., Lolic, M., Ponikvar, R., & Buturovic-Ponikvar, J. D-dimer levels in maintenance hemodialysis patients: High prevalence of positive values also in the group without predisposing diseases. Hemodialysis international. International Symposium on Home Hemodialysis 2016; 20(2), 198–203
- Diris JH, Hackeng CM, Kooman JP, Pinto YM, Hermens WT, van Dieijen-Visser MP. Impaired renal clearance explains elevated troponin T fragments in hemodialysis patients. Circulation 2004;109(1):23-5
- Giannitsis E, Katus HA. Troponin T release in hemodialysis patients. Circulation 2004;110(3):e25-6; author reply e25-6
- Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest 2020;130(5):2620-9
- Boonnak K, Vogel L, Feldmann F, Feldmann H, Legge KL, Subbarao K. Lymphopenia associated with highly virulent H5N1 virus infection due to plasmacytoid dendritic cell-mediated apoptosis of T cells. J Immunol 2014;192(12):5906-12.
- Cizmecioglu A, Akay Cizmecioglu H, Goktepe MH, Emsen A, Korkmaz C, Esenkaya Tasbent F, et al. Apoptosis-induced T-cell lymphopenia is related to COVID-19 severity. J Med Virol. 2021 May;93(5):2867-2874
- Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020; 71(15):762-768
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054-1062
- Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020;323(20):2052-2059
- Akalin E, Azzi Y, Bartash R, Seethamraju H, Parides M, Hemmige V, et al. Covid-19 and Kidney Transplantation. N Engl J Med 2020;382(25):2475-2477
- Scarpioni R, Manini A, Valsania T, De Amicis S, Albertazzi V, Melfa L, et al. Covid-19 and its impact on nephropathic patients: the experience at Ospedale "Guglielmo da Saliceto" in Piacenza. G Ital Nefrol 2020;37(2):2020-vol2
- Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, et al. Management of Patients on Dialysis and With Kidney Transplantation During the SARS-CoV-2 (COVID-19) Pandemic in Brescia, Italy. Kidney Int Rep 2020;5(5):580-585