Epidemiological Characteristics and Mortality Risk Factors Comparison in Dialysis and Non-Dialysis CKD Patients with COVID-19—A Single Center Experience

Niculae, Andrei; Peride, Ileana; Nechita, Ana-Maria; Petcu, Lucian Cristian; Ţigliş, Mirela; Checherita, Ionel Alexandru

doi:10.3390/jpm12060966

Cited by 3 publications

(3 citation statements)

References 48 publications

(51 reference statements)

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“…Several studies have investigated the role of creatinine levels or renal function on COVID-19 clinical outcome and on mortality, demonstrating a significant association between high levels of creatinine and COVID-19 severity and mortality [ 8 , 10 , 11 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. A systematic review performed by Izcovich and colleagues in 2020 aimed at identifying factors associated with a more severe COVID-19 presentation, which may help clinicians in the decision-making process of patients with COVID-19 [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Creatinine Levels at Admission on Disease Progression and Mortality in Patients with COVID-19—An Observational Retrospective Study

et al. 2023

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Introduction: Acute kidney disease and chronic kidney disease are considered conditions that can increase the mortality and severity of COVID-19. However, few studies have investigated the impact of creatinine levels on COVID-19 progression in patients without a history of chronic kidney disease. The aim of the study was to assess the impact of creatinine levels at hospital admission on COVID-19 progression and mortality. Methods: We performed a multicenter, observational, retrospective study involving seventeen COVID-19 Units in the Campania region in southern Italy. All adult (≥18 years) patients, hospitalized with a diagnosis of SARS-CoV-2 infection confirmed by a positive reverse transcriptase-polymerase chain reaction on a naso-oropharyngeal swab, from 28 February 2020 to 31 May 2021, were enrolled in the CoviCamp cohort. Results: Evaluating inclusion/exclusion criteria, 1357 patients were included. Considering in-hospital mortality and creatinine value at admission, the best cut-off point to discriminate a death during hospitalization was 1.115 mg/dL. The logistic regression demonstrated that factors independently associated with mortality were age (OR 1.082, CI: 1.054–1.110), Charlson Comorbidity Index (CCI) (OR 1.341, CI: 1.178–1.526), and an abnormal creatinine value at admission, defined as equal to or above 1.12 mg/dL (OR 2.233, CI: 1.373–3.634). Discussion: In conclusion, our study is in line with previous studies confirming that the creatinine serum level can predict mortality in COVID-19 patients and defining that the best cut-off of the creatinine serum level at admission to predict mortality was 1.12 mg/dL.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Creatinine Levels at Admission on Disease Progression and Mortality in Patients with COVID-19—An Observational Retrospective Study

et al. 2023

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“…Аналіз ниркових подій на тлі COVID-19 показав велику складність проблеми коронавірусної інфекції, що назвали синдемією [2]. «Синдемія» -термін, запропонований у 1990-х роках антропологом Мерріл ризики зниження рШКФ становили у групах відповідно 16,6 (95% ДІ 5,263-52,360, NNT 1,774) для пацієнтів, які отримували іАПФ, проти всіх пацієнтів з ХХН, 2,049 для БРА (95% ДІ 0,361-11,22) і 1,064 для ПІР проти всієї вибірки пацієнтів з ХХН (95% ДІ 0, 797,NNT 431,6). Після 12 тижнів спостереження рШКФ майже повернулася до вихідного рівня при ХХН 2-3а ст.…”

Section: вступunclassified

“…Протокол дослідження. Було впроваджено дизайн POEM (Patient-Oriented Evidence that Matters, пацієнторієнтовані докази, які мають значення) [6] за участю пацієнтів, які страждають на артеріальну гіпертензію та інфіковані SARS-CoV-2. Ще до захворювання на коронавірусну інфекцію пацієнти з наявністю гіпертензії регулярно приймали інгібітори ренін-ангіотензин-альдостеронової системи (іРААС), а саме: інгібітори ангіотензинперетворюючого ферменту (іАПФ), блокатори рецепторів ангіотензину (БРА) або прямий інгібітор реніну (ПІР) для досягнення цільового систолічного артеріального тиску (АТ) < 140 мм рт.ст.…”

Section: матеріали та методиunclassified

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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Features of the course of the new coronavirus infection COVID-19 in patients with chronic kidney disease

Bochkareva,

Petrova,

Shimokhina

et al. 2024

Nefrologiâ (St.-Peterbg.)

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BACKGROUND: CKD is one of the main comorbidities in those who die from COVID-19. Renal injury is the most common nonpulmonary infection of SARS-CoV-2 and has a wide range of manifestations, ranging from mild proteinuria and hematuria to progressive acute kidney injury (AKI) requiring renal replacement therapy (RRT).THE AIM: to study the features of the course of the new coronavirus infection COVID-19 in patients with chronic kidney disease.PATIENTS AND METHODS: The study included 79 patients with confirmed new coronavirus infection COVID-19 who hospitalized. The first group consisted of people with a history of CKD (44 people), the second group included people without a history of CKD (35 people). The diagnosis of CKD established based on the calculation of glomerular filtration rate using the CKD-EPI formula. The comorbidity index calculated using two scales: Charlson and CIRS-G. Statistical data analysis carried out using the Statistica 12.0 application package (StatSoft Inc., USA).RESULTS: Patients with COVID-19 and CKD had a higher comorbidity index: according to the Charlson index in one group of patients the indicator was 7 [5.0-9.0], and in group 2 it was 5 [4.0-6.0] (p<0.001). According to the CIRS-G index, in one group the indicator was 9 [7-11.5], in two group it was 4 [2-6] (p <0.001). Patients in one group had a greater degree of damage to the lung tissue according to MSCT of the OGK; in laboratory tests, the levels of CRP, ferritin, LDH, and d-dimer were higher; leukocytosis with a neutrophil shift in the leukocyte count observed.CONCLUSION: Patients with a history of chronic kidney disease (CKD) had more severe COVID-19 and higher mortality.

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Epidemiological Characteristics and Mortality Risk Factors Comparison in Dialysis and Non-Dialysis CKD Patients with COVID-19—A Single Center Experience

Cited by 3 publications

References 48 publications

Prognostic Value of Creatinine Levels at Admission on Disease Progression and Mortality in Patients with COVID-19—An Observational Retrospective Study

Prognostic Value of Creatinine Levels at Admission on Disease Progression and Mortality in Patients with COVID-19—An Observational Retrospective Study

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

Features of the course of the new coronavirus infection COVID-19 in patients with chronic kidney disease

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