TY - JOUR
T1 - Effect of COVID-19 on Kidney Disease Incidence and Management
AU - Mcadams, Meredith
AU - Ostrosky-Frid, Mauricio
AU - Rajora, Nilum
AU - Hedayati, Susan
N1 - Funding Information:
M. McAdams is supported by National Institute of Diabetes and Digestive and Kidney Diseases grant 5T32DK007257-38. M. Ostrosky-Frid is supported by the Internal Medicine Physician Scientist Training Program. S. Hedayati is supported by the Yin Quan-Yuen Distinguished Professorship in Nephrology at the University of Texas Southwestern Medical Center, Dallas, Texas. Author Contributions
Publisher Copyright:
Copyright © 2021 by the American Society of Nephrology.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - The COVID-19 outbreak has had substantial effects on the incidence and management of kidney diseases, including AKI, ESKD, GN, and kidney transplantation. Initial reports from China suggested a lower AKI incidence in patients with COVID-19, but more recent studies from North America reveal a much higher incidence, likely due to the higher prevalence of comorbid conditions, such as hypertension, diabetes, and CKD. AKI in this setting is associated with worse outcomes, including the requirement for vasopressors or mechanical ventilation and death. Performing RRT in those with AKI poses challenges, such as limiting exposure of staff, preserving PPE, coagulopathy, and hypoxemia due to acute respiratory distress syndrome. Continuous RRT is the preferred modality, with sustained low-efficiency dialysis also an option, both managed without 1:1 hemodialysis nursing support. Regional citrate is the preferred anticoagulation, but systemic unfractionated heparin may be used in patients with coagulopathy. The ultrafiltration rate has to be set carefully, taking into consideration hypotension, hypoxemia, and responsiveness to presser and ventilatory support. The chance of transmission puts in-center chronic hemodialysis and other immunosuppressed patients at particularly increased risk. Limited data show that patients with CKD are also at increased risk for more severe disease, if infected. Little is known about the virus's effects on immunocompromised patients with glomerular diseases and kidney transplants, which introduces challenges for management of immunosuppressant regimens. Although there are no standardized guidelines regarding the management of immunosuppression, several groups recommend stopping the antimetabolite in hospitalized transplant patients and continuing a reduced dose of calcineurin inhibitors. This comprehensive review critically appraises the best available evidence regarding the effect of COVID-19 on the incidence and management of kidney diseases. Where evidence is lacking, current expert opinion and clinical guidelines are reviewed, and knowledge gaps worth investigation are identified.
AB - The COVID-19 outbreak has had substantial effects on the incidence and management of kidney diseases, including AKI, ESKD, GN, and kidney transplantation. Initial reports from China suggested a lower AKI incidence in patients with COVID-19, but more recent studies from North America reveal a much higher incidence, likely due to the higher prevalence of comorbid conditions, such as hypertension, diabetes, and CKD. AKI in this setting is associated with worse outcomes, including the requirement for vasopressors or mechanical ventilation and death. Performing RRT in those with AKI poses challenges, such as limiting exposure of staff, preserving PPE, coagulopathy, and hypoxemia due to acute respiratory distress syndrome. Continuous RRT is the preferred modality, with sustained low-efficiency dialysis also an option, both managed without 1:1 hemodialysis nursing support. Regional citrate is the preferred anticoagulation, but systemic unfractionated heparin may be used in patients with coagulopathy. The ultrafiltration rate has to be set carefully, taking into consideration hypotension, hypoxemia, and responsiveness to presser and ventilatory support. The chance of transmission puts in-center chronic hemodialysis and other immunosuppressed patients at particularly increased risk. Limited data show that patients with CKD are also at increased risk for more severe disease, if infected. Little is known about the virus's effects on immunocompromised patients with glomerular diseases and kidney transplants, which introduces challenges for management of immunosuppressant regimens. Although there are no standardized guidelines regarding the management of immunosuppression, several groups recommend stopping the antimetabolite in hospitalized transplant patients and continuing a reduced dose of calcineurin inhibitors. This comprehensive review critically appraises the best available evidence regarding the effect of COVID-19 on the incidence and management of kidney diseases. Where evidence is lacking, current expert opinion and clinical guidelines are reviewed, and knowledge gaps worth investigation are identified.
KW - COVID-19
KW - ICU nephrology
KW - acute kidney injury
KW - chronic kidney disease
KW - dialysis
KW - end stage kidney disease
UR - http://www.scopus.com/inward/record.url?scp=85132780395&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85132780395&partnerID=8YFLogxK
U2 - 10.34067/KID.0006362020
DO - 10.34067/KID.0006362020
M3 - Review article
C2 - 35368812
AN - SCOPUS:85132780395
SN - 2641-7650
VL - 2
SP - 141
EP - 153
JO - Kidney360
JF - Kidney360
IS - 1
ER -