COVID-19: In Context

Changes in Treatment of Patients with Incident End-Stage Kidney Disease During the Novel Coronavirus Disease 2019 Pandemic

james.wetmore@hcmed.org — Fri, 17 Sep 2021 10:39:33 GMT-07:00

Background: The COVID-19 pandemic caused major disruptions to care for patients with advanced CKD. Methods: We investigated the incidence of documented ESKD, ESKD treatment modalities, changes in eGFR at dialysis initiation, and use of incident central venous catheters (CVCs) by epidemiologic week during the first half of 2020 compared to 2017-2019 historical trends, using Centers for Medicare & Medicaid Services data. We used Poisson and logistic regression for analyses of incidence and binary outcomes, respectively. Results: Incidence of documented ESKD dropped dramatically in 2020 compared with the expected incidence, particularly during epidemiologic weeks 15-18 (April; incidence rate ratio [IRR] 0.75, 95% CI 0.73-0.78). The decrease was most pronounced for individuals aged ≥75 years (IRR 0.69, 0.66-0.73). Preemptive kidney transplantation decreased markedly during weeks 15-18 (IRR 0.56, 0.46-0.67). Mean eGFR at dialysis initiation decreased by 0.33 mL/min/1.73 m2 in weeks 19-22; non-Hispanic Black patients exhibited the largest decrease, at 0.61 mL/min/1.73 m2. The odds of initiating dialysis with eGFR <10 ml/min/1.73 m2 were highest during weeks 19-22 (May; OR 1.14, 1.05-1.17), corresponding to an absolute increase of 2.9%. The odds of initiating peritoneal dialysis (versus hemodialysis) were 24% higher (OR 1.24, 1.14-1.34) in weeks 11-14, an absolute increase of 2.3%. Initiation with a CVC increased by 3.3% (OR 1.30, 1.20-1.41). Conclusions: During the first wave of the COVID-19 pandemic, the number of patients starting treatment for ESKD fell to a level not observed since 2011. Changes in documented ESKD incidence and other aspects of ESKD-related care may reflect differential access to care early in the pandemic.

Glomerular Disease in Temporal Association to SARS-CoV-2 Vaccination - A Series of 29 Cases

tiffany.caza@arkanalabs.com — Thu, 16 Sep 2021 09:50:05 GMT-07:00

Background: Immune responses to vaccination are a known trigger for a new onset of glomerular disease or disease flare in susceptible individuals. Mass immunization against SARS-CoV-2 in the COVID-19 pandemic provides a unique opportunity to study vaccination-associated autoimmune kidney diseases. In the recent literature, there are several case reports demonstrating a temporal association of SARS-CoV-2 immunization and kidney diseases. Methods: Here, we present a series of 29 cases of biopsy-proven glomerular disease in patients recently vaccinated against SARS-CoV-2 and identified patients who developed a new onset of IgA nephropathy, minimal change disease, membranous nephropathy, ANCA-associated glomerulonephritis, collapsing glomerulopathy, and diffuse lupus nephritis diagnosed on kidney biopsies post-immunization, as well as recurrent ANCA-associated glomerulonephritis. This included 28 cases of de novo glomerulonephritis within native kidney biopsies and one disease flare in an allograft. Results: The patients with collapsing glomerulopathy were of African American descent and had two APOL1 genomic risk alleles. A brief literature review of case reports and small series is also provided to include all reported cases to date (n=52). The incidence of induction of glomerular disease in response to SARS-CoV-2 immunization is unknown, however, there was no overall increase in incidence of glomerular disease when compared to the two years prior to the COVID-19 pandemic diagnosed on kidney biopsies in our practice. Conclusions: This suggests that glomerulonephritis in response to vaccination is rare, although should be monitored as a potential adverse event.

Extracorporeal blood purification is appropriate in critically ill patients with COVID-19 and multi-organ failure: CON

kashani.kianoush@mayo.edu — Thu, 19 Aug 2021 01:30:39 GMT-07:00

This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the PRO: 10.34067/KID.0006632020 and the COMMENTARY 10.34067/KID.0005242021

Extracorporeal blood purification is appropriate in critically ill patients with COVID-19 and multi-organ failure: PRO

kevin.chung@usuhs.edu — Thu, 19 Aug 2021 01:30:39 GMT-07:00

This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the CON: 10.34067/KID.0007382020 and the COMMENTARY 10.34067/KID.0005242021

Extracorporeal blood purification is appropriate in critically ill patients with COVID-19 and multi-organ failure: COMMENTARY

Marlies.Ostermann@gstt.nhs.uk — Thu, 19 Aug 2021 01:30:39 GMT-07:00

This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the PRO: 10.34067/KID.0006632020 and the CON: 10.34067/KID.0007382020

Evidence-Based Practices to Reduce COVID-19 Transmission in Dialysis Facilities

Kliger, Alan S. — Wed, 04 Aug 2021 06:10:08 GMT-07:00

Keeping Dialysis Patients Safe

Wager, Roberta L. — Wed, 04 Aug 2021 06:10:08 GMT-07:00

Prioritizing Peritoneal Catheter Placement during the COVID-19 Pandemic

Oliver, Matthew J. — Fri, 12 Mar 2021 06:08:00 GMT-08:00

Living Organ Donor Hesitancy about COVID-19 Vaccines: A New Kind of “Source Control Issue”

Jorgenson, Margaret R. — Thu, 29 Jul 2021 05:30:28 GMT-07:00

Risks and Benefits of Kidney Transplantation during the COVID-19 Pandemic: Transplant or Not Transplant?

Ajaimy, Maria — Thu, 13 May 2021 05:57:09 GMT-07:00

COVID-19 has significantly affected the transplant community, by leading to decreased transplant activity and increased waiting list time. As expected, COVID-19 causes substantial mortality in both ESKD and kidney transplant populations. This is due to underlying CKD and a high prevalence of comorbid conditions, such as diabetes mellitus, hypertension, and cardiovascular disease in this group. Transplant programs have faced the difficult decision of weighing the risks and benefits of transplantation during the pandemic. On one hand, there is a risk of COVID-19 exposure leading to infection while patients are on maximum immunosuppression. Alternatively, there are risks of delaying transplantation, which will increase waitlist times and may lead to waitlist-associated morbidity and mortality. Cautious and thoughtful selection of both the recipient’s and donor’s post-transplant management has been required during the pandemic, to mitigate the risk of morbidity and mortality associated with COVID-19. In this review article, we aimed to discuss previous publications related to clinical outcomes of COVID-19 disease in kidney transplant recipients, patients with ESKD on dialysis, or on the transplant waiting list, and the precautions transplant centers should take in decision making for recipient and donor selection and immunosuppressive management during the pandemic. Nevertheless, transplantation in this milieu does seem to be the correct decision, with careful patient and donor selection and safeguard protocols for infection prevention. Each center should conduct risk assessment on the basis of the patient’s age and medical comorbidities, waitlist time, degree of sensitization, cold ischemia time, status of vaccination, and severity of pandemic in their region.

Shining More Light on RAS Inhibition during the COVID-19 Pandemic

Rianto, Fitra — Mon, 12 Jul 2021 07:54:45 GMT-07:00

Balancing the Needs of Acute and Maintenance Dialysis Patients during the COVID-19 Pandemic

Carson, Rachel C. — Mon, 08 Feb 2021 09:47:52 GMT-08:00

The COVID-19 pandemic continues to strain health care systems and drive shortages in medical supplies and equipment around the world. Resource allocation in times of scarcity requires transparent, ethical frameworks to optimize decision making and reduce health care worker and patient distress. The complexity of allocating dialysis resources for both patients receiving acute and maintenance dialysis has not previously been addressed. Using a rapid, collaborative, and iterative process, BC Renal, a provincial network in Canada, engaged patients, doctors, ethicists, administrators, and nurses to develop a framework for addressing system capacity, communication challenges, and allocation decisions. The guiding ethical principles that underpin this framework are (1) maximizing benefits, (2) treating people fairly, (3) prioritizing the worst-off individuals, and (4) procedural justice. Algorithms to support resource allocation and triage of patients were tested using simulations, and the final framework was reviewed and endorsed by members of the provincial nephrology community. The unique aspects of this allocation framework are the consideration of two diverse patient groups who require dialysis (acute and maintenance), and the application of two allocation criteria (urgency and prognosis) to each group in a sequential matrix. We acknowledge the context of the Canadian health care system, and a universal payer in which this framework was developed. The intention is to promote fair decision making and to maintain an equitable reallocation of limited resources for a complex problem during a pandemic.

mRNA COVID-19 Vaccine for People with Kidney Failure: Hope but Prudence Warranted

Miskulin, Dana C. — Thu, 27 May 2021 09:25:51 GMT-07:00

Nephrology—Taking the Lead

Agarwal, Anupam — Mon, 01 Mar 2021 06:01:34 GMT-08:00

Vaccine and the Need To Be Heard: Considerations for COVID-19 Immunization in ESKD

Srivatana, Vesh — Thu, 08 Apr 2021 01:50:57 GMT-07:00

High Incidence of Circuit Clotting in Critically Ill COVID-19 Patients Treated with Renal Replacement Therapy

Grenon, Eloïse — Fri, 28 May 2021 10:31:36 GMT-07:00

Mass Disasters and Burnout in Nephrology Personnel

Sever, Mehmet Sukru — Thu, 07 Jan 2021 09:39:06 GMT-08:00

Mass disasters result in extensive health problems and make health care delivery problematic, as has been the case during the COVID-19 pandemic. Although COVID-19 was initially considered a pulmonary problem, it soon became clear that various other organs were involved. Thus, many care providers, including kidney health personnel, were overwhelmed or developed burnout. This review aims to describe the spectrum of burnout in mass disasters and suggests solutions specifically for nephrology personnel by extending previous experience to the COVID-19 pandemic. Burnout (a psychologic response to work-related stress) is already a frequent part of routine nephrology practice and, not surprisingly, is even more common during mass disasters due to increased workload and specific conditions, in addition to individual factors. Avoiding burnout is essential to prevent psychologic and somatic health problems in personnel as well as malpractice, understaffing, and inadequate health care delivery, all of which increase the health care burden of disasters. Burnout may be prevented by predisaster organizational measures, which include developing an overarching plan and optimizing health care infrastructure, and ad hoc disaster-specific measures that encompass both organizational and individual measures. Organizational measures include increasing safety, decreasing workload and fear of malpractice, optimizing medical staffing and material supplies, motivating personnel, providing mental health support, and enabling flexibility in working circumstances. Individual measures include training on coping with stress and problematic conditions, minimizing the stigma of emotional distress, and maintaining physical health. If these measures fall short, asking for external help is mandatory to avoid an inefficient disaster health care response. Minimizing burnout by applying these measures will improve health care provision, thus saving as many lives as possible.

COVID-19 and Dialysis Patients: Unsolved Problems in Early 2021

Kliger, Alan S. — Fri, 26 Feb 2021 10:17:36 GMT-08:00

SARS-CoV-2 Vaccines in Kidney Transplant Recipients: Will They Be Safe and Effective and How Will We Know?

Heldman, Madeleine R. — Wed, 24 Mar 2021 07:54:56 GMT-07:00

COVID-19 and AKI: Where Do We Stand?

Palevsky, Paul M. — Fri, 26 Feb 2021 10:17:36 GMT-08:00

Meeting the Demand for Renal Replacement Therapy during the COVID-19 Pandemic: A Manufacturer’s Perspective

Anger, Michael S. — Tue, 29 Dec 2020 01:46:37 GMT-08:00

Authors' Reply

Clarke, Candice L. — Tue, 29 Sep 2020 11:07:03 GMT-07:00

Remdesivir in COVID-19 Patients with Impaired Renal Function

Gevers, Sanna — Thu, 21 Jan 2021 10:45:06 GMT-08:00

Authors’ Reply

Adamsick, Meagan L. — Thu, 21 Jan 2021 10:45:07 GMT-08:00

Living behind the Mask amid Two Pandemics: COVID-19 and Social Injustice

Gee, Patrick O. — Tue, 08 Dec 2020 01:29:19 GMT-08:00

Effect of COVID-19 on Kidney Disease Incidence and Management

McAdams, Meredith — Tue, 24 Nov 2020 10:19:10 GMT-08:00

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.

COVID-19 and APOL1: Understanding Disease Mechanisms through Clinical Observation

Friedman, David J. — Mon, 07 Dec 2020 08:43:40 GMT-08:00

Does SARS-CoV-2 Infect the Kidney?

Khan, Shaza — Tue, 13 Oct 2020 06:52:13 GMT-07:00

Management of Hemodialysis Patients with Suspected or Confirmed COVID-19 Infection: Perspective from the Spanish Nephrology

Sánchez-Alvarez, Emilio — Fri, 11 Sep 2020 09:31:44 GMT-07:00

Beware the Ides of March: A Fellow’s Perspective on Surviving the COVID-19 Pandemic

Hindi, Judy — Thu, 24 Sep 2020 01:29:45 GMT-07:00

The Characteristics, Dynamics, and the Risk of Death in COVID-19 Positive Dialysis Patients in London, UK

Kular, Dalvir — Thu, 10 Sep 2020 08:21:38 GMT-07:00

COVID-19–Associated Acute Kidney Injury

Siew, Edward D. — Tue, 22 Sep 2020 12:25:26 GMT-07:00

Correction

American Society of Nephrology — Wed, 30 Sep 2020 10:00:27 GMT-07:00

Perspectives on COVID-19 from Singapore: Impact on ESKD Care and Medical Education

Coffman, Thomas M. — Tue, 18 Aug 2020 05:47:30 GMT-07:00

The Early Days

Roberts, Glenda V. — Wed, 29 Jul 2020 08:58:42 GMT-07:00

Caution in Identifying Coronaviruses by Electron Microscopy

Miller, Sarah E. — Fri, 10 Jul 2020 10:44:14 GMT-07:00

Postmortem Kidney Pathology Findings in Patients with COVID-19

Santoriello, Dominick — Wed, 29 Jul 2020 09:04:12 GMT-07:00

Authors’ Reply

Farkash, Evan A. — Wed, 12 Aug 2020 05:49:14 GMT-07:00

Kidney Involvement in COVID-19: Need for Better Definitions

Delsante, Marco — Thu, 09 Jul 2020 07:56:55 GMT-07:00

Rationing Scarce Resources: The Potential Impact of COVID-19 on Patients with Chronic Kidney Disease

Silberzweig, Jeffrey — Wed, 15 Jul 2020 12:55:08 GMT-07:00

Increasing Peritoneal Dialysis Use in Response to the COVID-19 Pandemic: Will It Go Viral?

Brown, Edwina A. — Mon, 03 Aug 2020 08:33:52 GMT-07:00

Technology, Telehealth, and Nephrology: The Time Is Now

Jain, Gaurav — Wed, 03 Jun 2020 10:15:34 GMT-07:00

Response to COVID-19 Infection in Hemodialysis Patients: An Australian Perspective

Polkinghorne, Kevan R. — Fri, 19 Jun 2020 09:12:27 GMT-07:00

COVID-19 in Patients with Kidney Disease

Ajaimy, Maria — Tue, 07 Jul 2020 07:17:46 GMT-07:00

Long-Term Hemodialysis during the COVID-19 Pandemic

Gedney, Nieltje — Thu, 02 Jul 2020 07:49:00 GMT-07:00

Possible Protective Effect of Renin-Angiotensin System Inhibitors in COVID-19 Induced Acute Kidney Injury

Kow, Chia Siang — Wed, 01 Jul 2020 08:29:06 GMT-07:00

COVID-19, Racism, and Racial Disparities in Kidney Disease: Galvanizing the Kidney Community Response

Crews, Deidra C. — Mon, 13 Jul 2020 11:02:22 GMT-07:00

This article contains a podcast athttps://www.asn-online.org/media/podcast/JASN/2020_07_21_JASN2020060809.mp3

Authors’ Reply

Batlle, Daniel — Wed, 01 Jul 2020 08:29:06 GMT-07:00

CKRT Clotting and Cerebrovascular Accident in a Critically Ill Patient

Cervantes, Carmen Elena — Thu, 30 Jul 2020 05:30:20 GMT-07:00

COVID-19: A Home Dialysis Nurse Perspective

Bushey, Margaret — Thu, 04 Jun 2020 01:34:49 GMT-07:00

Acute Kidney Injury in the Time of COVID-19

Chan, Lili — Thu, 11 Jun 2020 09:42:44 GMT-07:00

Genetic Roadmap for Kidney Involvement of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection

Zhang, Yue-miao — Thu, 23 Apr 2020 06:00:39 GMT-07:00

Acute Kidney Injury in COVID-19: Emerging Evidence of a Distinct Pathophysiology

Batlle, Daniel — Mon, 04 May 2020 10:56:16 GMT-07:00

Remdesivir in Patients with Acute or Chronic Kidney Disease and COVID-19

Adamsick, Meagan L. — Mon, 08 Jun 2020 05:30:27 GMT-07:00

Disaster Response to the COVID-19 Pandemic for Patients with Kidney Disease in New York City

Thu, 04 Jun 2020 05:58:30 GMT-07:00

Acute Abdominal Pain in a COVID-19 Patient

Mocerino, Ryan — Thu, 25 Jun 2020 05:30:20 GMT-07:00

Early Use of Telehealth in Home Dialysis during the COVID-19 Pandemic in New York City

Srivatana, Vesh — Tue, 28 Apr 2020 09:39:51 GMT-07:00

Providing Care to Patients with AKI and COVID-19 Infection: Experience of Front Line Nephrologists in New York

Fisher, Molly — Wed, 06 May 2020 01:43:10 GMT-07:00

COVID-19 Perspective from a Hemodialysis Patient

Allon, Michael — Thu, 07 May 2020 01:26:35 GMT-07:00

Impending Shortages of Kidney Replacement Therapy for COVID-19 Patients

Goldfarb, David S. — Tue, 28 Apr 2020 06:21:15 GMT-07:00

How COVID-19 Has Changed the Management of Glomerular Diseases

Bomback, Andrew S. — Fri, 24 Apr 2020 04:43:33 GMT-07:00

Outpatient Management of the Kidney Transplant Recipient during the SARS-CoV-2 Virus Pandemic

Gleeson, Shana E. — Tue, 28 Apr 2020 06:21:15 GMT-07:00

The Immunocompromised Transplant Recipient and SARS-CoV-2 Infection

Fishman, Jay A. — Tue, 28 Apr 2020 02:53:06 GMT-07:00

Counterpoint: Twice-Weekly Hemodialysis Should Be an Approach of Last Resort Even in Times of Dialysis Unit Stress

Mehrotra, Rajnish — Thu, 16 Apr 2020 06:17:58 GMT-07:00

COVID-19 and Calcineurin Inhibitors: Should They Get Left Out in the Storm?

Willicombe, Michelle — Mon, 20 Apr 2020 12:06:55 GMT-07:00

Twice-Weekly Hemodialysis Is an Option for Many Patients in Times of Dialysis Unit Stress

Meyer, Timothy W. — Thu, 16 Apr 2020 06:17:58 GMT-07:00

Peritoneal Dialysis for Acute Kidney Injury Treatment in the United States: Brought to You by the COVID-19 Pandemic

Srivatana, Vesh — Fri, 24 Apr 2020 02:30:46 GMT-07:00

Delivering Safe and Effective Hemodialysis in Patients with Suspected or Confirmed COVID-19 Infection: A Single-Center Perspective from Italy

Gallieni, Maurizio — Fri, 17 Apr 2020 10:39:57 GMT-07:00

On the Frontline of the COVID-19 Outbreak

Watnick, Suzanne — Sat, 28 Mar 2020 07:24:34 GMT-07:00

Sound Science before Quick Judgement Regarding RAS Blockade in COVID-19

Sparks, Matthew A. — Fri, 27 Mar 2020 02:03:21 GMT-07:00

Lessons from the Experience in Wuhan to Reduce Risk of COVID-19 Infection in Patients Undergoing Long-Term Hemodialysis

Li, Junhua — Thu, 02 Apr 2020 01:32:19 GMT-07:00

COVID-19 and the Inpatient Dialysis Unit

Burgner, Anna — Fri, 03 Apr 2020 02:54:11 GMT-07:00

Mitigating Risk of COVID-19 in Dialysis Facilities

Kliger, Alan S. — Fri, 20 Mar 2020 01:20:05 GMT-07:00

Management of Hemodialysis Patients with Suspected or Confirmed COVID-19 Infection: Perspective of Two Nephrologists in the United States

Mokrzycki, Michele H. — Wed, 25 Mar 2020 12:38:59 GMT-07:00