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Impact of COVID-19 on patients with CKD and ESRD

April 1, 2020

This article was last updated on: Wednesday April 1 at 9:39am EDT  

Patients with Chronic Kidney Disease (CKD), particularly those at the advanced stages of the disease as well as dialysis patients are at particular risk of the impact of COVID-19. Underlying comorbidities are known to increase the mortality rate of COVID-19 and initial data suggests that people with (CKD) are at greater risk of a more serious COVID-19 infection.

If you are a patient with concerns about COVID-19 or kidney disease we recommend reviewing the guidance on the National Kidney Foundation website

Despite the increase in risk patients that are receiving dialysis treatment should continue attending their dialysis treatments. The American Society of Nephrology and CDC are providing guidance to dialysis centers to help them maintain operations amidst the COVID-19 outbreak. For further information on mitigating Risk of COVID-19 in dialysis facilities please consult the perspective piece from Drs. Alan S. Kliger and Jeffrey Silberzweig in CJASN. 

Although there is no specific data on the risk of COVID-19 in transplant recipients, transplant recipients are assumed to be at higher risk but should continue taking their medication. See discussion in NephJC for further information.    

Venous access surgery, placement of AV fistulas and grafts as well as peritoneal catheters, is considered to be an essential surgery and should continue while COVID restrictions are in effect. Please see COVID-19 Guidelines for Triage of Vascular Surgery Patients. However, we are aware that this is not the case in all medical centers. 

An article published in Parma, Italy [1] highlighted that kidney involvement is frequent in patients that tested positive for coronavirus and Acute Kidney Injury (AKI) might be a predictor of mortality in infected patients and highlighted two studies that have shown a higher rate of renal abnormalities in coronavirus-positive patients. For further information on AKI and COVID-19 see the write up in NephJC.

A study from 2 hospitals in Wuhan, 1 hospital in Huangshi (Hubei province, 83 km from Wuhan) and 1 hospital in Chongqing  (754 km from Wuhan) [2] reported that there were elevated proteinuria levels in 63% of hospitalized patients as well as hematuria. 27% of patients studied showed renal function impairment. 

A second study conducted in Wuhan [3] showed that 44% had both hematuria and proteinuria (26.7% had hematuria only) and renal function decline in 15% of patients. 

But reports suggests that renal failure requiring dialysis is reported in a subset of patients admitted to the ICU (probably ~5%) and it often tends to be a late finding, occurring 1-2 weeks after admission. The purported mechanism is acute tubular necrosis due to generalized multi-organ failure. A study from Wuhan [4] observed complement deposition in the tubules in six patients.  

There has been some discourse on the increased risk of COVID-19 amongst patients receiving ACEi/ARB medications. However at this time there is not sufficient evidence to support that ACEi/ARB usage places patients at specific risk and it is not recommended that patients who are taking ACE inhibitors or ARB change their therapy. Neph JC have written up a detailed discussion of this subject

Important considerations for CKD care providers: 

  • What is your strategy for telehealth consults?
  • Have you communicated the risks to your most in-need patients?  
  • Can you limit the amount of blood draws required and allow patients to get tested at home or closer to where they live? 
  • Are you able to ensure regular supplies of equipment/medications? 

If you have any questions about the topics discussed above or are in need of help please get in touch with info@pulsedata.io

pulseData is actively conducting data surveillance for our partners and clients to provide resources and to help identify at-risk population for COVID-19 using our data intelligence platform.

[1] Are Kidneys Targeted by the Novel Coronavirus? https://www.cathlabdigest.com/content/are-kidneys-targeted-novel-coronavirus

[2] Li Z, Wu M, Guo J et al. Caution on Kidney Dysfunctions of 2019-nCoV Patients. medRxiv preprint doi: https://doi.org/10.1101/2020.02.08.20021212

[3] Cheng Y, Luo R, Wang K, et al.  Kidney impairment is associated with in-hospital death of COVID-19 patients. doi: https://doi.org/10.1101/2020.02.18.20023242

[4] Bo Diao, Chenhui Wang, Rongshuai et al. Human Kidney is a Target for Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection doi: https://doi.org/10.1101/2020.03.04.20031120 

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