scholarly journals COVID-19 in CKD Patients: Lessons from 553 CKD Patients with Biopsy-Proven Kidney Disease

2021 ◽  
pp. 1-8
Author(s):  
Juan León Román ◽  
Clara García-Carro ◽  
Irene Agraz ◽  
Nestor Toapanta ◽  
Ander Vergara ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Kidney Disease ◽  
Kidney Biopsy ◽  
Cox Regression ◽  
Gastrointestinal Symptoms ◽  
Bivariate Analysis ◽  
Chronic Obstructive ◽  
Nasopharyngeal Swab ◽  
Obstructive Pulmonary Disease ◽  
Immunosuppressed Patients

<b><i>Introduction:</i></b> Chronic kidney disease (CKD) patients infected with COVID-19 are at risk of serious complications such as hospitalization and death. The prognosis and lethality of COVID-19 infection in patients with established kidney disease has not been widely studied. <b><i>Methods:</i></b> Data included patients who underwent kidney biopsy at the Vall d’Hebron Hospital between January 2013 and February 2020 with COVID-19 diagnosis during the period from March 1 to May 15, 2020. <b><i>Results:</i></b> Thirty-nine (7%) patients were diagnosed with COVID-19 infection. Mean age was 63 ± 15 years and 48.7% were male. Hypertension was present in 79.5%, CKD without renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients; older (<i>p</i> = 0.01), hypertensive (<i>p</i> = 0.005), and immunosuppressed (<i>p</i> = 0.01) patients, those using RAS-blocking drugs (<i>p</i> = 0.04), and those with gastrointestinal symptoms (<i>p</i> = 0.02) were more likely to be tested for CO­VID-19. Twenty-two patients required hospitalization and 15.4% died. In bivariate analysis, mortality was associated with older age (<i>p</i> = 0.03), cardiovascular disease (<i>p</i> = 0.05), chronic obstructive pulmonary disease (<i>p</i> = 0.05), and low hemoglobin levels (<i>p</i> = 0.006). Adjusted Cox regression showed that low hemoglobin levels at admission had 1.81 greater risk of mortality. <b><i>Conclusions:</i></b> Patients with CO­VID-19 infection and kidney disease confirmed by kidney biopsy presented a mortality of 15.4%. Swab test for COVID-19 was more likely to be performed in older, hypertensive, and immunosuppressed patients, those using RAS-blocking drugs, and those with gastrointestinal symptoms. Low hemoglobin is a risk factor for mortality.

scholarly journals MO151CLINICAL COURSE AND OUTCOMES OF COVID-19 PATIENTS WITH BIOPSY-PROVEN GLOMERULAR AND TUBULAR KIDNEY DISEASE. LOW HEMOGLOBIN LEVELS AS A RISK FACTOR FOR MORTALITY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Juan León Román ◽  
Clara García Carro ◽  
Irene Agraz ◽  
Néstor Toapanta ◽  
Ander Vergara Arana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
Kidney Biopsy ◽  
Cox Regression ◽  
Gastrointestinal Symptoms ◽  
Bivariate Analysis ◽  
Chronic Obstructive ◽  
Nasopharyngeal Swab

Abstract Background and Aims COVID-19 infection is responsible for respiratory infection with variable clinical expression from its asymptomatic form to severe pneumonia associated with acute respiratory distress syndrome and death. Risk factors related to higher mortality are age over 65 years, cardiovascular, pulmonary and kidney disease, hypertension, and diabetes. There is limited scientific literature on COVID-19 infection and previous kidney disease, specifically in patients with glomerular and tubular kidney disease. The aim of this study was to determine general characteristics, analytical parameters and clinical evolution of patients with kidney disease who have undergone kidney biopsy and who presented infection or high suspicion of infection by COVID-19. Identify mortality and associated risk factors. Method we studied patients with high clinical suspicion of infection or confirmed infection by COVID-19 from March 2020 to May 15, 2020 of all patients who underwent percutaneous renal biopsy at the Vall d'Hebron Hospital between January 2013 and December 2019. Results 39 of the 553 patients have been diagnosed with COVID-19 infection since March 2020. The average age was 63±15 years and 48.7% were male. Hypertension was present in 79.5% of patients, chronic kidney disease without renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients; older patients (p=0.01), patients with hypertension (p=0.005), immunosuppression (p=0.01), use of RAS-blocking drugs (p=0.04) and gastrointestinal symptoms (p=0.02) were more likely to be tested for COVID-19. 22 patients required hospitalization and 15.4% died. In the bivariate analysis, mortality was associated with older age (p=0.03), cardiovascular disease (p=0.05), chronic obstructive pulmonary disease (COPD) (p=0.05) and low hemoglobin levels (p=0.006). Adjusted Cox regression showed that low hemoglobin levels (10.12±1.89g/dL) at admission had 1.81 greater risk of mortality [1.04-3.13; p=0.04]. Conclusion Patients with COVID-19 infection and kidney disease confirmed by kidney biopsy presented mortality of 15.4%. Swab test for COVID-19 was more likely to be performed in older, hypertensive, use of RAS-blocking drugs, immunosuppressed patients and those with gastrointestinal symptoms. Low hemoglobin is a risk factor for mortality.

scholarly journals Analysis of fatality of cases by the new coronavirus, in the Mexican state of Guanajuato: A cross-sectional study

2020 ◽  
Author(s):  
Nicolas Padilla-Raygoza ◽  
Gilberto Flores-Vargas ◽  
Efrain Navarro-Olivos ◽  
Elia Lara-Lona ◽  
Maria de Gallardo-Luna ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pulmonary Disease ◽  
Case Fatality ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Case Fatality Ratio ◽  
Male Sex

Abstract Background. The spread of infection and disease of SARS-CoV-2 is in all the world affecting more than 200 countries. Mexico has high new cases of disease and death for COVID-19. Although Guanajuato state also has a high number of new cases, the fatality of cases is below the mean in Mexico.Methods. It was a cross-sectional design, using the database of National Epidemiological Surveillance System in Mexico. It was collected data about age, sex, comorbidities (diabetes, chronic obstructive pulmonary disease, asthma, hypertension, cardiovascular disease, immunosuppression, chronic kidney disease, obesity and smoking), date of death, and real-time reverse transcription polymerase test. The statistical analysis was using Case Fatality Ratio, Chi squared test and P-value to show relationship among variables and Odds Ratio and confidence intervals at 95% to show the effect of comorbidities on death due to COVID-19.Results. There were 100,109 suspected cases, 41.69% were positive for SARS-CoV-2. Age from 50 or higher and male sex had higher effect on fatality by COVID-19. In Guanajuato state, 48.68% of deaths occurred in Instituto Mexicano del Seguro Social, with a case fatality ratio 15.63% and in the Secretaría de Salud del estado de Guanajuato occurred 42.10% of the deaths with a case fatality ratio of 4.14%. Diabetes (OR 5.16, CI95% 4.77–5.59), chronic obstructive pulmonary disease (OR 6.34, CI95% 5.37–7.49), immunosuppression (OR 2.85, CI95% 2.17–3.76), cardiovascular disease (OR 4.20, CI95% 3.51–5.02), hypertension (OR 4.74, CI95% 4.39–5.11), chronic kidney disease (OR 6.27, CI95% 5.30–7.42), obesity (OR 1.87, CI95% 1.72–2.03), and smoking (OR 1.60, CI95% 1.41–1.81) had effect on death by COVID-19. In all cases age and male sex, acted as confounder. Asthma had a preventive effect on death by COVID-19 (OR=0.72, CI95% 0.54–0.97) Conclusion. Among the Guanajuato population with COVID-19, the main risk factor for dying were advanced age and male sex; diabetes, chronic obstructive pulmonary disease, immunosuppression, cardiovascular disease, chronic kidney disease, obesity, and smoking are risk factors for dying from COVID-19. HIV/AIDS has no effect on fatality from SARS-CoV-2 disease. Asthma is shown as a protective factor for dying from COVID-19.

scholarly journals Analysis of Fatality of Cases by the New Coronavirus, in the Mexican State of Guanajuato: A Cross-sectional Study

2021 ◽  
pp. 110-121
Author(s):  
Nicolas Padilla-Raygoza ◽  
Gilberto Flores-Vargas ◽  
Efraín Navarro-Olivos ◽  
María de Jesús Gallardo-Luna ◽  
Francisco Javier Magos-Vazquez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pulmonary Disease ◽  
Case Fatality ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Case Fatality Ratio

Aims: COVID-19 has been a big public health challenge around the world in the past several months. The aim of this study is to describe the epidemic and report of fatality of confirmed cases of COVID-19 in the Mexican state of Guanajuato, until October 2, 2020. Study Design:  Cross-sectional, quantitative, analytical study. Place and Duration of Study: Registries of confirmed cases for COVID-19 in Mexican population from January until October 2, 2020, from National System of Epidemiological Surveillance/ General Direction of Epidemiology/ Secretary of Health, Mexico. Methodology: Based on the National Epidemiological Surveillance System Database from Mexico was used in this study. Data were collected on age, sex, comorbidities (i.e., diabetes, chronic obstructive pulmonary disease, asthma, hypertension, cardiovascular disease, immunosuppression, chronic kidney disease, obesity, and smoking), date of death, and real-time reverse transcription polymerase test results. Statistical analyses used were Case Fatality Ratio, Chi- squared test and P-value to show relationships among variables. Odds Ratio and confidence intervals at 95% were reported to show the effect of comorbidities on death due to COVID-19. Also, a Bayesian network model was fitted to assess the statistical dependence among risk factors, comorbidities, and death. Results: There were 100,109 suspected cases, of which 41.69% were positive for SARS-CoV-2. Being older than 60 and male had a higher effect on fatality by COVID-19. In Guanajuato state, 1,457 (48.68%) of deaths occurred in Mexican Institute of Social Security, with a case fatality ratio of 15.63%; meanwhile, in the Ministry of Health from Guanajuato State occurred 1,260 (42.10%) of the deaths with a case fatality ratio of 4.14%. Diabetes (OR 5.16, CI95% 4.77–5.59), chronic obstructive pulmonary disease (OR 6.34, CI95% 5.37–7.49), immunosuppression (OR 2.85, CI95% 2.17–3.76), cardiovascular disease (OR 4.20, CI95% 3.51–5.02), hypertension (OR 4.74, CI95% 4.39–5.11), chronic kidney disease (OR 6.27, CI95% 5.30–7.42), obesity (OR 1.87, CI95% 1.72–2.03), and smoking (OR 1.60, CI95% 1.41–1.81) had effect on death by COVID-19. Asthma had a preventive effect on death (OR=0.72, CI95% 0.54–0.97), but this effect is diluted after adjusting by sex and age. In all cases, age and sex, acted as confounder. Conclusion: Among the Guanajuato population with COVID-19, the main risk factor for dying were age and sex. However, diabetes, chronic obstructive pulmonary disease, immunosuppression, cardiovascular disease, chronic kidney disease, obesity, and smoking are risk factors for dying. Although, comorbidities and risk factors are highly correlated.  HIV/AIDS has no effect on fatality from SARS-CoV-2 disease and whereas asthma shows to be a protective factor.

scholarly journals The chronic ischaemic cardiovascular disease ESC Pilot Registry: Results of the six-month follow-up

2018 ◽  
Vol 25 (4) ◽  
pp. 377-387 ◽  
Author(s):  
Michel Komajda ◽  
Mathieu Kerneis ◽  
Luigi Tavazzi ◽  
Serban Balanescu ◽  
Francesco Cosentino ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pulmonary Disease ◽  
Clinical Outcomes ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
History Of

Aim Chronic ischaemic cardiovascular disease (CICD) remains a leading cause of morbidity and mortality worldwide. The CICD Pilot Registry enrolled 2420 patients across 10 European Society of Cardiology countries prospectively to describe characteristics, management strategies and clinical outcomes in this setting. We report here the six-month outcomes. Methods and results From the overall population, 2203 patients were analysed at six months. Fifty-eight patients (2.6%) died after inclusion; 522 patients (23.7%) experienced all-cause hospitalisation or death. The rate of prescription of angiotensin-converting enzyme inhibitors, beta-blockers and aspirin was mildly decreased at six months (all P < 0.02). Patients who experienced all-cause hospitalisation or death were older, more often had a history of non-ST-segment elevation myocardial infarction, of chronic kidney disease, peripheral revascularisation and/or chronic obstructive pulmonary disease than those without events. Independent predictors of all-cause mortality/hospitalisation were age (hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.07–1.27) per 10 years, and a history of previous peripheral revascularisation (HR 1.45, 95% CI 1.03–2.03), chronic kidney disease (HR 1.31, 95% CI 1.0–1.68) or chronic obstructive pulmonary disease (HR 1.42, 95% CI 1.06–1.91, all P < 0.05). We observed a higher rate of events in eastern, western and northern countries compared to southern countries and in cohort 1. Conclusion In this contemporary European registry of CICD patients, the rate of severe clinical outcomes at six months was high and was influenced by age, heart rate and comorbidities. The medical management of this condition remains suboptimal, emphasising the need for larger registries with long-term follow-up. Ad-hoc programmes aimed at implementing guidelines adherence and follow-up procedures are necessary, in order to improve quality of care and patient outcomes.

scholarly journals A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease

2019 ◽  
Vol 75 (3) ◽  
pp. 522-528 ◽  
Author(s):  
Rasheeda K Hall ◽  
Hui Zhou ◽  
Kristi Reynolds ◽  
Teresa N Harrison ◽  
C Barrett Bowling
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Emergency Department ◽  
Kidney Disease ◽  
Cox Regression ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Ulcer Disease

Abstract Background Older adults with chronic kidney disease (CKD)-discordant conditions (comorbid conditions with treatment recommendations that potentially complicate CKD management) have higher risk of hospitalization and death. Our goal is to develop a CKD-Discordance Index using electronic health records to improve recognition of discordance. Methods This retrospective cohort study included Kaiser Permanente Southern California patients aged ≥65 years and older with incident CKD (N = 30,932). To guide inclusion of conditions in the Index and weight each condition, we first developed a prediction model for 1-year hospitalization risk using Cox regression. Points were assigned proportional to regression coefficients derived from the model. Next, the CKD-Discordance Index was calculated as an individual’s total points divided by the maximum possible discordance points. The association between CKD-Discordance Index and hospitalizations, emergency department visits, and mortality was accessed using multivariable-adjusted Cox regression model. Results Overall, mean (SD) age was 77.9 (7.6) years, 55% of participants were female, 59.3% were white, and 32% (n = 9,869) had ≥1 hospitalization during 1 year of follow-up. The CKD-Discordance Index included the following variables: heart failure, gastroesophageal reflux disease/peptic ulcer disease, osteoarthritis, dementia, depression, cancer, chronic obstructive pulmonary disease/asthma, and having four or more prescribers. Compared to those with a CKD-Discordance Index of 0, adjusted hazard ratios (95% confidence interval) for hospitalization were 1.39 (1.27–1.51) and 1.81 (1.64–2.01) for those with a CKD-Discordance Index of 0.001–0.24 and ≥0.25, respectively (ptrend &lt; .001). A graded pattern of risk was seen for emergency department visits and all-cause mortality. Conclusion A data-driven approach identified CKD-discordant indicators for a CKD-Discordance Index. Higher CKD-Discordance Index was associated with health care utilization and mortality.

scholarly journals Clinical features and prognostic analysis of patients with Aspergillus isolation during acute exacerbation of chronic obstructive pulmonary disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu Gu ◽  
Xianping Ye ◽  
Yu Wang ◽  
Kunlu Shen ◽  
Jinjin Zhong ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Clinical Features ◽  
Antifungal Therapy ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Positive Culture ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background Lower respiratory tract (LRT) specimen culture is widely performed for the identification of Aspergillus. We investigated the clinical features and prognosis of patients with Aspergillus isolation from LRT specimens during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This is a 6-year single-center, real-world study. 75 cases out of 1131 hospitalized AECOPD patients were positive for Aspergillus. These patients were carefully evaluated and finally diagnosed of pulmonary aspergillosis (PA, 60 cases, 80%) or colonization (15 cases, 20%). Comparisons of clinical data were performed between these two groups. A cox regression model was used to confirm prognostic factors of Aspergillus infection. Results The PA group had worse lung function and higher rates of systemic corticosteroid use and broad-spectrum antibiotic use before admission than the colonization group. The PA group had significantly higher in-hospital mortality and 180-day mortality than the colonization group (45% (27/60) vs. 0% (0/15), p = 0.001, and 52.5% (31/59) vs. 6.7% (1/15), p < 0.001, respectively). By multivariable analysis among Aspergillus infection patients, antifungal therapy (HR 0.383, 95% CI 0.163–0.899, p = 0.027) was associated with improved survival, whereas accumulated dose of systemic steroids > 700 mg (HR 2.452, 95% CI 1.134–5.300, p = 0.023) and respiratory failure at admission (HR 5.983, 95% CI 2.487–14.397, p < 0.001) were independently associated with increased mortality. Significant survival differential was observed among PA patients without antifungals and antifungals initiated before and after Aspergillus positive culture (p = 0.001). Conclusions Aspergillus isolation in hospitalized AECOPD patients largely indicated PA. AECOPD patients with PA had worse prognosis than those with Aspergillus colonization. Empirical antifungal therapy is warranted to improve the prognosis for Aspergillus infection.

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