scholarly journals FC 027COVID-19 IN PATIENTS ON KIDNEY REPLACEMENT THERAPY - CLINICAL CHARACTERISTICS AT TRIAGE ASSOCIATED WITH ADMISSION, READMISSION AND SHORT-TERM OUTCOMES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sandip Mitra ◽  
Anu Jayanti ◽  
Priya Vart ◽  
Armando Coca ◽  
Maurizio Gallieni ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Kidney Transplant ◽  
Care Pathway ◽  
Initial Assessment ◽  
Pulmonary Insufficiency ◽  
Clinical Approach ◽  
Kidney Transplant Recipients ◽  
Short Term ◽  
Clinical Frailty Scale ◽  
Kidney Replacement Therapy

Abstract Background and Aims Patients on kidney replacement therapy (KRT) are at high risk of developing severe COVID-19 illness and often require high intensity care and utilisation of hospital resources. During the ongoing pandemic, the optimal care pathway and triage for KRT patients presenting with varying severity of COVID-19 illness is unknown. We studied clinical factors and outcomes associated with admission, readmission and short-term outcomes. Method Data from the European Renal Association COVID-19 Database (ERACODA) was analysed. This database includes granular data on dialysis patients and kidney transplant recipients with COVID-19 from all over Europe. The clinical and laboratory features at first presentation of hospitalized and non-hospitalized patients and those who returned for second presentation were studied. In addition, possible predictors of outcome in those who were not hospitalized at first presentation were identified. Results Among 1,423 KRT patients (haemodialysis; 1017/kidney transplant; 406) with COVID-19, 25% (n=355) were not hospitalized at first presentation. Of them, only 10% (n=36), presented for a second time in the hospital. The median interval between the first and second presentation was 5 days (Interquartile interval: 2-7 days). Patients who re-presented had worsening of pulmonary symptoms, a fall in oxygen saturation (97% to 90%), and an increase in C-reactive protein (26 mg/L to 73 mg/L) between their attendances. Patients who re-presented after initial assessment were older (72 vs. 63 years) and initially more often had pulmonary symptoms and abnormalities on lung imaging compared with those who did not present for a second time. The 28-day mortality rate of patients admitted at the second presentation was similar to that of patients admitted at first presentation (26.5% vs. 29.7%, p=0. 61). Among patients who were not hospitalized at first presentation (mortality 6%), age, prior smoking, clinical frailty scale, and shortness of breath at first presentation were identified as predictors of mortality. Conclusion KRT patients with COVID-19 and mild pulmonary abnormalities and no signs of pulmonary insufficiency can be safely returned without hospitalization. These patients should be advised to seek immediate contact when they develop respiratory distress. Our findings provide support for a risk-stratified clinical approach to admissions of KRT patients presenting with COVID-19. The study findings may be valuable for clinical triage and optimising hospital capacity utilisation during the ongoing pandemic.

scholarly journals FC 028COVID-19 RELATED MORTALITY IN KIDNEY TRANSPLANT AND DIALYSIS PATIENTS: A COMPARATIVE, PROSPECTIVE REGISTRY BASED STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Alexandre Candellier ◽  
Eric Jean Goffin ◽  
Priya Vart ◽  
Marlies Noordzij ◽  
Miha Arnol ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Replacement Therapy ◽  
Kidney Transplant ◽  
Hemodialysis Patients ◽  
Cox Proportional Hazards ◽  
Elderly Subjects ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Kidney Replacement Therapy ◽  
Adjusted Model

Abstract Background and Aims Studies examining kidney failure patients with COVID-19 reported higher mortality in hemodialysis patients than in kidney transplant recipients. However, hemodialysis patients are often older and have more comorbidities. This study investigated the association of type of kidney replacement therapy with COVID-19 severity adjusting for differences in characteristics. Method Data were retrieved from the European Renal Association COVID-19 Database (ERACODA), which includes kidney replacement therapy patients diagnosed with COVID-19 from all over Europe. We included all kidney transplant recipients and hemodialysis patients who presented between February 1st and December 1st 2020 and had complete information reason for COVID-19 screening and vital status at day 28. The diagnosis of COVID-19 was made based on a PCR of a nasal or pharyngeal swab specimens and/or COVID-19 compatible findings on a lung CT scan. The association of kidney transplantation or hemodialysis with 28-day mortality was examined using Cox proportional-hazards regression models adjusted for age, sex, frailty and comorbidities. Additionally, this association was investigated in the subsets of patients that were screened because of symptoms or have had routine screening. Results A total of 1,670 patients (496 functional kidney transplant recipients and 1,174 hemodialysis patients) were examined. 16.9% of kidney transplant recipients and 23.9% of hemodialysis patients died within 28 days of presentation. In an unadjusted model, the risk of 28-day mortality was 33% lower in kidney transplant recipients compared with hemodialysis patients (hazard ratio (HR): 0.67, 95% CI: 0.52, 0.85). However, in an age, sex and frailty adjusted model, the risk of 28-day mortality was 29% higher in kidney transplant recipients (HR=1.29, 95% CI: 1.00, 1.68), whereas in a fully adjusted model the risk was even 43% higher (HR=1.43, 95% CI: 1.06, 1.93). This association in patients who were screened because of symptoms (n=1,145) was similar (fully adjusted model HR=1.46, 95% CI: 1.05, 2.04). Results were similar when other endpoints were studied (e.g. risk for hospitalization, ICU admission or mortality beyond 28 days) as well as across subgroups. Only age was found to interact significantly, suggesting that the increased mortality risk associated with kidney transplantation was especially present in elderly subjects. Conclusion In this study, kidney transplant recipients had a greater risk of a more severe course of COVID-19 compared with hemodialysis patients when adjusted for age, sex and comorbidities.

scholarly journals Evaluation of PROMIS Preference Scoring System (PROPr) in Patients Undergoing Hemodialysis or Kidney Transplant

2021 ◽  
pp. CJN.01880221
Author(s):  
Jing Zhang ◽  
Barry Dewitt ◽  
Evan Tang ◽  
Daniel Breitner ◽  
Mohammed Saqib ◽  
...  
Keyword(s):  
Construct Validity ◽  
Replacement Therapy ◽  
Kidney Transplant ◽  
Short Form ◽  
Health Condition ◽  
Measurement Information ◽  
Kidney Transplant Recipients ◽  
Cross Sectional ◽  
Patient Reported ◽  
Kidney Replacement Therapy

Background and Objectives A preference-based health utility score (PROPr) can be calculated using Patient-Reported Outcomes Measurement Information System domain scores. We assessed the construct validity of PROPr among patients treated with kidney replacement therapy (hemodialysis or kidney transplant). Design, setting, participants and measurements Secondary analysis of data collected in multicenter, cross-sectional studies of adults treated with kidney replacement therapy, recruited between April 2016 to March 2020 in Toronto, Canada. All participants provided informed consent. The outcome was PROPr score. Co-administered outcome variables included the Short form 6-domain (SF-6D) and EuroQol 5-domain 5-level (EQ-5D-5L) scores. Socioeconomic and clinical variables included age, sex, diabetes, estimated Glomerular Filtration Rate (eGFR), serum albumin, hemoglobin, kidney replacement therapy and Charlson-comorbidity index. Construct validity was assessed through correlations between PROPr and SF-6D or EQ-5D-5L and associations between PROPr and other exposure variables. Health condition impact estimates (coefficients for health conditions compared to a referent category: e.g. dialysis vs kidney transplant) were calculated using multivariable linear regression. Results Mean (SD) age of the 524 participants was 57 (17) years, 58% were male and 45% white. Median (IQR) score was 0.39 (0.24-0.58) for PROPr, 0.69 (0.58-0.86) for SF-6D and 0.85 (0.70-0.91) for EQ-5D-5L. Large correlations were observed between PROPr vs SF-6D (0.79, 95%CI: 0.76 - 0.82) and EQ-5D-5L (0.71, 95%CI: 0.66 - 0.75). Both PROPr and the other utility indices demonstrated health condition impact in the expected direction. For example, the estimate for PROPr was -0.17 (95%CI: -0.13, -0.21) for dialysis (versus kidney transplant), -0.05 (95%CI: -0.11, 0.01, P=0.08) for kidney transplant recipients with eGFR <45 vs ≥45 ml/min/1.73m2 and -0.28 (95%CI: -0.22, -0.33) for moderate/severe versus no/mild depressive symptoms. Conclusions Our results support the validity of PROPr among patients treated with kidney replacement therapy.

scholarly journals COVID-19 in patients undergoing chronic kidney replacement therapy and kidney transplant recipients in Scotland: findings and experience from the Scottish renal registry

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Samira Bell ◽  
◽  
Jacqueline Campbell ◽  
Jackie McDonald ◽  
Martin O’Neill ◽  
...  
Keyword(s):  
Public Health ◽  
Replacement Therapy ◽  
Study Data ◽  
Data Sets ◽  
Kidney Transplant Recipients ◽  
The Public ◽  
Transplant Patients ◽  
Kidney Replacement Therapy ◽  
Observational Cohort ◽  
Respiratory Coronavirus

Abstract Background Infection with the severe acute respiratory coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic with coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2, overwhelming healthcare systems globally. Preliminary reports suggest a high incidence of infection and mortality with SARS-CoV-2 in patients receiving kidney replacement therapy (KRT). The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing KRT in Scotland. Methods Study design was an observational cohort study. Data were linked between the Scottish Renal Registry, Health Protection Scotland and the Scottish Intensive Care Society Audit Group national data sets using a unique patient identifier (Community Health Index (CHI)) for each individual by the Public Health and Intelligence unit of Public Health, Scotland. Descriptive statistics and survival analyses were performed. Results During the period 1st March 2020 to 31st May 2020, 110 patients receiving KRT tested positive for SARS-CoV-2 amounting to 2% of the prevalent KRT population. Of those affected, 86 were receiving haemodialysis or peritoneal dialysis and 24 had a renal transplant. Patients who tested positive were older and more likely to reside in more deprived postcodes. Mortality was high at 26.7% in the dialysis patients and 29.2% in the transplant patients. Conclusion The rate of detected SARS-CoV-2 in people receiving KRT in Scotland was relatively low but with a high mortality for those demonstrating infection. Although impossible to confirm, it appears that the measures taken within dialysis units coupled with the national shielding policy, have been effective in protecting this population from infection.

Nierenersatzverfahren: Information, Aufklärung, Dokumentation

2018 ◽  
Vol 143 (12) ◽  
pp. 863-870
Author(s):  
Jan Galle ◽  
Jana Reitlinger
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Transplantation ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Donation ◽  
Living Donation ◽  
Short Term ◽  
Donor Kidney ◽  
Kidney Replacement Therapy ◽  
Caring Environment

AbstractIn renal replacement therapy, different methods are available: hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx). In addition, variants can be used: HD as a home HD or center HD, PD as a conventional PD or automated (cycler) PD, KTx as a potentially short-term predictable living donation or conventional donor kidney donation. The patient and his familiar or caring environment must be informed accordingly. This means first of all: information about which procedures of kidney replacement therapy are possible and can be offered. Then the specific risks associated with each procedure should be elucidated (e. g. HD and shunt bleeding, PD and peritonitis, KTx and infections/neoplasias). This necessarily includes a structured documentation of the educating center/doctor about the communicated information and decisions taken.

scholarly journals Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants

2020 ◽  
Vol 9 (7) ◽  
pp. 2118 ◽  
Author(s):  
Maria Irene Bellini ◽  
Aisling E Courtney ◽  
Jennifer A McCaughan
Keyword(s):  
Kidney Transplantation ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Living Donor ◽  
Patient Survival ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Background: Failed kidney transplant recipients benefit from a new graft as the general incident dialysis population, although additional challenges in the management of these patients are often limiting the long-term outcomes. Previously failed grafts, a long history of comorbidities, side effects of long-term immunosuppression and previous surgical interventions are common characteristics in the repeated kidney transplantation population, leading to significant complex immunological and technical aspects and often compromising the short- and long-term results. Although recipients’ factors are acknowledged to represent one of the main determinants for graft and patient survival, there is increasing interest in expanding the donor’s pool safely, particularly for high-risk candidates. The role of living kidney donation in this peculiar context of repeated kidney transplantation has not been assessed thoroughly. The aim of the present study is to analyse the effects of a high-quality graft, such as the one retrieved from living kidney donors, in the repeated kidney transplant population context. Methods: Retrospective analysis of the outcomes of the repeated kidney transplant population at our institution from 1968 to 2019. Data were extracted from a prospectively maintained database and stratified according to the number of transplants: 1st, 2nd or 3rd+. The main outcomes were graft and patient survivals, recorded from time of transplant to graft failure (return to dialysis) and censored at patient death with a functioning graft. Duration of renal replacement therapy was expressed as cumulative time per month. A multivariate analysis considering death-censored graft survival, decade of transplantation, recipient age, donor age, living donor, transplant number, ischaemic time, time on renal replacement therapy prior to transplant and HLA mismatch at HLA-A, -B and -DR was conducted. In the multivariate analysis of recipient survival, diabetic nephropathy as primary renal disease was also included. Results: A total of 2395 kidney transplant recipients were analysed: 2062 (83.8%) with the 1st kidney transplant, 279 (11.3%) with the 2nd graft, 46 (2.2%) with the 3rd+. Mean age of 1st kidney transplant recipients was 43.6 ± 16.3 years, versus 39.9 ± 14.4 for 2nd and 41.4 ± 11.5 for 3rd+ (p < 0.001). Aside from being younger, repeated kidney transplant patients were also more often males (p = 0.006), with a longer time spent on renal replacement therapy (p < 0.0001) and a higher degree of sensitisation, expressed as calculated reaction frequency (p < 0.001). There was also an association between multiple kidney transplants and better HLA match at transplantation (p < 0.0001). A difference in death-censored graft survival by number of transplants was seen, with a median graft survival of 328 months for recipients of the 1st transplant, 209 months for the 2nd and 150 months for the 3rd+ (p = 0.038). The same difference was seen in deceased donor kidneys (p = 0.048), but not in grafts from living donors (p = 0.2). Patient survival was comparable between the three groups (p = 0.59). Conclusions: In the attempt to expand the organ donor pool, particular attention should be reserved to high complex recipients, such as the repeated kidney transplant population. In this peculiar context, the quality of the donor has been shown to represent a main determinant for graft survival—in fact, kidney retrieved from living donors provide comparable outcomes to those from single-graft recipients.

scholarly journals Incidence of Mortality, Acute Kidney Injury and Graft Loss in Adult Kidney Transplant Recipients with Coronavirus Disease 2019: Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (21) ◽  
pp. 5162
Author(s):  
Jia-Jin Chen ◽  
George Kuo ◽  
Tao Han Lee ◽  
Huang-Yu Yang ◽  
Hsin Hsu Wu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Transplant ◽  
Meta Analysis ◽  
Graft Loss ◽  
Kidney Injury ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Kidney Replacement Therapy

The adverse impact of Coronavirus disease 2019 (COVID-19) on kidney function has been reported since the global pandemic. The burden of COVID-19 on kidney transplant recipients, however, has not been systematically analyzed. A systematic review and meta-analysis with a random-effect model was conducted to explore the rate of mortality, intensive care unit admission, invasive mechanical ventilation, acute kidney injury, kidney replacement therapy and graft loss in the adult kidney transplant population with COVID-19. Sensitivity analysis, subgroup analysis and meta-regression were also performed. Results: we demonstrated a pooled mortality rate of 21% (95% CI: 19−23%), an intensive care unit admission rate of 26% (95% CI: 22–31%), an invasive ventilation rate among those who required intensive care unit care of 72% (95% CI: 62–81%), an acute kidney injury rate of 44% (95% CI: 39–49%), a kidney replacement therapy rate of 12% (95% CI: 9–15%), and a graft loss rate of 8% (95% CI: 5–15%) in kidney transplant recipients with COVID-19. The meta-regression indicated that advancing age is associated with higher mortality; every increase in age by 10 years was associated with an increased mortality rate of 3.7%. Regional differences in outcome were also detected. Further studies focused on treatments and risk factor identification are needed.

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