scholarly journals Epidemiology of COVID-19 Infection in Hospitalized End-Stage Kidney Disease Patients in a Predominantly African-American Population

2021 ◽  
pp. 1-9
Author(s):  
José E. Navarrete ◽  
David C. Tong ◽  
Jason Cobb ◽  
Frederic F. Rahbari-Oskoui ◽  
Darya Hosein ◽  
...  
Keyword(s):  
African American ◽  
Kidney Disease ◽  
Peripheral Vascular ◽  
C Reactive Protein ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
Reactive Protein ◽  
History Of ◽  
End Stage ◽  
D Dimer

<b><i>Background:</i></b> End-stage kidney disease patients on dialysis are particularly susceptible to COVID-19 infection due to comorbidities, age, and logistic constraints of dialysis making social distancing difficult. We describe our experience with hospitalized dialysis patients with COVID-19 and factors associated with mortality. <b><i>Methods:</i></b> From March 1, 2020, to May 31, 2020, all dialysis patients admitted to 4 Emory Hospitals and tested for COVID-19 were identified. Sociodemographic information and clinical and laboratory data were obtained from the medical record. Death was defined as an in-hospital death or transfer to hospice for end-of-life care. Patients were followed until discharge or death. <b><i>Results:</i></b> Sixty-four dialysis patients with COVID-19 were identified. Eighty-four percent were African-American. The median age was 64 years, and 59% were males. Four patients were on peritoneal dialysis, and 60 were on hemodialysis for a median time of 3.8 years, while 31% were obese. Fever (72%), cough (61%), and diarrhea (22%) were the most common symptoms at presentation. Thirty-three percent required admission to intensive care unit, and 23% required mechanical ventilation. The median length of stay was 10 days, while 11 patients (17%) died during hospitalization and 17% were discharged to a temporary rehabilitation facility. Age &#x3e;65 years (RR 13.7, CI: 1.9–100.7), C-reactive protein &#x3e;100 mg/dL (RR 8.3, CI: 1.1–60.4), peak D-dimer &#x3e;3,000 ng/mL (RR 4.3, CI: 1.03–18.2), bilirubin &#x3e;1 mg/dL (RR 3.9, CI: 1.5–10.4), and history of peripheral vascular disease (RR 3.2, CI: 1.2–9.1) were associated with mortality. Dialysis COVID-19-infected patients were more likely to develop thromboembolic complications than those without COVID-19 (RR 3.7, CI: 1.3–10.1). <b><i>Conclusion:</i></b> In a predominantly African-American population, the mortality of end-stage kidney disease patients admitted with COVID-19 infection was 17%. Age, C-reactive protein, D-dimer, bilirubin, and history of peripheral vascular disease were associated with worse survival.

Arrhythmias in dialysis patients

2021 ◽  
Vol 4 (57) ◽  
pp. 8-11
Author(s):  
Szymon Warwas ◽  
Marta Jagosz ◽  
Beata Średniawa ◽  
Michał Mazurek ◽  
Ewa Jędrzejczyk-Patej
Keyword(s):  
Cardiovascular Diseases ◽  
Sudden Cardiac Death ◽  
Kidney Disease ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
Common Cause ◽  
Conduction Disturbances ◽  
End Stage

The most common cause of death among dialysis patients with end-stage kidney disease are cardiovascular diseases. It is estimated that 18-27% of all deaths in dialysis patients are sudden cardiac deaths due to arrhythmias and conduction disturbances. The most common arrhythmias in dialysis patients, often leading to sudden death, are not ventricular arrhythmias but bradyarrhythmias. The article below discusses the most common arrhythmias in dialysis patients and methods of preventing sudden cardiac death in this group of patients.

Abstract 067: Predictors of High-sensitivity C-reactive Protein Elevation Among Patients With Myocardial Infarction: Insights From VIRGO and TRIUMPH

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Mohammed Qintar ◽  
Puza P Sharma ◽  
Yuanyuan Tang ◽  
Philip Jones ◽  
Yashashwi Pokharel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
High Sensitivity ◽  
Peripheral Vascular ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
History Of ◽  
Multivariable Regression ◽  
Hs Crp

Background: Elevated hs-CRP is associated with worse cardiovascular outcomes in patients with acute myocardial infarction (AMI), but little is known about predictors of elevated hs-CRP after AMI. Methods: TRIUMPH and VIRGO are prospective AMI registries that assessed hs-CRP levels 30 days after AMI. TRIUMPH assessed hs-CRP levels at 6 months. Multivariable regression analysis was conducted to examine predictors of elevated hs-CRP [≥2.0 mg/L] at 30 days and at 6 months after an AMI (TRIUMPH only). Results: Of 3410 patients in both registries, 58.6% had elevated hs-CRP 30 days post AMI. Patients with elevated hs-CRP were more likely to be female, black, obese, smokers, to have had higher LDL-C at the time of their AMI, with more peripheral vascular disease and history of heart failure, and were less likely to have had a prior PCI (Table). In TRIUMPH, baseline hs-CRP ≥2 mg/L (n=1301) was significantly associated with elevated hs-CRP at 6 months (p<0.001). Patients with elevated hs-CRP at 6 months (n=407) were more likely to be black, obese, smokers, have peripheral vascular disease and have higher baseline hs-CRP. Conclusions: hs-CRP remains elevated in a large proportion of patients following AMI. We identified several predictors of elevated hs-CRP at 1 and 6 months post AMI. Further studies are needed to validate the findings and understand the utility of routine screening of hs-CRP in post AMI patients.

scholarly journals A brief-review of the risk factors for covid-19 severity

2020 ◽  
Vol 54 ◽  
pp. 60 ◽  
Author(s):  
J. E. Rod ◽  
Oscar Oviedo-Trespalacios ◽  
Javier Cortes-Ramirez
Keyword(s):  
Risk Factors ◽  
Disease Severity ◽  
World Health ◽  
Future Research ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
History Of ◽  
Health Organization ◽  
High Consistency ◽  
D Dimer

The World Health Organization has emphasized that one of the most important questions to address regarding the covid-19 pandemic is to understand risk factors for disease severity. We conducted a brief review that synthesizes the available evidence and provides a judgment on the consistency of the association between risk factors and a composite end-point of severe-fatal covid-19. Additionally, we also conducted a comparability analysis of risk factors across 17 studies. We found evidence supporting a total of 60 predictors for disease severity, of which seven were deemed of high consistency, 40 of medium and 13 of low. Among the factors with high consistency of association, we found age, C-reactive protein, D-dimer, albumin, body temperature, SOFA score and diabetes. The results suggest that diabetes might be the most consistent comorbidity predicting disease severity and that future research should carefully consider the comparability of reporting cases, factors, and outcomes along the different stages of the natural history of covid-19.

ADMA and C-reactive protein as mortality predictors in dialysis patients

Open Medicine ◽  
2013 ◽  
Vol 8 (3) ◽  
pp. 346-353 ◽  
Author(s):  
Aleksandra Ignjatović ◽  
Tatjana Cvetković ◽  
Radmila Pavlović ◽  
Vidojko Đorđević ◽  
Zoran Milošević ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Univariate Analysis ◽  
C Reactive Protein ◽  
Dialysis Patients ◽  
Predictors Of Mortality ◽  
Reactive Protein ◽  
All Cause Mortality ◽  
Stage Renal Disease ◽  
End Stage

AbstractThere is a higher mortality between patients with end-stage renal disease than patients in the general population. These circumstances have led to a search for risk factors as predictors of mortality in dialysis patients. Amongst those, inhibitors of the nitric-oxide (NO) synthesis deserve special attention, since patients with end-stage renal disease are also characterized by accelerated atherosclerosis. Asymmetric-dimethylarginine (ADMA) and symmetric-dimethylarginine (SDMA), as well as C-reactive protein (CRP), have also been recognized as predictors of mortality in patients on dialysis. The aim of our study was to compare the prediction power of ADMA, SDMA and CRP for all-cause mortality in patients with end stage renal disease during the fourteen month follow-up. In total 162 patients on hemodialysis were included. ADMA and SDMA were measured by the high-performance liquid chromatography (HPLC); CRP was measured using immunonephelometric assays. During the 14-month period 28 patients (34.1%) died from all-cause mortality. Using univariate analysis, hazard ratios (HR) of the potential independent predictors of mortality in hemodialysis patients were ADMA (HR 1.39 (1.01–1.91) p=0.043) and CRP (HR 1.024 (1.009–1.1.040) p=0.001). Further, multivariate analysis (MVA), however, showed that ADMA is the only predictor of all-cause mortality (HR 1.76 (1.002–3.11) P=0.049), while SDMA failed to predict death in this population. Therefore, our data shows that ADMA is an independent and better marker of all-cause mortality compared with CRP.

scholarly journals Dysfunction of natural killer cells in end-stage kidney disease on hemodialysis

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kei Nagai
Keyword(s):  
Oxidative Stress ◽  
Kidney Disease ◽  
Nk Cells ◽  
Natural Killer ◽  
Nk Cell ◽  
Cell Number ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
Activating Receptors ◽  
End Stage

AbstractNatural killer (NK) cells are known to play an important role in defense against infection and tumors. Although there is no clear consensus, most studies have shown that the number and cytotoxicity of NK cells decreases in end-stage kidney disease (ESKD) patients undergoing hemodialysis. Uremic patients chronically suffer from oxidative stress, which could be responsible for downregulation of the activating receptors on NK cells and modulation of ligand expression for activating receptors. Theoretically, the reduced number of NK cells and decreased function might increase susceptibility to viral infections and cancer development in patients with ESKD. There is emerging evidence that NK cell numbers may be an outcome predictor in renal transplantation; however, the clinical significance of NK cell dysfunction in dialysis patients requires clarification. In this review, I describe NK cell number, cytotoxic activity, and activating mechanisms in the context of uremia and oxidative stress, which is anticipated to assist in elucidating the mechanisms underlying immunodeficiency in dialysis patients.

scholarly journals Extended Thromboprophylaxis in Patients with COVID-19

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1065-1065
Author(s):  
Wei Zhao ◽  
Pin Li ◽  
Scott Kaatz ◽  
Katie Latack ◽  
Lonni Schultz ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Discharge ◽  
Research Funding ◽  
C Reactive Protein ◽  
Post Discharge ◽  
Event Time ◽  
Reactive Protein ◽  
Short Course ◽  
History Of ◽  
D Dimer

Abstract Introduction Patients hospitalized with COVID-19 have an increased incidence of venous thromboembolism (VTE) and arterial thromboembolism (ATE) events. These thrombotic events increase readmission and mortality rate in COVID-19 survivors who are recently discharged from hospital. To lower the risk of VTE, a short course of post-discharge anticoagulation at either prophylactic or therapeutic dose has been variably prescribed among different facilities to COVID-19 patients. This practice, however, is challenged by less than 3% incidence of VTE in unselected patients. The net clinical benefit of extended thromboprophylaxis beyond hospitalization remains unclear. Methods We conducted a retrospective multicenter observational study of 5613 hospitalized COVID-19 patients. After applying the inclusion and exclusion criteria, 2838 patients were included in statistical analysis. Patients were excluded if they had negative SARS-CoV-2 PCR, remained hospitalized at the time of analysis, or were discharged to hospice service. The first symptomatic ATE and VTE events up to 90 days after patients' discharge from their index admission for COVID-19 were identified using ICD-10 codes, and subsequently validated by chart review. The predictors for post-discharge VTE were identified using multivariate logistic regression. The average protective effect of anticoagulation was assessed using inverse propensity score weighting. Results The mean age (SD) of our cohort was 63.4 (16.7) years old and 47.6% were male. Black, white and other races were 38.9%, 50.7% and 10.3%, respectively. Thirty-six (1.3%) patients developed post-discharge VTE events that require hospital visits (18 deep vein thromboses, 16 pulmonary embolisms and 2 portal vein thromboses). Fifteen (0.5%) patients developed post-discharge ATE events (14 acute coronary syndromes and 1 transient ischemic attack). The incidence of VTE decreased with time (p &lt;.001) with the median event time of 16 days (Figure 1). The incidence of ATE was unchanged with time (p =.369) with the median event time of 37 days (Figure 1). Patients who had a history of VTE (OR=3.24, 95% CI 1.34-7.86), peak D-dimer &gt;3 µg/mL (OR=3.76, 95% CI 1.86-7.57), and predischarge C-reactive protein &gt;10 mg/dL (OR=3.02, 95% CI 1.45-6.29) were at a high risk of developing VTE after hospital discharge (Figure 2). A short course of prophylactic or therapeutic anticoagulation after hospital discharge markedly reduced VTE (OR=0, 95% CI 0-0, p&lt;.001, and OR=0.176, 95% CI 0.04-0.75, p=.02, respectively). Conclusions Although extended thromboprophylaxis in unselected COVID-19 patients is not recommended, post-discharge anticoagulation may be considered in high-risk patients who have a history of VTE, peak D-dimer &gt;3 µg/mL and predischarge C-reactive protein &gt;10 mg/dL if their bleeding risk is low. Our study has provided the first evidence to guide the selection of hospitalized COVID-19 patients who may benefit from post-discharge anticoagulation. Figure 1 Figure 1. Disclosures Kaatz: Gilead: Consultancy; Novartis: Consultancy; CSL Behring: Consultancy; Bristol Myer Squibb: Consultancy, Research Funding; Alexion: Consultancy; Pfizer: Consultancy; Janssen: Consultancy, Research Funding; Osmosis Research: Research Funding.

scholarly journals Infective Endocarditis Hospitalizations and Outcomes in Patients With End‐Stage Kidney Disease: A Nationwide Data‐Linkage Study

2021 ◽  
Author(s):  
Peter J. Gallacher ◽  
David A. McAllister ◽  
Nicholas L. Mills ◽  
Nicholas L. Cruden ◽  
Anoop S. V. Shah ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Kidney Disease ◽  
Population Based ◽  
Linkage Study ◽  
Mortality Data ◽  
End Stage Kidney Disease ◽  
Patient Demographics ◽  
History Of ◽  
Short And Long Term ◽  
End Stage

Background We investigated the clinical features, microbiology, and short‐ and long‐term outcomes of incident infective endocarditis (IE) hospitalizations in patients with end‐stage kidney disease (ESKD) requiring dialysis or with a kidney transplant over 25 years in Scotland. Methods and Results In this retrospective, population‐based cohort study linking national hospitalization and mortality data, we identified patients with a history of ESKD and hospitalized with IE in Scotland between January 1, 1990 and December 31, 2014. From January 1, 2008, individual IE hospitalizations were additionally linked to national microbiology data. Multivariable logistic regression, adjusting for patient demographics and comorbidities, evaluated the association between ESKD and all‐cause death at 1 and 3 years. Of 7638 incident IE hospitalizations between 1990 and 2014, 2.8% (216/7638) occurred in 210 patients with ESKD and 97.2% (7422/7638) occurred in 7303 patients without ESKD. Positive findings from blood cultures were identified in 42% (950/2267) of incident IE hospitalizations from 2008. Staphylococcus aureus was isolated in 25.9% (21/81) and 12.8% (280/2186) of patients with and without ESKD, respectively ( P =0.002). ESKD was associated with an increased odds of death at 1 (44.9% versus 31.4%; adjusted odds ratio [aOR], 2.47, 95% CI, 1.85–3.30;, P <0.001) and 3 years (63.9% versus 42.8%; aOR, 3.77; 95% CI, 2.79–5.12; P <0.001). Conclusions IE is associated with a poor prognosis in patients with ESKD, especially in the longer term. Compared with patients without ESKD, patients with ESKD were twice as likely to die within 1 year, and 3 times as likely to die within 3 years of IE hospitalization.

scholarly journals Calciphylaxis or vascular oxalosis?

2020 ◽  
Author(s):  
Skye El-Saygeh ◽  
Douglas Roese ◽  
Sharon M Moe
Keyword(s):  
Kidney Disease ◽  
Primary Hyperoxaluria ◽  
Abrupt Onset ◽  
Limb Amputation ◽  
Peripheral Vascular ◽  
End Stage Kidney Disease ◽  
Primary Hyperoxaluria Type 1 ◽  
End Stage ◽  
Hyperoxaluria Type

Abstract We report the case of a 31-year-old female with primary hyperoxaluria type 1 with end-stage kidney disease who developed severe peripheral vascular disease leading to limb amputation initially thought to be secondary to calciphylaxis. However, polarized review of the pathologic specimen revealed calcium oxalate deposition in the lumen of blood vessels. This unusual presentation of systemic oxalosis demonstrates the adverse consequences of elevations of serum oxalate in patients with hyperoxaluria and that levels can acutely worsen with abrupt onset of kidney failure.

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