Abstract
Kidney impairment in hospitalized patients with SARS-CoV-2 infection is associated with increased in-hospital mortality and worse clinical evolution, raising concerns towards patients with chronic kidney disease (CKD). From a pathophysiological perspective, COVID-19 is characterized by an overproduction of inflammatory cytokines (IL-6, TNF-alpha), causing systemic inflammation and hypercoagulability, and multiple organ dysfunction syndrome. Emerging data postulate that CKD under conservative treatment or renal replacement therapy (RRT) is an important risk factor for disease severity and higher in-hospital mortality amongst patients with COVID-19. Regarding RAAS blockers therapy during the pandemic, the initial assumption of a potential increase and deleterious impact in infectivity, disease severity, and mortality was not evidenced in medical literature. Moreover, the challenge of implementing social distancing in patients requiring dialysis during the pandemic prompted national and international societies to publish recommendations regarding the adoption of safety measures to reduce transmission risk and optimize dialysis treatment during the COVID-19 pandemic. Current data convey that kidney transplant recipients are more vulnerable to more severe infection. Thus, we provide a comprehensive review of the clinical outcomes and prognosis of patients with CKD under conservative treatment and dialysis, and kidney transplant recipients and COVID-19 infection.
Highlights
In December 2019, cases of atypical pneumonia began to rise in the city of Wuhan, located in the providence of Hubei, China[1]
Besides lung involvement, other organ complications are observed in patients with severe acute respiratory syndrome (SARS)-CoV-2 infection such as kidney damage leading to acute kidney injury (AKI)[11], raising concerns regarding the clinical outcomes and prognosis of patients with preexisting comorbidities such as chronic kidney disease (CKD), end-stage kidney disease (ESKD), and kidney transplant recipients under immunosuppression therapy
A thorough scoping review based on the PubMed electronic bibliographic database was performed between April and September 2020, using the following Mesh terms: “Renal” OR “Kidney”, OR “Hemodialysis”, OR “Peritoneal Dialysis”, OR AND “Chronic Kidney Disease” AND “Kidney Transplant Recipients” AND “COVID-19”, with adoption of the PICO strategy and classification of the level of evidence
Summary
In December 2019, cases of atypical pneumonia began to rise in the city of Wuhan, located in the providence of Hubei, China[1]. In March 2020, amid initiation of global spread, the World Health Organization (WHO) declared the outbreak a pandemic, caused by SARS-CoV-2, a new positive-strand RNA virus from the coronoviridae family, being from the same family of the viruses responsible for the severe acute respiratory syndrome (SARS) in 2002 and the middle east respiratory syndrome (MERS) in 20122-4. Besides a high transmission rate, authors postulate that a crucial factor regarding the transmission of COVID-19 infection is the high level of SARS-CoV-2 present in the upper respiratory tract, even among pre-symptomatic patients, contributing to the global spread of the disease[5,6,7,8]. Besides lung involvement, other organ complications are observed in patients with SARS-CoV-2 infection such as kidney damage leading to acute kidney injury (AKI)[11], raising concerns regarding the clinical outcomes and prognosis of patients with preexisting comorbidities such as chronic kidney disease (CKD), end-stage kidney disease (ESKD), and kidney transplant recipients under immunosuppression therapy
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