| Title:
|
COVID-19 and kidney disease: insights from epidemiology to inform clinical practice |
| Abstract:
|
Over the course of the COVID-19 pandemic numerous studies have aimed to address the challenges faced by patients with kidney disease and their caregivers. These studies addressed areas of concern such as the high infection and mortality risk of patients on in-centre haemodialysis and transplant recipients. However the ability to draw meaningful conclusions from these studies has in some instances been challenging owing to barriers in aspects of usual care data limitations and problematic methodological practices. In many settings access to SARS-CoV-2 testing differed substantially between patient groups whereas the incidence of SARS-CoV-2 infection varied over time and place because of differences in viral prevalence targeted public health policies and vaccination rates. The absence of baseline kidney function data posed problems in the classification of chronic kidney disease and acute kidney injury in some studies potentially compromising the generalizability of findings. Study findings also require attentive appraisal in terms of the effects of confounding collider bias and chance. As this pandemic continues and in the future the implementation of sustainable and integrated research infrastructure is needed in settings across the world to minimize infection transmission and both prevent and plan for the short-term and long-term complications of infectious diseases. Registries can support the real-world evaluation of vaccines and therapies in patients with advanced kidney disease while enabling monitoring of rare complications. |
| Published:
|
2022-04-13 |
| Journal:
|
Nat Rev Nephrol |
| DOI:
|
10.1038/s41581-022-00570-3 |
| DOI_URL:
|
http://doi.org/10.1038/s41581-022-00570-3 |
| Author Name:
|
Mahalingasivam Viyaasan |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/mahalingasivam_viyaasan |
| Author Name:
|
Su Guobin |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/su_guobin |
| Author Name:
|
Iwagami Masao |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/iwagami_masao |
| Author Name:
|
Davids Mogamat Razeen |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/davids_mogamat_razeen |
| Author Name:
|
Wetmore James B |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/wetmore_james_b |
| Author Name:
|
Nitsch Dorothea |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/nitsch_dorothea |
| sha:
|
e30941ddb6f1329eb57355b8b6cdb2f2a71cdf90 |
| license:
|
no-cc |
| license_url:
|
[no creative commons license associated] |
| source_x:
|
Medline; PMC; WHO |
| source_x_url:
|
https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/https://www.who.int/ |
| pubmed_id:
|
35418695 |
| pubmed_id_url:
|
https://www.ncbi.nlm.nih.gov/pubmed/35418695 |
| pmcid:
|
PMC9006492 |
| pmcid_url:
|
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9006492 |
| url:
|
https://www.ncbi.nlm.nih.gov/pubmed/35418695/
https://doi.org/10.1038/s41581-022-00570-3 |
| has_full_text:
|
TRUE |
| Keywords Extracted from Text Content:
|
people
body
Ad26.COV2.S
Kidney
SGLT2
Single-centre
baricitinib
SARS-CoV-2 antibodies
serum creatinine
fluids
convalescent plasma
COVID-19 epidemiology 2
tocilizumab
cellular
graft
Colombia
most-part
lowresource
non-steroidal anti-inflammatory drugs 116, 117
Fig. 1
graft biopsy
ACE inhibitors [109] [110] [111] [112] [113
hydroxychloroquine
liver recipients
donors
blood
COVID-19
peritoneal
COVID- 19
Kidney transplant recipients
SARS-CoV-2 monoclonal antibody
ERACODA
organ
solid organ
lockdowns
venous
serum creatinine-based GFR
BK polyomavirus
ACE inhibitors 108
COVID-19 vaccines
Sweden 10
UK
corticosteroids
lower-income
ReF. 59
São Paulo
EHRs
Urine
ACE
adenoviral
cardiovascular
anti-HLA
liver
kidney biopsies
UK ISARIC
RECOVERY
arterial
participants
calcineurin
kidney recipients
recipients
gastrointestinal
Mogamat Razeen Davids 6
azithromycin
transplants
COVID-19 diagnosis 1
cytomegalovirus
Wuhan,
glomerular
Guobin Su 2
heart
Supplementary Table 1
KRT 79
angiotensin-converting enzyme (
Renal Patients
intravenous immunoglobulin
renal
SARS-CoV-2
solid organs
biopsy
vascular
citrate
BNT162b2
individuals
kidney
SARS-CoV-2 antibodies 8
London,
France
Fig. 1c
lopinavir-ritonavir
post-COVID-19
solid organ recipients
tubular
prednisolone
ACE2
patients
patient
www.nature.com/nrneph
solid organ transplants
ISARIC
Flanders
CKD stage 5
seroresponse
CKD
biopsies
Serum creatinine
casirivimab-imdevimab
oxygen
arterial thromboembolic
KRT patients
90,91
line
ReF. 107
KRT
cell
CKD stage 4-5
Dexamethasone
survivors
Patients
cells
dexamethasone
Dorothea Nitsch 1,11 ✉
https://doi.org/10.1038/s41581-022-00570-3
Priya Vart
Al-Aly |
| Extracted Text Content in Record:
|
First 5000 Characters:The abrupt arrival of the COVID-19 pandemic in early 2020 posed unforeseen challenges for patients with kidney disease and their care providers. Day-to-day priorities shifted towards the rapid reconfiguration of services to protect patients on in-centre haemodialysis who were unable to strictly adhere to social distancing policies due to their need to attend treatment. Concerns also existed that transplantation might place new recipients at a heightened risk of postoperative death. There were instances during the pandemic in which some critical care units became overwhelmed with an unprecedented demand for acute kidney replacement therapy (KRT). Despite the rapid development of vaccines and identification of effective treatments for severe disease, many of these challenges persist with the continuing emergence of novel SARS-CoV-2 variants. Lessons from learned experiences and the published literature must, therefore, be rapidly applied to better cope with ongoing challenges and similar crises that may arise in the future.
To best inform clinical care, epidemiological studies -ranging from small single-centre case series to large registry and population-wide cohorts -have been conducted across a range of settings. However, the COVID-19 pandemic has presented unique challenges, and many of these studies have encountered methodological difficulties arising from barriers in aspects of usual care, limitations in data collection and challenges in study design ( Table 1; Supplementary Table 1 ). For example, such studies should ideally investigate and account for variations in health-care delivery, temporal trends and geographical factors that arose as a consequence of the pandemic. These methodological challenges have also hindered comparisons between epidemiological studies. Meta-analyses that use aggregated outcomes from studies that have not investigated and/or accounted for these variables may be limited in their conclusions -a fact that has been well-acknowledged 1 .
Collider bias is an important problem encountered in COVID-19 epidemiology 2 (Fig. 1 , Table 1; Supplementary Table 1 ). Collider bias occurs when both the risk factor or exposure of interest (for example, kidney transplantation) and the factors on the pathway to the COVID-19 and kidney disease: insights from epidemiology to inform clinical practice Viyaasan Mahalingasivam 1 , Guobin Su 2, 3, 4 , Masao Iwagami 1, 5 , Mogamat Razeen Davids 6, 7, 8 , James B. Wetmore 9, 10 and Dorothea Nitsch 1,11 ✉ Abstract | Over the course of the COVID-19 pandemic, numerous studies have aimed to address the challenges faced by patients with kidney disease and their caregivers. These studies addressed areas of concern such as the high infection and mortality risk of patients on in-centre haemodialysis and transplant recipients. However, the ability to draw meaningful conclusions from these studies has in some instances been challenging, owing to barriers in aspects of usual care, data limitations and problematic methodological practices. In many settings, access to SARS-CoV-2 testing differed substantially between patient groups, whereas the incidence of SARS-CoV-2 infection varied over time and place because of differences in viral prevalence, targeted public health policies and vaccination rates. The absence of baseline kidney function data posed problems in the classification of chronic kidney disease and acute kidney injury in some studies, p ot en ti ally compromising the generalizability of findings. Study findings also r e q u i re a t t e n tive a p p ra isal i n t e r ms o f t h e effects of confounding, collider bias and chance. As this pandemic continues and in the future, the implementation of sustainable and integrated research infrastructure is needed in settings across the world to minimize infection transmission and both prevent and plan for the short-term and long-term complications of infectious diseases. Registries can support the real-world evaluation of vaccines and therapies in patients with advanced kidney disease while enabling monitoring of rare complications.
Nature reviews | Nephrology outcome of interest (for example, disease severity on the pathway to death) influence the mechanisms behind selection into a study sample population. Causal inference based on analyses of such a selected study sample cannot then be generalized to a wider population of interest and, depending on the circumstances, may not be internally valid due to selection bias. Epidemiological studies therefore require well-defined study populations in which outcome events (for example, SARS-CoV-2 infection and its consequences) are determined as accurately as possible for every study participant. Although individuals on long-term KRT are generally included in national registries, a lack of baseline kidney function data makes it difficult to define populations with chronic kidney disease (CKD) and acute kidney injury (AKI) for prospective outcome assessment.
In this R |
| Keywords Extracted from PMC Text:
|
comorbidities60
ICU65,66
participants126
SARS-CoV-2 positivity69
azithromycin121–123
well-acknowledged1
SARS-CoV-2
settings47
Sweden10,28,61
graft biopsy
all30
membranous nephropathy94
SARS-CoV-2 antibodies8
pandemic120
kidney recipients28,35
dexamethasone
39%118
discharge20
UK63
ERACODA
ISARIC
Colombia
Dexamethasone
COVID-19 epidemiology2
solid organ transplants
serology testing36
prognosis57,58
organ
COVID-19
seroresponse
BNT162b2 Pfizer
discharge19
intravenous immunoglobulin
people
vasculitis93
limited73
ACE inhibitors109–113
kidney diseases128
cardiovascular
list45
COVID-19 diagnosis1,15,16
patients
unavailable8
solid organ recipients
Fig. 1c
serum creatinine-based GFR
vascular
heart
angiotensin-converting enzyme (
England14
solid organs
individuals
venovenous
health-care providers10,28
disease95
solid organ
COVID-19 vaccines
State13
prednisolone
China3
hydroxychloroquine
Patients
liver
eGFR101,104
population10
Serum creatinine
citrate
KRT79
Ad26.COV2.S
lopinavir
patient
kidney diseases139
shortages87
IgA nephropathy92
convalescent plasma
donors64
Single-centre
tubular
refs59,118,119
body
status21
Kidney transplant recipients
cytomegalovirus
venous
Wuhan,
multi-morbidity77
respectively)102
Renal Patients
population10,28
16–49
KRT
liver recipients
biopsy
care78
participants
ICU101
lockdowns
UK
CKD
tocilizumab
blood
consumables86
SARS-CoV-2 antibodies
graft
RECOVERY
ACE inhibitors108
BNT162b2
ACE
baricitinib
CKD status82
kidney biopsies
calcineurin
arterial
SARS-CoV-2 monoclonal antibody
KRT89
casirivimab
France
Wuhan
kidney function60
corticosteroids
AKI76
kidney recipients
line
capacity90,91
adenoviral
COVID-19 pandemic65
CKD stages
serum creatinine
cell
USA110
arterial thromboembolic
ritonavir
glomerular
peritoneal
most-part
London,
refs70,71
setting74
survivors
gastrointestinal
treatment114,115
cells
non-steroidal anti-inflammatory drugs116,117
dexamethasone85
BK polyomavirus
kidney
response87
regions12
graft function26
UK85
discharge81
oxygen
pandemic18
cellular
São Paulo
tocilizumab52,53,56
anti-HLA
Supplementary Table 1
Flanders
biopsies
groups125
fluids
safely6,9
haemodialysis15
mild3
ref.59
CKD itself77
post-COVID-19
regions111–113
ACE2
CKD stage 5
recipients
settings9
Fig. 1
transplants
16–60 |
| Extracted PMC Text Content in Record:
|
First 5000 Characters:The abrupt arrival of the COVID-19 pandemic in early 2020 posed unforeseen challenges for patients with kidney disease and their care providers. Day-to-day priorities shifted towards the rapid reconfiguration of services to protect patients on in-centre haemodialysis who were unable to strictly adhere to social distancing policies due to their need to attend treatment. Concerns also existed that transplantation might place new recipients at a heightened risk of postoperative death. There were instances during the pandemic in which some critical care units became overwhelmed with an unprecedented demand for acute kidney replacement therapy (KRT). Despite the rapid development of vaccines and identification of effective treatments for severe disease, many of these challenges persist with the continuing emergence of novel SARS-CoV-2 variants. Lessons from learned experiences and the published literature must, therefore, be rapidly applied to better cope with ongoing challenges and similar crises that may arise in the future.
To best inform clinical care, epidemiological studies — ranging from small single-centre case series to large registry and population-wide cohorts — have been conducted across a range of settings. However, the COVID-19 pandemic has presented unique challenges, and many of these studies have encountered methodological difficulties arising from barriers in aspects of usual care, limitations in data collection and challenges in study design (Table 1; Supplementary Table 1). For example, such studies should ideally investigate and account for variations in health-care delivery, temporal trends and geographical factors that arose as a consequence of the pandemic. These methodological challenges have also hindered comparisons between epidemiological studies. Meta-analyses that use aggregated outcomes from studies that have not investigated and/or accounted for these variables may be limited in their conclusions — a fact that has been well-acknowledged1.
Collider bias is an important problem encountered in COVID-19 epidemiology2 (Fig. 1, Table 1; Supplementary Table 1). Collider bias occurs when both the risk factor or exposure of interest (for example, kidney transplantation) and the factors on the pathway to the outcome of interest (for example, disease severity on the pathway to death) influence the mechanisms behind selection into a study sample population. Causal inference based on analyses of such a selected study sample cannot then be generalized to a wider population of interest and, depending on the circumstances, may not be internally valid due to selection bias. Epidemiological studies therefore require well-defined study populations in which outcome events (for example, SARS-CoV-2 infection and its consequences) are determined as accurately as possible for every study participant. Although individuals on long-term KRT are generally included in national registries, a lack of baseline kidney function data makes it difficult to define populations with chronic kidney disease (CKD) and acute kidney injury (AKI) for prospective outcome assessment.
In this Review, we discuss a range of epidemiological challenges posed by the COVID-19 pandemic — a unique situation in which timely, reliable research was needed in the face of an unprecedented public health challenge. We discuss some of the major obstacles encountered when conducting epidemiological research in populations with kidney disease in a pandemic setting (Table 1; Supplementary Table 1), including challenges in ascertaining COVID-19-related outcomes in the dialysis and transplant populations, confounding factors such as barriers to health care, and the challenges in identifying and defining people with CKD or AKI (the 'denominators'). We focus particularly on studies that have relevance for public health and their ability to inform future research endeavours and study design.
Data on the incidence of COVID-19 among patients receiving in-centre haemodialysis is generally of high quality. The first cases of COVID-19 among patients receiving in-centre haemodialysis were from Wuhan, China3, with additional reports emerging as the pandemic spread to other parts of the world4–7.Throughout the pandemic, patients on in-centre haemodialysis were more likely than members of the general population to be exposed to SARS-CoV-2, as a consequence of the requirement to attend dialysis centres three times weekly, even during lockdowns. Often, attendance would involve shared patient transportation to and from home and interactions with other patients and dialysis staff. Despite the implementation of infection control procedures, these interactions increased exposure risk, especially in the early phases of the pandemic when asymptomatic screening was unavailable8 and personal protective equipment was lacking in some settings9. It is therefore unsurprising that the incidence of COVID-19 is higher in patients on in-centre haemodialysis than in the general |
| PDF JSON Files:
|
document_parses/pdf_json/e30941ddb6f1329eb57355b8b6cdb2f2a71cdf90.json |
| PMC JSON Files:
|
document_parses/pmc_json/PMC9006492.xml.json |
| G_ID:
|
covid_19_and_kidney_disease_insights_from_epidemiology_to_inform_clinical_practice |
