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      Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

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          Abstract

          The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce.

          Abstract

          In this Review, the authors summarize the challenges associated with the care of patients with kidney disease during the COVID-19 pandemic. They describe the major challenges and missed opportunities, global inequalities in health care, and offer a framework for future pandemic preparedness.

          Key points

          • Acute kidney injury is common in severe coronavirus disease 2019 (COVID-19) and is associated with increased mortality.

          • Patients with chronic kidney disease are at a high risk of severe COVID-19 and severe outcomes, and should be prioritized for therapeutics, including vaccines.

          • Establishment of global collaborative registries is key to assessing the severity and risk factors of infection.

          • Interruptions in routine care have been common and highlighted the advantages of temporary implementation of telemedicine and home dialysis.

          • There have been gross inequities in access to COVID-19 testing, personal protective equipment, provision of dialysis services, COVID-19 vaccines and therapeutics rollout.

          • To prepare for future pandemics, it is important to stockpile emergency medical equipment, invest in resilient health care systems, have global cooperation in providing care, explore and advance remote care globally, address moral distress to improve the well-being of patients and care providers, build public trust in scientific recommendations and advocate for kidney patients to be included in clinical trials and global registries.

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          Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

          Mark Peters (2021)
          Abstract Background Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. Methods In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. Results A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55). Conclusions In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.)
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            Using social and behavioural science to support COVID-19 pandemic response

            Jay Bavel, Katherine Baicker, Paulo S Boggio … (2020)
            The COVID-19 pandemic represents a massive global health crisis. Because the crisis requires large-scale behaviour change and places significant psychological burdens on individuals, insights from the social and behavioural sciences can be used to help align human behaviour with the recommendations of epidemiologists and public health experts. Here we discuss evidence from a selection of research topics relevant to pandemics, including work on navigating threats, social and cultural influences on behaviour, science communication, moral decision-making, leadership, and stress and coping. In each section, we note the nature and quality of prior research, including uncertainty and unsettled issues. We identify several insights for effective response to the COVID-19 pandemic and highlight important gaps researchers should move quickly to fill in the coming weeks and months.
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              ACUTE KIDNEY INJURY IN PATIENTS HOSPITALIZED WITH COVID-19

              Jamie Hirsch, Jia H. Ng, Daniel Ross … (2020)
              The rate of acute kidney injury (AKI) associated with patients hospitalized with Covid-19, and associated outcomes are not well understood. This study describes the presentation, risk factors and outcomes of AKI in patients hospitalized with Covid-19. We reviewed the health records for all patients hospitalized with Covid-19 between March 1, and April 5, 2020, at 13 academic and community hospitals in metropolitan New York. Patients younger than 18 years of age, with end stage kidney disease or with a kidney transplant were excluded. AKI was defined according to KDIGO criteria. Of 5,449 patients admitted with Covid-19, AKI developed in 1,993 (36.6%). The peak stages of AKI were stage 1 in 46.5%, stage 2 in 22.4% and stage 3 in 31.1%. Of these, 14.3% required renal replacement therapy (RRT). AKI was primarily seen in Covid-19 patients with respiratory failure, with 89.7% of patients on mechanical ventilation developing AKI compared to 21.7% of non-ventilated patients. 276/285 (96.8%) of patients requiring RRT were on ventilators. Of patients who required ventilation and developed AKI, 52.2% had the onset of AKI within 24 hours of intubation. Risk factors for AKI included older age, diabetes mellitus, cardiovascular disease, black race, hypertension and need for ventilation and vasopressor medications. Among patients with AKI, 694 died (35%), 519 (26%) were discharged and 780 (39%) were still hospitalized. AKI occurs frequently among patients with Covid-19 disease. It occurs early and in temporal association with respiratory failure and is associated with a poor prognosis.
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                Author and article information

                Contributors
                Duvuru Geetha:
                ORCID: http://orcid.org/0000-0001-8353-5542
                gduvura@jhmi.edu
                Journal
                Journal ID (nlm-ta): Nat Rev Nephrol
                Journal ID (iso-abbrev): Nat Rev Nephrol
                Title: Nature Reviews. Nephrology
                Publisher: Nature Publishing Group UK (London )
                ISSN (Print): 1759-5061
                ISSN (Electronic): 1759-507X
                Publication date (Electronic): 24 August 2022
                Pages: 1-14
                Affiliations
                [1 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Medicine, Division of Nephrology, , Johns Hopkins University School of Medicine, ; Baltimore, Maryland USA
                [2 ]GRID grid.5335.0, ISNI 0000000121885934, Department of Medicine, , University of Cambridge, ; Cambridge, UK
                [3 ]GRID grid.4563.4, ISNI 0000 0004 1936 8868, Department of Lifespan and Population Health, , University of Nottingham, ; Nottingham, UK
                [4 ]GRID grid.414807.e, ISNI 0000 0004 1766 8840, Department of Nephrology, , Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, ; Mumbai, India
                [5 ]GRID grid.5361.1, ISNI 0000 0000 8853 2677, Department of Visceral, Transplant and Thoracic Surgery, , Center of Operative Medicine, Medical University of Innsbruck, ; Innsbruck, Austria
                [6 ]GRID grid.168010.e, ISNI 0000000419368956, Department of Medicine, Division of Nephrology, , Stanford University School of Medicine, ; Standford, California USA
                [7 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Department of Internal Medicine, , Keck School of Medicine of University of Southern California, ; Los Angeles, California USA
                [8 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Leonard D. Schaeffer Center for Health Policy & Economics, , University of Southern California, ; Los Angeles, California USA
                [9 ]GRID grid.475435.4, Department of Nephrology, , Copenhagen University Hospital Rigshospitalet, ; Copenhagen, Denmark
                [10 ]GRID grid.453951.f, ISNI 0000 0004 0646 9598, Department of Research, , The Danish Heart Foundation, ; Copenhagen, Denmark
                [11 ]Principal, Voice of the Patient Inc, St. Louis, Missouri USA
                [12 ]GRID grid.261331.4, ISNI 0000 0001 2285 7943, Division of Nephrology and Hypertension, Nationwide Children’s Hospital and Department of Paediatrics, , The Ohio State University College of Medicine, ; Columbus, Ohio USA
                [13 ]GRID grid.1002.3, ISNI 0000 0004 1936 7857, Department of Renal Medicine, Eastern Health Clinical School, , Monash University, ; Melbourne, Australia
                [14 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Department of Nephrology and Palliative Care, St Vincent’s Hospital Melbourne, Australia and Department of Medicine, , University of Melbourne, ; Parkville, Australia
                [15 ]GRID grid.9829.a, ISNI 0000000109466120, Department of Medicine, , Kwame Nkrumah University of Science and Technology, ; Kumasi, Ghana
                [16 ]GRID grid.415450.1, ISNI 0000 0004 0466 0719, Renal Unit, Komfo Anokye Teaching Hospital, ; Kumasi, Ghana
                [17 ]GRID grid.8065.b, ISNI 0000000121828067, Consultant Nephrologist and Professor in the Department of Clinical Medicine, Faculty of Medicine, , University of Colombo, ; Colombo, Sri Lanka
                [18 ]University Medical Unit, National Hospital of Sri Lanka and National Institute of Nephrology, Dialysis & Transplantation, Colombo, Sri Lanka
                [19 ]GRID grid.412259.9, ISNI 0000 0001 2161 1343, Faculty of Medicine, , Universiti Teknologi MARA, ; Selangor, Malaysia
                [20 ]GRID grid.4491.8, ISNI 0000 0004 1937 116X, Department of Nephrology, , Charles University, ; Prague, Czech Republic
                [21 ]GRID grid.265219.b, ISNI 0000 0001 2217 8588, Deming Department of Medicine, , Tulane University School of Medicine, ; New Orleans, Louisiana USA
                [22 ]GRID grid.239573.9, ISNI 0000 0000 9025 8099, Division of Nephrology & Hypertension, , Cincinnati Children’s Hospital Medical Center, ; Cincinnati, Ohio USA
                [23 ]GRID grid.239573.9, ISNI 0000 0000 9025 8099, James M. Anderson Center for Health Systems Excellence, , Cincinnati Children’s Hospital Medical Center, ; Cincinnati, Ohio USA
                [24 ]GRID grid.24827.3b, ISNI 0000 0001 2179 9593, Department of Paediatrics, , University of Cincinnati School of Medicine, ; Cincinnati, Ohio USA
                [25 ]GRID grid.239573.9, ISNI 0000 0000 9025 8099, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, ; Cincinnati, Ohio USA
                [26 ]GRID grid.464831.c, ISNI 0000 0004 8496 8261, George Institute for Global Health, ; New Delhi, India
                [27 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, School of Public Health, , Imperial College, ; London, UK
                [28 ]GRID grid.411639.8, ISNI 0000 0001 0571 5193, Prasanna School of Public Health, , Manipal Academy of Higher Education, ; Manipal, India
                [29 ]GRID grid.21729.3f, ISNI 0000000419368729, Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, , Columbia University, ; New York, USA
                [30 ]GRID grid.38142.3c, ISNI 000000041936754X, Associate Scientist, Renal Division, , Brigham and Women’s Hospital, Harvard Medical School, ; Boston, USA
                [31 ]GRID grid.7836.a, ISNI 0000 0004 1937 1151, Honorary Associate Professor, Department of Paediatrics and Child Health, , University of Cape Town, ; Cape Town, South Africa
                [32 ]GRID grid.412341.1, ISNI 0000 0001 0726 4330, Nephrologist, , University Childrens Hospital, ; Zurich, Switzerland
                Author information
                http://orcid.org/0000-0001-8353-5542
                http://orcid.org/0000-0002-2945-2946
                http://orcid.org/0000-0003-2490-025X
                http://orcid.org/0000-0002-8015-9470
                http://orcid.org/0000-0001-9051-7385
                Article
                Publisher ID: 618
                DOI: 10.1038/s41581-022-00618-4
                PMC ID: 9400561
                PubMed ID: 36002770
                SO-VID: 642a131c-70a3-4857-8b79-54a18950bb6d
                Copyright © © Springer Nature Limited 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date accepted : 29 July 2022
                Categories
                Subject: Review Article

                Keywords: nephrology,infectious diseases
                Data availability:
                Keywords: nephrology, infectious diseases

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