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Nephrologists on Lessons Learned With Kidney Disease in COVID-19

The Story So Far in China; AKI Common in Those With COVID-19

Bruchfeld spoke about a prospective single-center study of 701 patients with COVID-19 in Wuhan, China, published in Kidney International.

Of the patients in the study, 43.9% had proteinuria and 26.7% had hematuria on admission, she noted. The prevalence of elevated serum creatinine, elevated blood urea nitrogen, and estimated glomerular filtration rate < 60 mL/min/1.73m2 were 14.4%, 13.1%, and 13.1%, respectively.

And during the study period, 5.1% of patients developed acute kidney injury (AKI).

Kidney disease influenced mortality, varying from a doubling of death risk with elevated baseline serum creatinine (hazard ratio, 2.10) to an almost quadrupling with elevated baseline blood urea nitrogen (HR, 3.97).

For those with AKI, the risk of dying was almost doubled for stage 1 to more than quadrupled for stage 3.

A similar pattern was seen for proteinuria, and for hematuria, although the risks were even higher for the latter.

“Our findings show the prevalence of kidney disease on admission, and the development of acute kidney disease during hospitalization, is high and is associated with in-hospital mortality,” say Yichun Cheng, MD, Department of Nephrology, Huazhong University of Science and Technology, Wuhan, China.

And in a meta-analysis of 30 studies involving 53,000 patients in China — albeit a preprint that has not been peer-reviewed — chronic kidney disease was associated with a sixfold increased risk of severe COVID-19 (odds ratio, 6.0).

This compared with an OR of 5.3 for chronic obstructive pulmonary disease and 3.2 for cerebrovascular disease, Bruchfeld reported.

Dialysis/Transplant COVID-19 Experience in Spain

Soler reported that in her Barcelona registry there are currently 405 in-center hemodialysis patients hospitalized with COVID-19, among whom there have been 94 deaths (23%).

Among 26 peritoneal dialysis patients, there have been five deaths (19%), and in 206 kidney transplant patients with COVID-19, there were 35 deaths (17%).

She also reported on treatments. The most common were hydroxychloroquine (75%), lopinavir/ritonavir (47%), steroids (15%), interferon (11%), and tocilizumab (3%).

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