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Coronavirus disease 2019 in chronic kidney disease
Luis D'Marco1, María Jesús Puchades1, María Romero-Parra1
1Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain.
Insights
Patients with chronic kidney disease (CKD) face a significantly higher risk of severe COVID-19 and mortality. Their altered immune systems and inflammation increase susceptibility to infections and complications.
Area of Science:
- Nephrology
- Infectious Diseases
- Immunology
Background:
- Chronic kidney disease (CKD) patients exhibit altered immune function and chronic inflammation, increasing infection susceptibility.
- CKD is associated with higher rates of cardiovascular disease and overall infections compared to the general population.
Purpose of the Study:
- To review the chronic immunologic changes in CKD patients.
- To assess the heightened risk and clinical implications of COVID-19 in CKD patients.
- To discuss specific COVID-19 therapeutic strategies for CKD patients.
Main Methods:
- Literature review focusing on immunologic changes in CKD.
- Analysis of COVID-19 risk, morbidity, and mortality in CKD populations.
- Examination of therapeutic considerations for COVID-19 in CKD.
Main Results:
- CKD patients have a 3-fold higher risk of severe COVID-19 compared to non-CKD patients.
- CKD is 12-fold more prevalent in intensive care units among COVID-19 patients than in non-hospitalized individuals.
- Mortality rates for hemodialysis patients with acute COVID-19 range from 15-25%, even without pneumonia.
Conclusions:
- CKD patients represent a vulnerable population for severe COVID-19 outcomes due to immunologic and inflammatory factors.
- The increased risk and severity of COVID-19 in CKD necessitate tailored clinical management and therapeutic approaches.
- Further research into specific COVID-19 therapies for CKD patients is crucial to mitigate morbidity and mortality.
Abstract:
The clinical spectrum of coronavirus disease 2019 (COVID-19) infection ranges from asymptomatic infection to severe pneumonia with respiratory failure and even death. More severe cases with higher mortality have been reported in older patients and in those with chronic illness such as hypertension, diabetes or cardiovascular diseases. In this regard, patients with chronic kidney disease (CKD) have a higher rate of all-type infections and cardiovascular disease than the general population. A markedly altered immune system and immunosuppressed state may predispose CKD patients to infectious complications. Likewise, they have a state of chronic systemic inflammation that may increase their morbidity and mortality. In this review we discuss the chronic immunologic changes observed in CKD patients, the risk of COVID-19 infections and the clinical implications for and specific COVID-19 therapy in CKD patients. Indeed, the risk for severe COVID-19 is 3-fold higher in CKD than in non-CKD patients; CKD is 12-fold more frequent in intensive care unit than in non-hospitalized COVID-19 patients, and this ratio is higher than for diabetes or cardiovascular disease; and acute COVID-19 mortality is 15-25% for haemodialysis patients even when not developing pneumonia.
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