439c1dee05e44686c0a43d4d28e943c0 pmc_34098555.pdf 2961778bc1aff29068542aa66912bf3af49d47fd pmc_34098555.pdf c6295a0b26cb998af08b8e6b424f92c92e09ad0a8d69d1224e8a46eeea72f971 pmc_34098555.pdf Title: COVID-19 in CKD Patients: Lessons from 553 CKD Patients with Biopsy-Proven Kidney Disease Subject: Introduction: Chronic kidney disease (CKD) patients infected with COVID-19 are at risk of serious complications such as hospitalization and death. The prognosis and lethality of COVID-19 infection in patients with established kidney disease has not been widely studied. Methods: Data included patients who underwent kidney biopsy at the Vall d’Hebron Hospital between January 2013 and February 2020 with COVID-19 diagnosis during the period from March 1 to May 15, 2020. Results: Thirty-nine (7%) patients were diagnosed with COVID-19 infection. Mean age was 63 ± 15 years and 48.7% were male. Hypertension was present in 79.5%, CKD without renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients; older (p = 0.01), hypertensive (p = 0.005), and immunosuppressed (p = 0.01) patients, those using RAS-blocking drugs (p = 0.04), and those with gastrointestinal symptoms (p = 0.02) were more likely to be tested for CO­VID-19. Twenty-two patients required hospitalization and 15.4% died. In bivariate analysis, mortality was associated with older age (p = 0.03), cardiovascular disease (p = 0.05), chronic obstructive pulmonary disease (p = 0.05), and low hemoglobin levels (p = 0.006). Adjusted Cox regression showed that low hemoglobin levels at admission had 1.81 greater risk of mortality. Conclusions: Patients with CO­VID-19 infection and kidney disease confirmed by kidney biopsy presented a mortality of 15.4%. Swab test for COVID-19 was more likely to be performed in older, hypertensive, and immunosuppressed patients, those using RAS-blocking drugs, and those with gastrointestinal symptoms. Low hemoglobin is a risk factor for mortality. Author: Román J.L.; García-Carro C.; Agraz I.; Toapanta N.; Vergara A.; Gabaldón A.; Torres I.; Bury R.; Baldallo C.; Serón D.; Soler M.J. 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Subject: Introduction: Chronic kidney disease (CKD) patients infected with COVID-19 are at risk of serious complications such as hospitalization and death. The prognosis and lethality of COVID-19 infection in patients with established kidney disease has not been 眀椀搀攀氀礀 猀琀甀搀椀攀搀⸀ 䴀攀琀栀漀搀猀㨀 䐀愀琀愀 椀渀挀氀甀搀攀搀 瀀愀琀椀攀渀琀猀 眀栀漀 甀渀搀攀爀眀攀渀琀 欀椀搀渀攀礀 戀椀漀瀀猀礀 愀琀 琀栀攀 嘀愀氀氀 搠ᤀ䠀攀戀爀漀渀 䠀漀猀瀀椀琀愀氀 戀攀琀眀攀攀渀 䨀愀渀甀愀爀礀 ㈀　㄀㌀and February 2020 with COVID-19 diagnosis during the period from March 1 to May 15, 2020. Results: Thirty-nine (7%) patients w攀爀攀 搀椀愀最渀漀猀攀搀 眀椀琀栀 䌀伀嘀䤀䐀ⴀ㄀㤀 椀渀昀攀挀琀椀漀渀⸀ 䴀攀愀渀 愀最攀 眀愀猀 㘀㌀ 넀 ㄀㔀 礀攀愀爀猀 愀渀搀 㐀㠀⸀㜀─ 眀攀爀攀 洀愀氀攀⸀ 䠀礀瀀攀爀琀攀渀猀椀漀渀 眀愀猀 瀀爀攀猀攀渀琀 椀渀 㜀㤀⸀㔀─Ⰰ 䌀䬀䐀 眀thout renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients㬀 漀氀搀攀爀 瀀 㴀 　⸀　㄀Ⰰ 栀礀瀀攀爀琀攀渀猀椀瘀攀 瀀 㴀 　⸀　　㔀Ⰰ 愀渀搀 椀洀洀甀渀漀猀甀瀀瀀爀攀猀猀攀搀 瀀 㴀 　⸀　㄀ 瀀愀琀椀攀渀琀猀Ⰰ 琀栀漀猀攀 甀猀椀渀最 刀䄀匀ⴀ戀氀漀挀欀椀渀最 搀爀甀最猀 瀀 㴀 　⸀　㐀Ⰰ 愀渀搀 琀栀漀猀攀 眀椀琀栀 最愀猀琀爀漀椀渀琀攀猀琀椀渀愀氀 猀礀洀瀀琀漀洀猀 瀀 㴀 　⸀　㈀ 眀攀爀攀 洀漀爀攀 氀椀欀攀氀礀 琀漀 戀攀 琀攀猀琀攀搀 昀漀爀 䌀伀관嘀䤀䐀ⴀ㄀㤀⸀ 吀眀攀渀琀礀ⴀ琀眀漀 瀀愀琀椀攀渀琀猀 爀攀焀甀椀爀攀搀 栀漀猀瀀椀琀愀氀椀稀愀琀椀漀渀 愀渀搀 ㄀㔀⸀㐀─ 搀椀攀搀⸀ 䤀渀 戀椀瘀愀爀椀愀琀攀 愀渀愀氀礀猀椀猀Ⰰ 洀漀爀琀愀氀椀琀礀 眀愀猀 愀猀猀漀挀椀愀琀攀搀 眀椀琀栀 漀氀搀攀爀 愀最攀 瀀 㴀 　⸀　㌀Ⰰ 挀愀爀搀椀漀瘀愀猀挀甀氀r disease (p = 0.05), chronic obstructive pulmonary disease (p = 0.05), and low hemoglobin levels (p = 0.006). Adjusted Cox 爀攀最爀攀猀猀椀漀渀 猀栀漀眀攀搀 琀栀愀琀 氀漀眀 栀攀洀漀最氀漀戀椀渀 氀攀瘀攀氀猀 愀琀 愀搀洀椀猀猀椀漀渀 栀愀搀 ㄀⸀㠀㄀ 最爀攀愀琀攀爀 爀椀猀欀 漀昀 洀漀爀琀愀氀椀琀礀⸀ 䌀漀渀挀氀甀猀椀漀渀猀㨀 倀愀琀椀攀渀琀猀 眀椀琀栀 䌀伀관嘀䤀䐀19 infection and kidney disease confirmed by kidney biopsy presented a mortality of 15.4%. Swab test for COVID-19 was more like氀礀 琀漀 戀攀 瀀攀爀昀漀爀洀攀搀 椀渀 漀氀搀攀爀Ⰰ 栀礀瀀攀爀琀攀渀猀椀瘀攀Ⰰ 愀渀搀 椀洀洀甀渀漀猀甀瀀瀀爀攀猀猀攀搀 瀀愀琀椀攀渀琀猀Ⰰ 琀栀漀猀攀 甀猀椀渀最 刀䄀匀ⴀ戀氀漀挀欀椀渀最 搀爀甀最猀Ⰰ 愀渀搀 琀栀漀猀攀 眀椀琀栀 最愀猀琀爀漀ntestinal symptoms. Low hemoglobin is a risk factor for mortality. Creator: Adobe InDesign 16.2 (Windows) Producer: Adobe PDF Library 15.0 CreationDate: Mon Jun 07 12:38:12 CEST 2021 ModDate: Fri Jun 25 10:55:34 CEST 2021 ID: 0xb875c2fe383be645bd13311c6f96a5c4, 0x4f80e60ee1fa2b4db2a30348e3c66c6c Filters: FilterPipeline: FlateDecode FilterPipeline: DCTDecode Images: Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 821 ImageHeight: 538 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Intent: RelativeColorimetric Name: X Fonts: Type1: Font: BaseFont: UZDYSE+MyriadPro-Bold FontSubset: true FirstChar: 32 LastChar: 121 FontDescriptor: FontName: UZDYSE+MyriadPro-Bold Flags: Nonsymbolic FontBBox: -92, -250, 1256, 897 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: QGDVOM+MyriadPro-Regular FontSubset: true FirstChar: 32 LastChar: 243 FontDescriptor: FontName: QGDVOM+MyriadPro-Regular Flags: Nonsymbolic FontBBox: -46, -250, 1126, 881 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: GXVDEG+MinionPro-Bold FontSubset: true FirstChar: 46 LastChar: 54 FontDescriptor: FontName: GXVDEG+MinionPro-Bold Flags: Serif, Nonsymbolic FontBBox: -318, -360, 1684, 917 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: OJWZMQ+MinionPro-It FontSubset: true FirstChar: 110 LastChar: 116 FontDescriptor: FontName: OJWZMQ+MinionPro-It Flags: Serif, Nonsymbolic, Italic FontBBox: -201, -360, 1684, 919 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: ERCWCK+MinionPro-Regular FontSubset: true FirstChar: 27 LastChar: 252 FontDescriptor: FontName: ERCWCK+MinionPro-Regular Flags: Serif, Nonsymbolic FontBBox: -289, -360, 1684, 917 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: HOMOSE+MyriadPro-BoldIt FontSubset: true FirstChar: 58 LastChar: 117 FontDescriptor: FontName: HOMOSE+MyriadPro-BoldIt Flags: Nonsymbolic, Italic FontBBox: -96, -250, 1225, 889 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: SPZXQI+MyriadPro-It FontSubset: true FirstChar: 112 LastChar: 112 FontDescriptor: FontName: SPZXQI+MyriadPro-It Flags: Nonsymbolic, Italic FontBBox: -112, -250, 1090, 873 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true TrueType: Font: BaseFont: AOYTYS+Cambria FontSubset: true FirstChar: 32 LastChar: 42 FontDescriptor: FontName: AOYTYS+Cambria Flags: Serif, Nonsymbolic FontBBox: -1475, -2464, 2868, 3117 FontFile2: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: WIVVUA+SegoeUI FontSubset: true FirstChar: 32 LastChar: 118 FontDescriptor: FontName: WIVVUA+SegoeUI Flags: Nonsymbolic FontBBox: -573, -411, 1999, 1298 FontFile2: true Encoding: WinAnsiEncoding ToUnicode: true XMP: 2021-06-07T12:38:12+02:00 2021-06-25T13:55:34+05:30 2021-06-25T13:55:34+05:30 Adobe InDesign 16.2 (Windows) uuid:32869913-7532-4e22-b3b2-fc6a9666d265 adobe:docid:indd:a1ace0ee-97e8-11da-8f16-a6a04fdc746b xmp.id:d6a41a39-d11c-a146-997b-f7203ebb5318 proof:pdf xmp.iid:28da961b-6003-034f-b6a0-5a56284ed927 xmp.did:bc22386f-af3f-aa45-91c3-3970d882ebca adobe:docid:indd:a1ace0ee-97e8-11da-8f16-a6a04fdc746b default converted from application/x-indesign to application/pdf Adobe InDesign 16.2 (Windows) / 2021-06-07T12:38:12+02:00 application/pdf Román J.L.; García-Carro C.; Agraz I.; Toapanta N.; Vergara A.; Gabaldón A.; Torres I.; Bury R.; Baldallo C.; Serón D.; Soler M.J. COVID-19 in CKD Patients: Lessons from 553 CKD Patients with Biopsy-Proven Kidney Disease This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Introduction: Chronic kidney disease (CKD) patients infected with COVID-19 are at risk of serious complications such as hospitalization and death. The prognosis and lethality of COVID-19 infection in patients with established kidney disease has not been widely studied. Methods: Data included patients who underwent kidney biopsy at the Vall d’Hebron Hospital between January 2013 and February 2020 with COVID-19 diagnosis during the period from March 1 to May 15, 2020. Results: Thirty-nine (7%) patients were diagnosed with COVID-19 infection. Mean age was 63 ± 15 years and 48.7% were male. Hypertension was present in 79.5%, CKD without renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients; older (p = 0.01), hypertensive (p = 0.005), and immunosuppressed (p = 0.01) patients, those using RAS-blocking drugs (p = 0.04), and those with gastrointestinal symptoms (p = 0.02) were more likely to be tested for CO­VID-19. Twenty-two patients required hospitalization and 15.4% died. In bivariate analysis, mortality was associated with older age (p = 0.03), cardiovascular disease (p = 0.05), chronic obstructive pulmonary disease (p = 0.05), and low hemoglobin levels (p = 0.006). Adjusted Cox regression showed that low hemoglobin levels at admission had 1.81 greater risk of mortality. Conclusions: Patients with CO­VID-19 infection and kidney disease confirmed by kidney biopsy presented a mortality of 15.4%. Swab test for COVID-19 was more likely to be performed in older, hypertensive, and immunosuppressed patients, those using RAS-blocking drugs, and those with gastrointestinal symptoms. Low hemoglobin is a risk factor for mortality. 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