COVID-19 incidence and outcomes among patients with kidney replacement therapy

Background We aimed to investigate the incidence, fatality, and associated factors in patients with hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT) hospitalized for coronavirus disease 2019 (COVID-19) infection and reimbursed from the National Health Security Office (NHSO). Methods The retrospective cohort analysis was conducted from an electronic-claimed database, and COVID-19 vaccination status was evaluated in patients with HD, PD, and KT from January 2020 to December 2021. There were 85,305 patients reimbursed for HD, PD, and KT by the NHSO. The rates of COVID-19 infection, COVID-19 vaccination, comorbidities, fatalities, and the cost of treatment were evaluated. Results COVID-19 infection was observed in 1,799 of 36,982 HD cases (4.9%), 1,531 of 45,453 PD cases (3.4%), and 95 of 2,870 KT cases (3.3%). Patients receiving COVID-19 vaccinations were most common in the KT group, followed by those with HD and PD (76.93% vs. 70.65% vs. 51.34%, respectively). KT patients had a lower fatality rate compared to those with PD and HD (8.42% vs. 18.41% vs. 21.40%, respectively). Advanced age, diabetes, cardiovascular diseases, and COVID-19 vaccination status were associated with fatality. The adjusted odds ratios of fatality after receiving one or two doses of vaccines were 0.7 (95% confidence interval [CI], 0.6–0.9) and 0.3 (95% CI, 0.2–0.4), respectively. The cost of treatment was highest in patients with HD, followed by PD and KT. Conclusion The incidence of COVID-19 infection was higher in patients with HD than in those with PD or KT. COVID-19 vaccination following the national health policy should be encouraged for these patients to prevent fatality

Renal fibrosis

Renal fibrosis, characterized by tubulointerstitial fibrosis and glomerulosclerosis, is the final manifestation of chronic kidney disease. Renal fibrosis is characterized by an excessive accumulation and deposition of extracellular matrix components. This pathologic result usually originates from both underlying complicated cellular activities such as epithelial-to-mesenchymal transition, fibroblast activation, monocyte/macrophage infiltration, and cellular apoptosis and the activation of signaling molecules such as transforming growth factor beta and angiotensin II. However, because the pathogenesis of renal fibrosis is extremely complicated and our knowledge regarding this condition is still limited, further studies are needed

Acute kidney injury in a patient presenting with cirrhosis

Acute kidney injury (AKI) often occurs in patients with cirrhosis. AKI remains a leading complication and a major cause of death in cirrhotic patients. The common causes of AKI in these patients are prerenal azotemia, acute tubular necrosis (ATN) and hepatorenal syndrome (HRS). Patients with decompensated cirrhosis are susceptible to developing AKI due to the progressive vasodilation leading to relative hypovolemia and decrease in renal blood flow. The AKI is frequently precipitated by events which increase the decline of kidney function or effective circulatory volume such as gastrointestinal hemorrhage, nephrotoxic agents and septicemia. In conclusion, patients with cirrhotic conditions who experience acute onset of azothemia and oliguria, the diagnosis of AKI from ATN or HRS should be considered even though the differentiation of HRS from ATN remains difficult. The prognosis for cirrhotic patient with AKI, therefore, depends an accurate and immediate diagnosis and treatment

The equation to estimate glomerular filtration rate: the MDRD equation and CKD-EPI equation

The assessment of kidney function is an important part of medical practice for detection of chronic kidney disease (CKD), evaluation of rate of progression and its severity, and the appropriate management including renal replacement therapy (RRT). It is essential to assess overall health such as selecting the correct dosage for drugs which are excreted by the kidneys. The gold standard for estimating glomerular filtration rate (GFR) is costly, burdensome and not available in many places. Several formulas for estimating GFR have been developed. The most widely studied of these are the Modification of Diet in Renal Disease (Modification of Diet in Renal Disease Study; MDRD equation) and the CKD-EPI equation. Both of these equations provide a clinically useful to estimate GFR and easy to implement since they require only serum creatinine, sex, age and race. However, it has been shown previously that the MDRD Study equation underestimates the measured GFR (mGFR) at eGFR >60 mL/min/1.73 m2. The CKD-EPI equation is shown in less bias than the MDRD Study equation is in many subgroups. Currently, this equation should be replaced the MDRD Study equation for general clinical use and can be reported throughout the GFR range. Further study should be investigated which equation is the most accurate in Thai population

The impact of the quality of care and other factors on progression of chronic kidney disease in Thai patients with Type 2 Diabetes Mellitus: A nationwide cohort study.

The present study investigates the impact of quality of care (QoC) and other factors on chronic kidney disease (CKD) stage progression among Type 2 Diabetes Mellitus (T2DM) patients.This study employed a retrospective cohort from a nationwide Diabetes and Hypertension study involving 595 Thai hospitals. T2DM patients who were observed at least 2 times in the 3 years follow-up (between 2011-2013) were included in our study. Ordinal logistic mixed effect regression modeling was used to investigate the association between the QoC and other factors with CKD stage progression.After adjusting for covariates, we found that the achievement of the HbA1c clinical targets (≤7%) was the only QoC indicator protective against the CKD stage progression (adjusted OR = 0.76; 95%CI = 0.59-0.98; p<0.05). In terms of other covariates, age, occupation, type of health insurance, region of residence, HDL-C, triglyceride, hypertension and insulin sensitizer were also strongly associated with CKD stage progression.This cohort study demonstrates the achievement of the HbA1c clinical target (≤7%) is the only QoC indicator protective against progression of CKD stage. Neither of the other clinical targets (BP and LDL-C) nor any process of care targets could be shown to be associated with CKD stage progression. Therefore, close monitoring of blood sugar control is important to slow CKD progression, but long-term prospective cohorts are needed to gain better insights into the impact of QoC indicators on CKD progression

Renal Thrombotic Microangiopathy after Hematopoietic Cell Transplant: Role of GVHD in Pathogenesis

Background and objectives: Thrombotic microangiopathy (TMA) is a known complication of hematopoietic cell transplantation (HCT). The etiology and diagnosis of TMA in this patient population is often difficult because thrombocytopenia, microangiopathic hemolytic anemia, and kidney injury occur frequently in HCT recipients, and are the result of a variety of insults