Acute Kidney Injury in Patients with COVID – 19 Infection: Α Tertiary Referral Hospital Experience

The emersion of the new coronavirus SARS COV 2 (Severe Acute Respiratory SyndromeCoronavirus 2) was rapidly characterized as a pandemic by WHO. The majormanifestation of the virus is respiratory distress; however, the involvement of other organsshould not be overlooked. The kidney is one of the most important target organsof the specific virus with acute kidney injury (AKI) described in 5-36% of COVIDpositive patients and an average 25% within the severely ill.Purp ose: The purpose of this study was to consider the incidence of AKI in patientswith COVID 19 in our cohort and to better understand risk factors associated withAKI. Further, we wanted to investigate the impact of AKI on survival and in hospitalmortality.Methods: Patients admitted to Evagelismos General Hospital with confirmed COVID-19 infection from 11th March until 22th May were investigated. Patients 18 yearsold as well as transplanted patients were excluded from this study. AKI was definedaccording to the AKI criteria.Results : From 99 patients with COVID-19 infection, AKI occurred in 41 (41.4%).A total of 44 patients (44.4%) were admitted to Intensive Care Unit (ICU) and 31 ofthem (70.5%) developed AKI. Of the 44 patients with AKI, 16 (39%) required renalreplacement therapy. Hospital mortality, in total, was 16.2% (37% among patientswith AKI versus 0.02% among those without AKI, p=0.000).Conclusion: AKI was common among patients hospitalized with COVID 19. AKIwas associated with older age, clinical severity and existing CKD

The effect of vitamin K2 supplementation on vascular calcification in haemodialysis patients: a 1-year follow-up randomized trial

INTRODUCTION - Vascular calcification (VC) represents an independent risk factor for cardiovascular disease in hemodialysis patients. Matrix GLA protein (MGP) is one of the most potent inhibitors of VC and its activation is vitamin K dependent. Patients on Hemodialysis (HD) have high levels of uncarboxylated-MGP, an inactive form of MGP. Increasing evidence suggest that they may benefit from vitamin K2 supplementation. The aim of this study was to investigate the role of oral vitamin K2 administration, to the prevention of vascular calcification progression among haemodialysis patients. PATIENTS - METHODS This was a single cohort, prospective, randomized, controlled trial in hemodialysis patients. Patients with a history of impaired mental function, low life expectancy and chronic gastrointestinal disorders were excluded. All patients were randomly assigned in two main groups (vitamin K2 200μg/day and controls). Blood samples were taken from both groups at the initiation of the study and after 3 months. The ucMGP concentrations were quantified by ELISA. Haemoglobin, calcium, phosphorus, creatinine, ferritin and parathyroid hormone were measured using standard laboratory techniques. An abdominal computed tomography scan (CT) was performed by all patients at the beginning and at the end of the one year follow up period. The aortic calcification of the abdominal aorta was evaluated based on the Agatston score, using Hounsfield scale. Ethics Committee approved trial protocol, while all patients who participated in the study signed an informed consent. RESULTS Overall 102 patients (46 males, age 68,3±14,6 years) were included in the study. After one year of follow up, 22 patients from the vitamin K2 group (mean age 70.09 ± 12.68 years) and 30 patients from the control group (mean age 64.74 ± 16.95 years) were included in the study. The drop-outs during the follow up, were similar between the two study groups.At baseline, among the two study groups, no statistically significant differences were identified in demographics, comorbidities and uc-MGP values. At 3 months, uc-MGP levels decreased at a rate of 26% in the vitamin K2 group, but these results were not statistically significant (13769.59 ± 16799 vs 10969.92 ± 8717 ng/ml, p>0,05. In the control group, uc-MGP levels remained unchanged (11625.79 ± 11230 vs 11471.79 ±10732 ng/ml, p=ns).After one year of treatment, uc-MGP values were further reduced by 39% from the three-month value (from 10969.92 ± 8717 to 6810.3 ± 9141.8 ng/ml, p=0.009) and by 48% from the baseline value (p=0.001). Furthermore, uc-MGP was increased by 12% in the control group during the one year of follow up (from 11625.79 ± 11230 ng/ml to 13041.87 ± 12579.4 ng/ml, p=ns). There was no significant difference of aortic calcification estimation score between vitamin K2 and control group either at the start or at on one year of follow up. We observed a deterior of Agatston score (p=0.02), without a statistical important difference between the groups (p≥ 0.05). CONCLUSIONS Hemodialysis patients tend to have increased uc-MGP levels probably because of the well-established vitamin K deficit. Orally administered vitamin K2 resulted in a significant decrease in uc-MGP levels. This effect though, is not a sufficient nor the decisive factor that determines vascular calcification progression which is a multi-factorial pathophysiologic procedure. Larger studies are needed to confirm whether preventive vitamin K2 supplementation is warranted in ESRD patients.Σκοπός: Σκοπός της μελέτης είναι η εκτίμηση της από του στόματος χορήγησης βιταμίνης Κ2, στην πρόληψη και εξέλιξη των αγγειακών ασβεστώσεων, στους αιμοκαθαιρόμενους ασθενείς. Υλικά & Μέθοδοι: Η μελέτη αυτή είναι μια παρεμβατική, τυχαιοποιημένη,προοπτική μελέτη σε αιμοκαθαιρόμενους ασθενείς, διάρκειας ενός έτους. Έγινε τυχαιοποιημένος διαχωρισμός των αιμοκαθαιρόμενων της μελέτης σε δύο κύριες ομάδες. Στην πρώτη ομάδα χορηγήθηκαν 200 μgr βιταμίνη Κ2 p.o. καθημερινά για ένα έτος. Η δεύτερη ομάδα χρησιμοποιήθηκε σαν ομάδα ελέγχου. Μετρήθηκε η uc-MGP σε όλους τους ασθενείς στην αρχή της μελέτης, σε 3 μήνες και σε ένα χρόνο από την έναρξη αυτής. Έγινε αξονική οπισθοπεριτοναίου για την μέτρηση των ασβεστώσεων της κοιλιακής αορτής κατά την έναρξη της μελέτης και μετά από την ενός έτους χορήγηση βιταμίνης Κ2. Λήφθηκε υπόψιν και ο καθιερωμένος περιοδικός εργαστηριακός έλεγχος και η συννοσηρότητα του δείγματος αυτού. Η στατιστικη ανάλυση έγινε με SPSS 21.0. Αποτελέσματα: 102 ασθενείς πήραν μέρος στη μελέτη. Στα αποτελέσματα των τριων πρώτων μηνών φάνηκε μείωση της uc-MGP στην ομάδα που έλαβε βιταμίνη Κ2 κατά 26%, ενώ στην ομάδα ελέγχου παρέμεινε σταθερή. Από τα εως τώρα αποτελέσματα των μετρήσεων των ασβεστώσεων της κοιλιακής αορτής, δεν διαπιστώθηκε στατιστικά σημαντική διαφοροποίηση μεταξύ των ομάδων της μελέτης. Συμπεράσματα: Οι αιμοκαθαιρόμενοι ασθενείς παρουσιάζουν αυξημένα επίπεδα uc-MGP, λόγω της ανεπάρκειας που παρουσιάζουν σε βιταμίνη Κ. Η από του στόματος χορήγηση βιταμίνης Κ2, μειώνει σημαντικά τα επίπεδα της uc-MGP. Το αποτέλεσμα αυτό μπορεί να είναι ωφέλιμο στην πρόληψη των αγγειακών ασβεστώσεων