More than one-third of patients hospitalized for COVID-19 in a large metropolitan New York heath system developed acute kidney injury (AKI), according to a study published in Kidney International (1).
The largest study to date on the incidence of AKI in the United States, the study included 5449 adults admitted with COVID-19 to one of 13 hospitals in the Northwell Health system and found that 36.6% of the patients experienced a kidney injury. There was also a strong relationship between kidney injury and respiratory failure, noted study co-author Jia Hwei Ng, MD, Assistant Professor of Medicine
The New England Journal of Medicine has retracted one of the articles cited in the June Kidney News article, “Evidence Mounts that RAS-Blocking Medications Pose No Danger to COVID-19.”
The Kidney News article described this retracted article as “a database study of 8910 [COVID-19] patients who had been hospitalized in 11 countries on three continents. That study found that neither ACE inhibitors nor ARBs were associated with an increased risk of in-hospital death.”
The retraction of this one article does not materially affect the KN article’s conclusion citing an expert consensus that
For diabetic patients in high-deductible health plans (HDHPs), the introduction of preventive drug lists (PDLs)—with no copayments for preventive medications—is associated with lower out-of-pocket costs and increased use of essential medications, reports a study in Medical Care.
The researchers evaluated a natural experiment using data on commercially insured patients with diabetes enrolled in HDHPs (individual deductible at least $1000) linked to health savings accounts. Approximately 1750 patients in an intervention group were switched by their employers to PDL coverage. This meant that essential medications and supplies for preventing adverse outcomes of diabetes—including antidiabetic drugs, insulin, test strips, and
Many professional societies staked out the early position that COVID-19 patients should continue their blood pressure medications in the absence of a clear reason to stop them. And the early evidence to date has reinforced those recommendations.
It will take at least several months for more definitive answers from clinical trials, but the three largest observational studies to date found no signals of harm among patients taking inhibitors of the renin-angiotensin system (RAS) pathway.
Published in the May 1, 2020, New England Journal of Medicine, the studies are “definitely the biggest and most authoritative” so far, said Matthew
SARS-CoV-2 infection, the causative agent of coronavirus disease 2019 (COVID-19), was declared a pandemic on March 11, 2020, with more than 1.4 million people afflicted by April 8, 2020, and more than 80,000 deaths (1). Physical distancing is the cornerstone of slowing disease transmission to mitigate an overwhelming demand for healthcare resources that exceeds capacity. This strategy was used as early as the fifth century BC (2), more recently during the 1918 influenza pandemic, and during the 2009 severe acute respiratory syndrome (SARS) and 2012 Middle East Respiratory Syndrome epidemics. Early physical distancing has in part
As the first wave of survivors of severe COVID-19 begin to leave hospitals, many face a new challenge—dialysis.
Acute kidney injury (AKI) is recognized as a common complication in patients who develop severe COVID-19 infections requiring intensive care. Among those who recover enough to be discharged from the hospital, between 20% and 90% may require dialysis, according to reports from around the country, said Jeffrey Silberzweig, MD, co-chair of the ASN COVID-19 Response team, during a recent ASN webinar (1).
“We need to anticipate a surge of these patients,” Silberzweig said.
As New York City hospitals braced for a potentially overwhelming surge of COVID-19 cases, Columbia University Medical Center nephrologist Sumit Mohan, MD, MPH, and his colleagues had to transform the way they provided kidney transplant care.
“We put a pause on nearly all kidney transplants,” said Mohan, an associate professor of epidemiology and medicine at Columbia University. All elective procedures were put on hold to free up space and ventilators for a surge of COVID-19 patients. For kidney transplant patients with living donors, they decided it was safer to postpone surgeries to prevent donors or immune-suppressed recipients from becoming infected
As COVID-19 started to take hold in countries like China and Italy, Marian Michaels, MD, MPH, thought the transplant community in the United States and Canada would benefit from having information about the then-rising epidemic so they could establish solid plans for their patients and programs. She had no idea how prescient that decision would be.
Michaels, a pediatric infectious diseases physician at UPMC Children’s Hospital of Pittsburgh, gathered fellow infectious disease transplant experts to publish a framework for keeping patients and hospital staffs safe during an outbreak of COVID-19 (1). Michaels noted that individual transplant centers may
The American Association of Kidney Patients (AAKP) recently held a webinar about coronavirus and kidney patients in partnership with the Centers for Disease Control and Prevention (CDC). Shannon Novosad, MD, MPH, a medical officer with the CDC’s dialysis safety team, discussed tips for kidney patients to protect themselves at home, in the community, or in healthcare facilities, including general advice on handwashing and social distancing. She also suggested that patients have a plan in case they become ill and that they have several weeks’ worth of medications and supplies. It is important, she added, that they not postpone dialysis treatment.
Jeffrey Perl, Alan S. Kliger, Martin J. Schreiber, and the Home Dialysis Subcommittee of the ASN COVID-19 Response Team
The world is struggling with the new and uncertain realities of the COVID-19 pandemic, which has challenged all facets of the healthcare system in unprecedented ways. As the initial experience in the United States has taught us, none are more vulnerable to COVID-19–related morbidity and mortality than the ESRD population (1). These individuals carry a high burden of comorbidity, may be immunocompromised, have high rates of healthcare use, and often have a high prevalence of many of the symptoms that overlap with those of COVID-19. Moreover, the risk of viral transmission may be greatest for patients receiving in-center