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3. Association of obesity with 3-month mortality in kidney failure patients with COVID-19

Author

Tantisattamo, Ekamol, Imhof, Celine, Jager, Kitty J., Hilbrands, Luuk B., Guidotti, Rebecca, Islam, Mahmud, Katicic, Dajana, Konings, Constantijn, Molenaar, Femke M., Nistor, Ionut, Noordzij, Marlies, Rodríguez Ferrero, Mariá Luisa, Verhoeven, Martine A. M., de Vries, Aiko P. J., Kalantar-Zadeh, Kamyar, Gansevoort, Ron T., Vart, Priya, van der Net, Jeroen B., Essig, Marie, du Buf-Vereijken, Peggy W. G., van Ginneken, Betty, Maas, Nanda, van Jaarsveld, Brigit C., Bemelman, Frederike J., Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G., Nurmohamed, Azam, Vogt, Liffert, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M., Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Radulescu, Daniela, Hengst, Maaike, Rydzewski, Andrzej, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Oliveira, Joaõ, Alferes, Daniela G., Zakharova, Elena V., Ambuehl, Patrice Max, Walker, Andrea, Lepeytre, Fanny, Rabate, Clementine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Majstorovic, Gordana Strazmester, ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Liakopoulos, Vassilios, Zanen, Adriaan L., Logtenberg, Susan J. J., Fricke, Lutz, Kuryata, Olexandr, Slebe, Jeroen J. P., Elhafeez, Samar Abd, Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E. J., Hesselink, Dennis A., Kal-van Gestel, J., Eiselt, Jaromir, Kielberger, Lukas, el-Wakil, Hala S., Logan, Ian, Canal, Cristina, Facundo, Carme, Ramos, Ana M., Debska-Slizien, Alicja, Veldhuizen, Nicoline M. H., Tigka, Eirini, Konsta, Maria Anna Polyzou, Panagoutsos, Stylianos, Mallamaci, Francesca, Postorino, Adele, Cambareri, Francesco, Matceac, Irina, Covic, Adrian, Groeneveld, J. H. M., Jousma, Jolanda, van Buren, Marjolijn, Diekmann, Fritz, Oppenheimer, Federico, Blasco, Miquel, Pereira, Tiago Assis, Santos, Augusto Cesar S., Arias-Cabrales, Carlos, Crespo, Marta, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Mendoza-Valderrey, Alberto, Martins, Ana Cristina, Mateus, Catarina, Alvila, Goncalo, Laranjinha, Ivo, Hofstra, Julia M., Siezenga, Machiel A., Franco, Antonio, Arroyo, David, Castellano, Sandra, Manzanos, Sagrario Balda, Haridian Sosa Barrios, R., Lemahieu, Wim, Bartelet, Karlijn, Dirim, Ahmet Burak, Demir, Erol, Sever, Mehmet Sukru, Turkmen, Aydin, Safak, Seda, Hollander, Daan A. M. J., Büttner, Stefan, Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petruliene, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M., Christiaans, Maarten H. L., Hemmelder, Marc H., Kumar, Mohan N., di Luca, Marina, Tuǧlular, Serhan Z., Ziekenhuis, Martini, Kramer, Andrea B., Beerenhout, Charles, Luik, Peter T., Kerschbaum, Julia, Tiefenthaler, Martin, Watschinger, Bruno, Adema, Aaltje Y., Stepanov, Vadim A., Zulkarnaev, Alexey B., Turkmen, Kultigin, Gandolfini, Ilaria, Maggiore, Umberto, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W. H., Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Kerckhoffs, Angele, Els van de Logt, Anne, Maas, Rutger, Duivenvoorden, Raphaël, Lebedeva, Olga, Lopez, Veronica, Reichert, Louis J. M., Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V., Zanoli, Luca, Marcantoni, Carmelita, van Kempen, Gijs, van Gils-Verrij, Liesbeth E. A., Harty, John C., Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, Lentini, Paolo, den Deurwaarder, Edwin, Stendahl, Maria, Rahimzadeh, Hormat, Schouten, Marcel, Rychlik, Ivan, Cabezas-Reina, Carlos J., Roca, Ana Maria, Nauta, Ferdau, Sahin, Idris, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, de Arriba, Gabriel, Meijers, Björn K. I., Naesens, Maarten, Kuypers, Dirk, Desschans, Bruno, Tonnerlier, Annelies, Wissing, Karl M., Dedinska, Ivana, Pessolano, Giuseppina, Malik, Shafi, Dounousi, Evangelia, Papachristou, Evangelos, Berger, Stefan P., Meijer, Esther, Sanders, Jan Stephan F., Franssen, Casper F. M., Özyilmaz, Akin, Ponikvar, Jadranka Buturović, Pernat, Andreja Marn, Kovac, Damjan, Arnol, Miha, Ekart, Robert, Abrahams, Alferso C., van Zuilen, Arjan D., Meijvis, Sabine C. A., Dolmans, Helma, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Soler, Maria Jose, Luik, Antinus J., van Kuijk, Willi H. M., Stikkelbroeck, Lonneke W. H., Hermans, Marc M. H., Rimsevicius, Laurynas, Righetti, Marco, Heitink-ter Braak, Nicole, Medical Informatics, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, ACS - Pulmonary hypertension & thrombosis, Nephrology, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, Clinical sciences, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, ACS - Diabetes & metabolism, Internal Medicine, Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), van der Net, Jeroen B, Essig, Marie, du Buf-Vereijken, Peggy W G, van Ginneken, Betty, Maas, Nanda, van Jaarsveld, Brigit C, Bemelman, Frederike J, Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G, Nurmohamed, Azam, Vogt, Liffert, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M, Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Radulescu, Daniela, Hengst, Maaike, Rydzewski, Andrzej, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G, Zakharova, Elena V, Ambuehl, Patrice Max, Walker, Andrea, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Majstorovic, Gordana Strazmester, Ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Liakopoulos, Vassilios, Zanen, Adriaan L, Logtenberg, Susan J J, Fricke, Lutz, Kuryata, Olexandr, Slebe, Jeroen J P, ElHafeez, Samar Abd, Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E J, Hesselink, Dennis A, Kal-van Gestel, J., Eiselt, Jaromir, Kielberger, Lukas, El-Wakil, Hala S, Logan, Ian, Canal, Cristina, Facundo, Carme, Ramos, Ana M, Debska-Slizien, Alicja, Veldhuizen, Nicoline M H, Tigka, Eirini, Konsta, Maria Anna Polyzou, Panagoutsos, Stylianos, Mallamaci, Francesca, Postorino, Adele, Cambareri, Francesco, Matceac, Irina, Covic, Adrian, Groeneveld, J H M, Jousma, Jolanda, van Buren, Marjolijn, Diekmann, Fritz, Oppenheimer, Federico, Blasco, Miquel, Pereira, Tiago Assis, Santos, Augusto Cesar S, Arias-Cabrales, Carlos, Crespo, Marta, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Mendoza-Valderrey, Alberto, Martins, Ana Cristina, Mateus, Catarina, Alvila, Goncalo, Laranjinha, Ivo, Hofstra, Julia M, Siezenga, Machiel A, Franco, Antonio, Arroyo, David, Castellano, Sandra, Manzanos, Sagrario Balda, Haridian Sosa Barrios, R., Lemahieu, Wim, Bartelet, Karlijn, Dirim, Ahmet Burak, Demir, Erol, Sever, Mehmet Sukru, Turkmen, Aydin, Şafak, Seda, Hollander, Daan A M J, Büttner, Stefan, Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petrulienė, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M, Christiaans, Maarten H L, Hemmelder, Marc H, Kumar N, Mohan, Di Luca, Marina, Tuğlular, Serhan Z, Ziekenhuis, Martini, Kramer, Andrea B, Beerenhout, Charles, Luik, Peter T, Kerschbaum, Julia, Tiefenthaler, Martin, Watschinger, Bruno, Adema, Aaltje Y, Stepanov, Vadim A, Zulkarnaev, Alexey B, Turkmen, Kultigin, Gandolfini, Ilaria, Maggiore, Umberto, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W H, Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Kerckhoffs, Angele, Els van de Logt, Anne, Maas, Rutger, Duivenvoorden, Raphaël, Lebedeva, Olga, Lopez, Veronica, Reichert, Louis J M, Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V, Zanoli, Luca, Marcantoni, Carmelita, van Kempen, Gijs, van Gils-Verrij, Liesbeth E A, Harty, John C, Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, Lentini, Paolo, den Deurwaarder, Edwin, Stendahl, Maria, Rahimzadeh, Hormat, Schouten, Marcel, Rychlik, Ivan, Cabezas-Reina, Carlos J, Roca, Ana Maria, Nauta, Ferdau, Sahin, İdris, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, de Arriba, Gabriel, Meijers, Björn K I, Naesens, Maarten, Kuypers, Dirk, Desschans, Bruno, Tonnerlier, Annelies, Wissing, Karl M, Dedinska, Ivana, Pessolano, Giuseppina, Malik, Shafi, Dounousi, Evangelia, Papachristou, Evangelos, Berger, Stefan P, Meijer, Esther, Sanders, Jan Stephan F, Franssen, Casper F M, Özyilmaz, Akin, Ponikvar, Jadranka Buturović, Pernat, Andreja Marn, Kovac, Damjan, Arnol, Miha, Ekart, Robert, Abrahams, Alferso C, van Zuilen, Arjan D, Meijvis, Sabine C A, Dolmans, Helma, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Soler, Maria Jose, Luik, Antinus J, van Kuijk, Willi H M, Stikkelbroeck, Lonneke W H, Hermans, Marc M H, Rimševičius, Laurynas, Righetti, Marco, and Heitink-Ter Braak, Nicole

Subjects
Transplantation, COVID-19, infectious diseases, mortality, DIALYSIS PATIENTS, kidney failure, BODY-MASS INDEX, obesity paradox, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], TRANSPLANT, SDG 3 - Good Health and Well-being, Nephrology, ERACODA, reverse epidemiology, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11]
Abstract

Background In the general population with coronavirus disease 2019 (COVID-19), obesity is associated with an increased risk of mortality. Given the typically observed obesity paradox among patients on kidney function replacement therapy (KFRT), especially dialysis patients, we examined the association of obesity with mortality among dialysis patients or living with a kidney transplant with COVID-19. Methods Data from the European Renal Association COVID-19 Database (ERACODA) were used. KFRT patients diagnosed with COVID-19 between 1 February 2020 and 31 January 2021 were included. The association of Quetelet's body mass index (BMI) (kg/m2), divided into: Results In 3160 patients on KFRT (mean age: 65 years, male: 61%), 99 patients were lean, 1151 normal weight (reference), 1160 overweight, 525 obese I and 225 obese II/III. During follow-up of 3 months, 28, 20, 21, 23 and 27% of patients died in these categories, respectively. In the fully adjusted model, the hazard ratios (HRs) for 3-month mortality were 1.65 [95% confidence interval (CI): 1.10, 2.47], 1 (ref.), 1.07 (95% CI: 0.89, 1.28), 1.17 (95% CI: 0.93, 1.46) and 1.71 (95% CI: 1.27, 2.30), respectively. Results were similar among dialysis patients (N = 2343) and among those living with a kidney transplant (N = 817) (Pinteraction = 0.99), but differed by sex (Pinteraction = 0.019). In males, the HRs for the association of aforementioned BMI categories with 3-month mortality were 2.07 (95% CI: 1.22, 3.52), 1 (ref.), 0.97 (95% CI: 0.78. 1.21), 0.99 (95% CI: 0.74, 1.33) and 1.22 (95% CI: 0.78, 1.91), respectively, and in females corresponding HRs were 1.34 (95% CI: 0.70, 2.57), 1 (ref.), 1.31 (95% CI: 0.94, 1.85), 1.54 (95% CI: 1.05, 2.26) and 2.49 (95% CI: 1.62, 3.84), respectively. Conclusion In KFRT patients with COVID-19, on dialysis or a kidney transplant, obesity is associated with an increased risk of mortality at 3 months. This is in contrast to the obesity paradox generally observed in dialysis patients. Additional studies are required to corroborate the sex difference in the association of obesity with mortality.

Published
2022

4. COVID-19-related mortality in kidney transplant and haemodialysis patients

Author

Goffin, Eric, Candellier, Alexandre, Vart, Priya, Noordzij, Marlies, Arnol, Miha, Covic, Adrian, Lentini, Paolo, Malik, Shafi, Reichert, Louis J., Sever, Mehmet S., Watschinger, Bruno, Jager, Kitty J., Gansevoort, Ron T., van der Net, Jeroen B., Essig, Marie, du Buf-Vereijken, Peggy W. G., van Ginneken, Betty, Vogt, Liffert, van Jaarsveld, Brigit C., Bemelman, Frederike J., Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G., Nurmohamed, Azam, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Avitum, B. Braun, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M., Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Hengst, Maaike, Rydzewski, Andrzej, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G., Zakharova, Elena V., Ambuehl, Patrice Max, Walker, Andrea, Winzeler, Rebecca, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Katicic, Dajana, ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Zanen, Adriaan L., Logtenberg, Susan J. J., Fricke, Lutz, Slebe, Jeroen J. P., Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E. J., Eiselt, Jaromir, Kielberger, Lukas, el-Wakil, Hala S., Verhoeven, Martine A. M., Canal, Cristina, Facundo, Carme, Ramos, Ana M., Debska-Slizien, Alicja, Veldhuizen, Nicoline M. H., Tigka, Eirini, Konsta, Maria Anna Polyzou, Panagoutsos, Stylianos, Mallamaci, Francesca, Matceac, Irina, Nistor, Ionut, Cordos, Monica, Groeneveld, J. H. M., Jousma, Jolanda, van Buren, Marjolijn, Elhafeez, Samar Abd, Diekmann, Fritz, Pereira, Tiago Assis, Santos, Augusto Cesar S., Arias-Cabrales, Carlos, Crespo, Marta, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Hofstra, Julia M., Franco, Antonio, Arroyo, David, Rodríguez-Ferrero, Maria Luisa, Manzanos, Sagrario Balda, Barrios, R. Haridian Sosa, Ávila, Gonçalo, Laranjinha, Ivo, Mateus, Catarina, Lemahieu, Wim, Dirim, Ahmet Burak, Demir, Erol, Å afak, Seda, Turkmen, Aydin, Hollander, Daan A. M. J., Büttner, Stefan, de Vries, Aiko P. J., Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petruliene, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M., Christiaans, Maarten H. L., Hemmelder, Marc, Kumar, Mohan N., di Luca, Marina, Tuǧlular, Serhan Z., Kramer, Andrea, Beerenhout, Charles, Luik, Peter T., Kerschbaum, Julia, Tiefenthaler, Martin, Adema, Aaltje Y., Stepanov, Vadim A., Zulkarnaev, Alexey B., Turkmen, Kultigin, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W. H., Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Duivenvoorden, Raphaël, Hilbrands, Luuk, Kerckhoffs, Angele, Maas, Rutger, Lebedeva, Olga, Lopez, Veronica, Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V., Zanoli, Luca, Marcantoni, Carmelita, van Gils-Verrij, Liesbeth E. A., Harty, John C., Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, den Deurwaarder, Edwin, Stendahl, Maria, Rahimzadeh, Hormat, Schouten, Marcel, Rychlik, Ivan, Cabezas-Reina, Carlos J., Roca, Ana Maria, Nauta, Ferdau, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, Meijers, Björn K. I., Naesens, Maarten, Kuypers, Dirk, Desschans, Bruno, Tonnelier, Annelies, Wissing, Karl M., de Arriba, Gabriel, Dedinska, Ivana, Pessolano, Giuseppina, Gandolfini, Ilaria, Maggiore, Umberto, Papachristou, Evangelos, Franssen, Casper F. M., Berger, Stefan P., Meijer, Esther, Özyilmaz, Akin, Sanders, Jan Stephan F., Ponikvar, Jadranka Buturović, Pernat, Andreja Marn, Kovac, Damjan, Ekart, Robert, Abrahams, Alferso C., Molenaar, Femke M., van Zuilen, Arjan D., Meijvis, Sabine C. A., Dolmans, Helma, Tantisattamos, Ekamol, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Sabiu, Gianmarco, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Luik, Antinus J., van Kuijk, Willi H. M., Stikkelbroeck, Lonneke W. H., Hermans, Marc M. H., Rimsevicius, Laurynas, Righetti, Marco, Islam, Mahmud, Braak, Nicole Heitink-Ter, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Internal Medicine, Clinical sciences, Nephrology, ACS - Diabetes & metabolism, AII - Inflammatory diseases, AII - Infectious diseases, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Medical Informatics, ACS - Pulmonary hypertension & thrombosis, APH - Aging & Later Life, APH - Quality of Care, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, and APH - Global Health

Subjects
medicine.medical_specialty, kidney, Original Article - Dialysis, medicine.medical_treatment, infectious diseases, law.invention, Kidney Failure, SDG 3 - Good Health and Well-being, Renal Dialysis, Risk Factors, law, Internal medicine, medicine, Humans, COVID-19, dialysis, mortality, transplantation, Registries, Renal replacement therapy, Chronic, AcademicSubjects/MED00340, Kidney transplantation, Dialysis, Transplantation, SARS-CoV-2, business.industry, Kidney Transplantation/adverse effects, Hazard ratio, medicine.disease, Kidney Transplantation, Intensive care unit, Comorbidity, Transplant Recipients, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Kidney Failure, Chronic/therapy, Nephrology, Kidney Failure, Chronic, Hemodialysis, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business
Abstract

BACKGROUND AND AIMS: Studies examining kidney failure patients with COVID-19 reported higher mortality in hemodialysis patients than in kidney transplant recipients. However, hemodialysis patients are often older and have more comorbidities. This study investigated the association of type of kidney replacement therapy with COVID-19 severity adjusting for differences in characteristics. METHOD: Data were retrieved from the European Renal Association COVID-19 Database (ERACODA), which includes kidney replacement therapy patients diagnosed with COVID-19 from all over Europe. We included all kidney transplant recipients and hemodialysis patients who presented between February 1st and December 1st 2020 and had complete information reason for COVID-19 screening and vital status at day 28. The diagnosis of COVID-19 was made based on a PCR of a nasal or pharyngeal swab specimens and/or COVID-19 compatible findings on a lung CT scan. The association of kidney transplantation or hemodialysis with 28-day mortality was examined using Cox proportional-hazards regression models adjusted for age, sex, frailty and comorbidities. Additionally, this association was investigated in the subsets of patients that were screened because of symptoms or have had routine screening. RESULTS: A total of 1,670 patients (496 functional kidney transplant recipients and 1,174 hemodialysis patients) were examined. 16.9% of kidney transplant recipients and 23.9% of hemodialysis patients died within 28 days of presentation. In an unadjusted model, the risk of 28-day mortality was 33% lower in kidney transplant recipients compared with hemodialysis patients (hazard ratio (HR): 0.67, 95% CI: 0.52, 0.85). However, in an age, sex and frailty adjusted model, the risk of 28-day mortality was 29% higher in kidney transplant recipients (HR=1.29, 95% CI: 1.00, 1.68), whereas in a fully adjusted model the risk was even 43% higher (HR=1.43, 95% CI: 1.06, 1.93). This association in patients who were screened because of symptoms (n=1,145) was similar (fully adjusted model HR=1.46, 95% CI: 1.05, 2.04). Results were similar when other endpoints were studied (e.g. risk for hospitalization, ICU admission or mortality beyond 28 days) as well as across subgroups. Only age was found to interact significantly, suggesting that the increased mortality risk associated with kidney transplantation was especially present in elderly subjects. CONCLUSION: In this study, kidney transplant recipients had a greater risk of a more severe course of COVID-19 compared with hemodialysis patients when adjusted for age, sex and comorbidities.

Published
2021

5. Sex differences in COVID-19 mortality risk in patients on kidney function replacement therapy

Author

Vart, Priya, Duivenvoorden, Raphaël, Adema, Aaltje, Covic, Adrian, Finne, Patrik, Braak, Nicole Heijtink-ter, Laine, Kaisa, Noordzij, Marlies, Schouten, Marcel, Jager, Kitty J., Gansevoort, Ron T., van der Net, Jeroen B., Essig, Marie, du Buf-Vereijken, Peggy W. G., van Ginneken, Betty, Maas, Nanda, van Jaarsveld, Brigit C., Bemelman, Frederike J., Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G., Nurmohamed, Azam, Vogt, Liffert, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M., Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Radulescu, Daniela, Hengst, Maaike, Konings, Constantijn, Rydzewski, Andrzej, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G., Zakharova, Elena V., Ambühl, Patrice Max, Guidotti, Rebecca, Walker, Andrea, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Majstorovic, Gordana Strazmester, Katicic, Dajana, ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Liakopoulos, Vassilios, Zanen, Adriaan L., Logtenberg, Susan J. J., Fricke, Lutz, Kuryata, Olexandr, Slebe, Jeroen J. P., ElHafeez, Samar Abd, Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E. J., Hesselink, Dennis A., Kal-van Gestel, J., Eiselt, Jaromir, Kielberger, Lukas, El-Wakil, Hala S., Verhoeven, Martine, Logan, Ian, Canal, Cristina, Facundo, Carme, Ramos, Ana M., Debska-Slizien, Alicja, Veldhuizen, Nicoline M. H., Tigka, Eirini, Konsta, Maria Anna Polyzou, Panagoutsos, Stylianos, Mallamaci, Francesca, Postorino, Adele, Cambareri, Francesco, Matceac, Irina, Nistor, Ionut, Groeneveld, J. H.M., Jousma, Jolanda, van Buren, Marjolijn, Diekmann, Fritz, Oppenheimer, Federico, Blasco, Miquel, Pereira, Tiago Assis, Santos, Augusto Cesar S., Arias-Cabrales, Carlos, Crespo, Marta, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Mendoza-Valderrey, Alberto, Martins, Ana Cristina, Mateus, Catarina, Alvila, Goncalo, Laranjinha, Ivo, Hofstra, Julia M., Siezenga, Machiel A., Franco, Antonio, Arroyo, David, Castellano, Sandra, Rodríguez-Ferrero, Maria Luisa, Manzanos, Sagrario Balda, Barrios, R. Haridian Sosa, Lemahieu, Wim, Bartelet, Karlijn, Dirim, Ahmet Burak, Demir, Erol, Sever, Mehmet Sukru, Turkmen, Aydin, Şafak, Seda, Hollander, Daan A. M. J., Büttner, Stefan, de Vries, Aiko P. J., Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petrulienė, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M., Christiaans, Maarten H. L., Hemmelder, Marc H., MohanKumar, N., Di Luca, Marina, Tuğlular, Serhan Z., Kramer, Andrea B., Beerenhout, Charles, Luik, Peter T., Kerschbaum, Julia, Tiefenthaler, Martin, Watschinger, Bruno, Stepanov, Vadim A., Zulkarnaev, Alexey B., Turkmen, Kultigin, Gandolfini, Ilaria, Maggiore, Umberto, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W. H., Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Kerckhoffs, Angele, van de Logt, Anne Els, Maas, Rutger, Hilbrands, Luuk B., Lebedeva, Olga, Lopez, Veronica, Reichert, Louis J. M., Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V., Zanoli, Luca, Marcantoni, Carmelita, van Kempen, Gijs, van Gils-Verrij, Liesbeth E. A., Harty, John C., Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, Lentini, Paolo, den Deurwaarder, Edwin, Stendahl, Maria, Rahimzadeh, Hormat, Rychlik, Ivan, Cabezas-Reina, Carlos J., Roca, Ana Maria, Nauta, Ferdau, Sahin, İdris, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, de Arriba, Gabriel, Meijers, Björn K. I., Naesens, Maarten, Kuypers, Dirk, Desschans, Bruno, Tonnerlier, Annelies, Wissing, Karl M., Dedinska, Ivana, Pessolano, Giuseppina, Malik, Shafi, Dounousi, Evangelia, Papachristou, Evangelos, Berger, Stefan P., Sanders, Jan Stephan F., Franssen, Casper F. M., Özyilmaz, Akin, Ponikvar, Jadranka Buturović, Pernat, Andreja Marn, Kovac, Damjan, Arnol, Miha, Ekart, Robert, Abrahams, Alferso C., Molenaar, Femke M., van Zuilen, Arjan D., Meijvis, Sabine C. A., Dolmans, Helma, Tantisattamo, Ekamol, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Soler, Maria Jose, Luik, Antinus J., van Kuijk, Willi H. M., Stikkelbroeck, Lonneke W. H., Hermans, Marc M. H., Rimševičius, Laurynas, Righetti, Marco, Islam, Mahmud, Clinical sciences, Nephrology, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Groningen Institute for Organ Transplantation (GIOT), Medical Informatics, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, ACS - Pulmonary hypertension & thrombosis, AII - Inflammatory diseases, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, Internal Medicine, Department of Medicine, Clinicum, University of Helsinki, Helsinki University Hospital Area, ACS - Diabetes & metabolism, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, and UCL - (SLuc) Service de néphrologie

Subjects
Male, kidney, Transplant, infectious diseases, Kidney, All institutes and research themes of the Radboud University Medical Center, COVID‐19, Renal Dialysis, Risk Factors, risk factors, Humans, Eracoda, Aged, Sex Characteristics, Multidisciplinary, Dialysis patients, Kidney Transplantation/adverse effects, COVID-19, Middle Aged, Kidney Transplantation, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Nephrology, 3121 General medicine, internal medicine and other clinical medicine, mortality risk, Immunosuppressive Agents/therapeutic use, Female, Immunosuppressive Agents
Abstract

In the general population with COVID-19, the male sex is an established risk factor for mortality, in part due to a more robust immune response to COVID-19 in women. Because patients on kidney function replacement therapy (KFRT) have an impaired immune response, especially kidney transplant recipients due to their use of immunosuppressants, we examined whether the male sex is still a risk factor for mortality among patients on KFRT with COVID-19. From the European Renal Association COVID-19 Database (ERACODA), we examined patients on KFRT with COVID-19 who presented between February 1st, 2020, and April 30th, 2021. 1204 kidney transplant recipients (male 62.0%, mean age 56.4 years) and 3206 dialysis patients (male 61.8%, mean age 67.7 years) were examined. Three-month mortality in kidney transplant recipients was 16.9% in males and 18.6% in females (p = 0.31) and in dialysis patients 27.1% in males and 21.9% in females (p = 0.001). The adjusted HR for the risk of 3-month mortality in males (vs females) was 0.89 (95% CI 65, 1.23, p = 0.49) in kidney transplant recipients and 1.33 (95% CI 1.13, 1.56, p = 0.001) in dialysis patients (pinteraction = 0.02). In a fully adjusted model, the aHR for the risk of 3-month mortality in kidney transplant recipients (vs. dialysis patients) was 1.39 (95% CI 1.02, 1.89, p = 0.04) in males and 2.04 (95% CI 1.40, 2.97, p interaction = 0.02). In patients on KFRT with COVID-19, the male sex is not a risk factor for mortality among kidney transplant recipients but remains a risk factor among dialysis patients. The use of immunosuppressants in kidney transplant recipients, among other factors, may have narrowed the difference in the immune response to COVID-19 between men and women, and therefore reduced the sex difference in COVID-19 mortality risk.

Published
2022

6. Clinical, Functional, and Mental Health Outcomes in Kidney Transplant Recipients 3 Months After a Diagnosis of COVID-19

Author

Duivenvoorden, Raphaël, Vart, Priya, Noordzij, Marlies, Soares Dos Santos, Augusto C., Zulkarnaev, Alex B., Franssen, Casper F. M., Kuypers, Dirk, Demir, Erol, Rahimzadeh, Hormat, Kerschbaum, Julia, Jager, Kitty J., Turkmen, Kultigin, Hemmelder, Marc H., Schouten, Marcel, Rodríguez-Ferrero, María Luisa, Crespo, Marta, Gansevoort, Ron T., Hilbrands, Luuk B., van der Net, Jeroen B., Essig, Marie, du Buf-Vereijken, Peggy W. G., van Ginneken, Betty, Maas, Nanda, Vogt, Liffert, van Jaarsveld, Brigit C., Bemelman, Frederike J., Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G., Nurmohamed, Azam, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M., Montero Perez, Nuria, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Hengst, Maaike, Konings, Constantijn, Rydzewski, Andrzej, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G., Radulescu, Daniela, Zakharova, Elena V., Ambuehl, Patrice Max, Guidotti, Rebecca, Walker, Andrea, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Strazmester Majstorovic, Gordana, Katicic, Dajana, ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Liakopoulos, Vassilios, Zanen, Adriaan L., Logtenberg, Susan J. J., Fricke, Lutz, Kuryata, Olexandr, Slebe, Jeroen J. P., Abd Elhafeez, Samar, Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E. J., Hesselink, Dennis A., Kal-van Gestel, J., Eiselt, Jaromir, Kielberger, Lukas, el-Wakil, Hala S., Verhoeven, Martine, Logan, Ian, Canal, Cristina, Facundo, Carme, Ramos, Ana M., Debska-Slizien, Alicja, Veldhuizen, Nicoline M. H., Tigka, Eirini, Polyzou Konsta, Maria Anna, Panagoutsos, Stylianos, Mallamaci, Francesca, Postorino, Adele, Cambareri, Francesco, Matceac, Irina, Nistor, Ionut, Covic, Adrian, Groeneveld, J. H. M., Jousma, Jolanda, van Buren, Marjolijn, Diekmann, Fritz, Oppenheimer, Federico, Blasco, Miquel, Assis Pereira, Tiago, Arias-Cabrales, Carlos, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Mendoza-Valderrey, Alberto, Martins, Ana Cristina, Mateus, Catarina, Alvila, Goncalo, Laranjinha, Ivo, Hofstra, Julia M., Siezenga, Machiel A., Franco, Antonio, Arroyo, David, Castellano, Sandra, Balda Manzanos, Sagrario, Sosa Barrios, R. Haridian, Lemahieu, Wim, Bartelet, Karlijn, Burak Dirim, Ahmet, Sukru Sever, Mehmet, Turkmen, Aydin, Şafak, Seda, Hollander, Daan A. M. J., Büttner, Stefan, de Vries, Aiko P. J., Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petruliene, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M., Christiaans, Maarten H. L., Mohan Kumar, N., di Luca, Marina, Tuǧlular, Serhan Z., Kramer, Andrea, Beerenhout, Charles, Luik, Peter T., Tiefenthaler, Martin, Watschinger, Bruno, Adema, Aaltje Y., Stepanov, Vadim A., Gandolfini, Ilaria, Maggiore, Umberto, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W. H., Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Kerckhoffs, Angele, van de Logt, Anne Els, Maas, Rutger, Lebedeva, Olga, Lopez, Veronica, Reichert, Louis J. M., Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V., Zanoli, Luca, Marcantoni, Carmelita, van Kempen, Gijs, van Gils-Verrij, Liesbeth E. A., Harty, John C., Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, Lentini, Paolo, den Deurwaarder, Edwin, Stendahl, Maria, Rychlik, Ivan, Cabezas-Reina, Carlos J., Maria Roca, Ana, Nauta, Ferdau, Sahin, İdris, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, de Arriba, Gabriel, Meijers, Björn K. I., Naesens, Maarten, Desschans, Bruno, Tonnerlier, Annelies, Wissing, Karl M., Dedinska, Ivana, Pessolano, Giuseppina, Malik, Shafi, Dounousi, Evangelia, Papachristou, Evangelos, Berger, Stefan P., Meijer, Esther, Sanders, Jan Stephan F., Özyilmaz, Akin, Buturović Ponikvar, Jadranka, Marn Pernat, Andreja, Kovac, Damjan, Arnol, Miha, Ekart, Robert, Abrahams, Alferso C., Molenaar, Femke M., van Zuilen, Arjan D., Meijvis, Sabine C. A., Dolmans, Helma, Tantisattamo, Ekamol, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Jose Soler, Maria, Luik, Antinus J., van Kuijk, Willi H. M., Stikkelbroeck, Lonneke W. H., Hermans, Marc M. H., Rimsevicius, Laurynas, Righetti, Marco, Islam, Mahmud, Heitink-ter Braak, Nicole, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Medical Informatics, ACS - Pulmonary hypertension & thrombosis, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, Nephrology, ACS - Diabetes & metabolism, Internal Medicine, Interne Geneeskunde, RS: Carim - V02 Hypertension and target organ damage, and Clinical sciences

Subjects
kidney transplant, Adult, Kidney Disease, Outcome Assessment, Renal and urogenital, infectious diseases, Medical and Health Sciences, clinical, DISEASE, All institutes and research themes of the Radboud University Medical Center, Rare Diseases, SDG 3 - Good Health and Well-being, 7.1 Individual care needs, Clinical Research, Outcome Assessment, Health Care, Humans, Retrospective Studies, Transplantation, SARS-CoV-2, MORTALITY, Rehabilitation, COVID-19, mental health outcomes, survive, Organ Transplantation, Original Clinical Science—General, Middle Aged, SOLID-ORGAN TRANSPLANT, Kidney Transplantation, Transplant Recipients, DIALYSIS PATIENTS, Health Care, functional, Intensive Care Units, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Good Health and Well Being, Nephrology, ERACODA, ERACODA Collaborators, Surgery, Management of diseases and conditions, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11]
Abstract

BACKGROUND: Kidney transplant patients are at high risk for coronavirus disease 2019 (COVID-19)-related mortality. However, limited data are available on longer-term clinical, functional, and mental health outcomes in patients who survive COVID-19.METHODS: We analyzed data from adult kidney transplant patients in the European Renal Association COVID-19 Database who presented with COVID-19 between February 1, 2020, and January 31, 2021.RESULTS: We included 912 patients with a mean age of 56.7 (±13.7) y. 26.4% were not hospitalized, 57.5% were hospitalized without need for intensive care unit (ICU) admission, and 16.1% were hospitalized and admitted to the ICU. At 3 mo follow-up survival was 82.3% overall, and 98.8%, 84.2%, and 49.0%, respectively, in each group. At 3 mo follow-up biopsy-proven acute rejection, need for renal replacement therapy, and graft failure occurred in the overall group in 0.8%, 2.6%, and 1.8% respectively, and in 2.1%, 10.6%, and 10.6% of ICU-admitted patients, respectively. Of the surviving patients, 83.3% and 94.4% reached their pre-COVID-19 physician-reported functional and mental health status, respectively, within 3 mo. Of patients who had not yet reached their prior functional and mental health status, their treating physicians expected that 79.6% and 80.0%, respectively, still would do so within the coming year. ICU admission was independently associated with a low likelihood to reach prior functional and mental health status.CONCLUSIONS: In kidney transplant recipients alive at 3-mo follow-up, clinical, physician-reported functional, and mental health recovery was good for both nonhospitalized and hospitalized patients. Recovery was, however, less favorable for patients who had been admitted to the ICU.

Published
2022

11. Renin-Angiotensin System Blockers and the Risk of COVID-19–Related Mortality in Patients with Kidney Failure

Author

Soler, Maria Jose, Noordzij, Marlies, Abramowicz, Daniel, de Arriba, Gabriel, Basile, Carlo, van Buren, Marjolijn, Covic, Adrian, Crespo, Marta, Duivenvoorden, Raphaël, Massy, Ziad A., Ortiz, Alberto, Sanchez, J. Emilio, Petridou, Emily, Stevens, Kate, White, Colin, Vart, Priya, Gansevoort, Ron T., van der Net, Jeroen B., Essig, Marie, du Buf-Vereijken, Peggy W.G., van Ginneken, Betty, Maas, Nanda, Vogt, Liffert, van Jaarsveld, Brigit C., Jager, Kitty J., Bemelman, Frederike J., Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G., Nurmohamed, Azam, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M., Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Hengst, Maaike, Rydzewski, Andrzej, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G., Zakharova, Elena V., Ambuehl, Patrice Max, Winzeler, Rebecca, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Katicic, Dajana, Dam, Marc ten, Krüger, Thilo, Brzosko, Szymon, van Zanen, A.L., Logtenberg, Susan J.J., Fricke, Lutz, Slebe, Jeroen J.P., Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E.J., Eiselt, Jaromir, Kielberger, Lukas, El-Wakil, Hala S., ElHafeez, Samar Abd, Canal, Cristina, Facundo, Carme, Ramos, Ana M., Debska-Slizien, Alicja, Veldhuizen, Nicoline M.H., Panagoutsos, Stylianos, Matceac, Irina, Nistor, Ionut, Cordos, Monica, Groeneveld, J.H.M, Jousma, Jolanda, Diekmann, Fritz, Pereira, Tiago Assis, Santos, Augusto Cesar S., Arias-Cabrales, Carlos, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Arenas Jimenez, Maria Dolores, Hofstra, Julia M., Franco, Antonio, Arroyo, David, Rodríguez-Ferrero, Maria Luisa, Manzanos, Sagrario Balda, Sosa Barrios, R. Haridian, Lemahieu, Wim, Bartelet, Karlijn, Dirim, Ahmet Burak, Demir, Erol, Sever, Mehmet Sukru, Turkmen, Aydin, Hollander, Daan A.M.J., Büttner, Stefan, de Vries, Aiko P.J., Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petruliene, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M., Christiaans, Maarten H.L., Hemmelder, Marc, Di Luca, Marina, Tuğlular, Serhan Z., Beerenhout, Charles, Luik, Peter T., Kerschbaum, Julia, Tiefenthaler, Martin, Watschinger, Bruno, Adema, Aaltje Y., Stepanov, Vadim A., Zulkarnaev, Alexey B., Turkmen, Kultigin, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W.H., Pini, Stefano, de Biase, Consuelo, Hilbrands, Luuk, Kerckhoffs, Angele, van de Logt, Anne Els, Maas, Rutger, Lebedeva, Olga, Lopez, Veronica, Reichert, Louis J.M., Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V., Zanoli, Luca, Marcantoni, Carmelita, van Gils-Verrij, Liesbeth E.A., Harty, John C., Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, Lentini, Paolo, den Deurwaarder, Edwin, Stendahl, Maria, Rahimzadeh, Hormat, Schouten, Marcel, Rychlik, Ivan, Cabezas-Reina, Carlos J., Roca, Ana Maria, Nauta, Ferdau, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, Meijers, Björn K.I., Naesens, Maarten, Kuypers, Dirk, Desschans, Bruno, Tonnerlier, Annelies, Wissing, Karl M., Dedinska, Ivana, Pessolano, Giuseppina, Gandolfini, Ilaria, Maggiore, Umberto, Malik, Shafi, Papachristou, Evangelos, Franssen, Casper F.M., Berger, Stefan P., Meijer, Esther, Sanders, Jan Stephan F., Ponikvar, Jadranka Buturović, Pernat, Andreja Marn, Kovac, Damjan, Arnol, Miha, Ekart, Robert, Abrahams, Alferso C., Molenaar, Femke M., van Zuilen, Arjan D., Meijvis, Sabine C.A., Dolmans, Helma, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Luik, Antinus J., van Kuijk, Willi H.M., Stikkelbroeck, Lonneke W.H., Hermans, Marc M.H., Rimsevicius, Laurynas, Righetti, Marco, Islam, Mahmud, and Braak, Nicole Heitink-ter

Published
2021
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16. Urinary Immunoglobulin G to Albumin Ratio and N-Acetyl-Beta-D-Glucosaminidase as Early Predictors of Therapeutic Response in ANCA-Associated Glomerulonephritis

Author

Mravljak, Marija, primary, Vizjak, Alenka, additional, Ferluga, Dusan, additional, Pajek, Jernej, additional, Kovac, Damjan, additional, Skoberne, Andrej, additional, Ales Rigler, Andreja, additional, Kveder, Radoslav, additional, Kosir, Andrej, additional, and Lindic, Jelka, additional

Published
2013
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18. Clinical outcome of patients with coexistent antineutrophil cytoplasmic antibodies and antibodies against glomerular basement membrane.

Author

Lindic J, Vizjak A, Ferluga D, Kovac D, Ales A, Kveder R, Ponikvar R, and Bren A

Subjects
Aged, Anti-Glomerular Basement Membrane Disease therapy, Cyclophosphamide therapeutic use, Female, Follow-Up Studies, Humans, Immunoglobulins, Intravenous therapeutic use, Immunologic Factors therapeutic use, Immunosuppressive Agents therapeutic use, Methylprednisolone therapeutic use, Middle Aged, Necrosis etiology, Necrosis pathology, Plasma Exchange methods, Recurrence, Renal Dialysis, Anti-Glomerular Basement Membrane Disease immunology, Antibodies, Antineutrophil Cytoplasmic immunology, Autoantibodies immunology, Peroxidase immunology
Abstract

Antineutrophil cytoplasmic antibodies (ANCA) and antibodies against glomerular basement membrane (anti-GBM) rarely coexist. Both antibodies may be associated with rapidly progressive glomerulonephritis and pulmonary hemorrhage. We describe the clinical, serological and histological features of our patients with dual antibodies. From 1977 to 2008, 48 patients with anti-GBM antibody-associated renal disease were observed. Eight out of the 30 tested patients (26.7%), all females, had positive myeloperoxidase (MPO)-ANCA coexistent with anti-GBM antibodies. The patients' mean age was 63.4 +/- 7.8 years. Five presented with pulmonary-renal syndrome, all but one were dialysis-dependent on admission. They had constitutional symptoms and different organ involvement. The kidney biopsies revealed intense linear staining for immunoglobulin G and C3 along the glomerular and distal tubular basement membrane associated with irregular diffuse or focal extracapillary crescentic glomerulonephritis with necrosis of varying extent. Lesions of varying ages were characteristically expressed. Seven patients were treated with methylprednisolone and plasma exchange, four with cyclophosphamide, and one with intravenous immunoglobulin. After 28-74 months, there were three dialysis-dependent survivors and one patient with stable chronic renal disease. Two clinical relapses with pulmonary involvement and MPO-ANCA positivity without anti-GBM antibodies occurred in two dialysis-dependent patients. In summary, screening for ANCA and anti-GBM antibodies should be undertaken in patients with clinical signs of systemic vasculitis. In dialysis-dependent patients, the goal of treatment is to limit the damage of other involved organs and not to preserve renal function. Careful follow-up is necessary due to the relapsing nature of the ANCA component of the disease.

Published
2009
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19. Acute kidney injury in immunoglobulin A nephropathy: potential role of macroscopic hematuria and acute tubulointerstitial injury.

Author

Kveder R, Lindic J, Ales A, Kovac D, Vizjak A, and Ferluga D

Subjects
Acute Kidney Injury physiopathology, Adult, Aged, Biopsy, Needle, Creatinine blood, Female, Follow-Up Studies, Glomerulonephritis, IGA complications, Glomerulonephritis, IGA therapy, Glucocorticoids therapeutic use, Hematuria complications, Humans, Kidney Tubules pathology, Male, Methylprednisolone therapeutic use, Middle Aged, Nephritis, Interstitial complications, Renal Dialysis, Retrospective Studies, Acute Kidney Injury etiology, Glomerulonephritis, IGA physiopathology, Hematuria physiopathology, Nephritis, Interstitial physiopathology
Abstract

The aim of our retrospective study was to analyze the clinical course and outcome of patients with immunoglobulin A (IgA) nephropathy who presented with macroscopic hematuria and acute kidney injury (AKI). During the period from 1990 to 2005, seven out of 584 adult patients with IgA nephropathy (1.2%) fulfilled the criteria for macroscopic hematuria-induced AKI. There was an equal gender distribution among our patients, and a rather high average age at presentation (55.7 +/- 10.9 years). Four patients who were oliguric upon admission to hospital needed hemodialysis treatment. The average serum creatinine at the time of kidney biopsy was 429.8 +/- 377 micromol/L (median value 378). The percutaneous kidney needle biopsies showed focal proliferative crescentic glomerulonephritis of subclass III, according to the Haas scheme, associated with prominent red blood cell tubular casts and acute tubulointerstitial nephritis. Four patients with the most prominent crescents and tubulointerstitial involvement were treated with methylprednisolone. All patients, treated and untreated, recovered their kidney function (the serum creatinine at a median follow-up of 15 months was 111.7 +/- 38 micromol/L). In conclusion, AKI in IgA nephropathy accompanied by macroscopic hematuria appears to have been a reversible condition in our series of patients. Regarding pathogenesis, the kidney biopsy study points to the important role of glomerular bleeding with consequent, widespread obstructive red blood cell tubular casts accompanied by tubular injury and interstitial nephritis.

Published
2009
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20. Encapsulating peritoneal sclerosis in patients on peritoneal dialysis in Slovenia.

Author

Lindic J, Rupnik AT, Tomazic J, Skoberne A, Gucek A, Ferluga D, Pintar T, Ales A, Kovac D, Kveder R, Pajek J, Savicki-Ponikvar B, and Bren A

Subjects
Adult, Female, Follow-Up Studies, Humans, Kidney Failure, Chronic therapy, Male, Middle Aged, Peritoneal Diseases mortality, Peritoneal Diseases therapy, Peritoneum pathology, Retrospective Studies, Sclerosis mortality, Sclerosis therapy, Slovenia epidemiology, Young Adult, Peritoneal Dialysis adverse effects, Peritoneal Diseases etiology, Sclerosis etiology
Abstract

Encapsulating peritoneal sclerosis (EPS) is a rare complication in patients on peritoneal dialysis (PD), the prevalence of which increases with the time spent on PD. Various causative factors have been proposed, but the pathogenesis still remains unclear. The aim of our retrospective study was to analyze the basic clinical characteristics and outcomes of five patients diagnosed with EPS out of 423 patients treated with PD between January 1983 and December 2003. One patient was admitted due to ultrafiltration failure of the peritoneal membrane, and four patients were admitted for acute peritonitis. All of our patients presented with clinical symptoms suggestive of obstructive ileus. We confirmed the diagnosis of EPS with a computer tomography scan, a diagnostic laparotomy or laparoscopy, and a biopsy of the parietal peritoneum. We treated all of our patients with catheter removal, transferal to hemodialysis, antibiotics, complete parenteral nutrition, methylprednisolone, and tamoxifen for 6 months. One patient was treated with surgical enterolysis and died of septic complications, another patient died of sudden cardiac death during treatment. Three patients were doing well for 4-7 months after the treatment was started. The incidence of EPS was 1.2% and the mortality rate was 40%. EPS is a rare complication in longstanding PD patients in our institution. Despite treatment with hemodialysis, complete parenteral nutrition, steroids, tamoxifen and surgical intervention, the mortality rate is high and comparable to other reports.

Published
2009
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21. Haemodialysis clearance of baclofen.

Author

Brvar M, Vrtovec M, Kovac D, Kozelj G, Pezdir T, and Bunc M

Subjects
Acute Kidney Injury metabolism, Acute Kidney Injury therapy, Area Under Curve, Baclofen adverse effects, Baclofen blood, Drug Overdose, GABA Agonists adverse effects, GABA Agonists blood, Humans, Male, Metabolic Clearance Rate, Middle Aged, Baclofen pharmacokinetics, Coma chemically induced, GABA Agonists pharmacokinetics, Renal Dialysis
Abstract

Background: Baclofen is a centrally acting gamma-aminobutyric acid agonist used for spasticity of spinal origin and mainly excreted unchanged by the kidneys. We report haemodialysis clearance and the haemodialysis removal rate constant of baclofen in a comatose patient with baclofen overdose due to acute renal failure., Case Report: A 60-year-old man with spastic tetraplegia on chronic baclofen therapy was admitted due to pneumonia and acute renal failure. The patient became comatose and, as a result of the baclofen dosage being left unchanged despite a deterioration leading to renal failure due to hypotension, the concentration of baclofen was determined to be in the toxic range (0.70 mg/L). During a 4-hour-long bicarbonate haemodialysis the patient woke up and became completely orientated and cooperative. Baclofen therapy was subsequently stopped, and the patient remained conscious. The pharmacokinetics calculations revealed a baclofen haemodialysis removal rate constant of 0.152 h(-1) and a haemodialysis clearance of 2.14 mL/s., Conclusions: Patients on a stable baclofen regime can develop baclofen toxicity due to acute renal failure. Haemodialysis removes baclofen as effectively as normal kidneys, and it would appear that haemodialysis is a reasonable treatment modality in patients with accidental baclofen overdose due to acute renal failure.

Published
2007
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