NKF Clinical Digest - COVID-19
A message from our Chief Medical Officer
Welcome to the NKF Clinical Digest. This resource is an ongoing compilation of the latest clinical information regarding COVID-19, curated by NKF subject matter experts. Our goal is to make it easy for the interdisciplinary team to find current data on the implications of COVID-19 for people living with kidney diseases. The NKF Clinical Digest will also provide links to the most current patient resources and educational tools developed by NKF to support people living with kidney diseases through this crisis. This compendium of resources will also include information regarding NKF’s recent advocacy activities to improve the care and the safety of people living with kidney diseases. We hope that you find the NKF Clinical Digest – COVID-19 a valuable resource as you care for kidney patients during these extraordinary times.
– Joseph A. Vassalotti, MD
Chief Medical Officer, National Kidney Foundation
General information about COVID-19
Blood Group Type and Risk of COVID-19
COVID-19 Outcomes Among Hospitalized Health Care Workers
A propensity-matched multicenter cohort study matching 122 healthcare workers (HCWs) hospitalized with COVID-19 to 366 hospitalized non-HCWs with COVID-19 was conducted to evaluate the association between HCW status and outcomes among hospitalized COVID-19 patients. Although HCWs are at higher risk for contracting COVID-19, it is uncertain whether they are at risk for worse outcomes.
This retrospective, observational cohort study included consecutive adult patients hospitalized with a diagnosis of laboratory-confirmed COVID-19 across 36 North American centers from April 15 to June 5, 2020. Data were collected from 1992 patients. The primary outcome was reaching the need for mechanical ventilation or death.
Of the 1790 patients included, there were 127 HCWs and 1663 non-HCWs. After 3:1 propensity score matching, 122 HCWs were matched to 366 non-HCWs. In the matched cohort, the odds of the primary outcome, mechanical ventilation or death, were not significantly between HCWs and non-HCWs (AOR, 0.60; 95% CI, 0.34-1.04). The HCWs were less likely to need admission to an intensive care unit (AOR, 0.56; 95% CI, 0.34-0.92) and were also less likely to need admission for longer than 7 days (AOR, 0.53; 95% CI, 0.34-0.83). There were no differences between matched HCWs and non-HCWs in the need for mechanical ventilation (AOR, 0.66; 95% CI, 0.37-1.17), death (AOR, 0.47; 95% CI, 0.18-1.27), or vasopressors (AOR, 0.68; 95% CI, 0.37-1.24).
In conclusion, this study found that HCW status is not associated with worse outcomes as compared with non-HCWs hospitalized with COVID-19. HCW status was also associated with a shorter hospital admission and less likelihood for intensive care unit admission.
Source: Yang JU, Parkins MD, Canakis A, et al. Outcomes of COVID-19 among hospitalized health care workers in North America. JAMA Netw Open. 2021;4(1):e2035699.
Respiratory Function in Infants and Young Children Wearing Masks During the COVID-19 Pandemic
Respiratory and Psychophysical Sequelae Among COVID-19 Patients After Hospital Discharge
Pregnancy Outcomes and COVID-19
Clinical Outcomes in Patients with Heart Failure Hospitalized with COVID-19
Assessment of Immunological Memory to COVID-19
Risk Factors Associated with In-Hospital Mortality in Patients With COVID-19
COVID-19 In-patients at High Risk of Readmission for 10 Days Post-discharge
Diagnosis-Wide Analysis of Covid-19 Complication: An Exposure-Crossover Study
Public health & COVID-19
Media Consumption on Public Knowledge on COVID-19
The Seen and the Unseen: Race and Social Inequities Affecting Kidney Care
Alcohol Consumption Sharply Rises During COVID-19 Pandemic
Community-Level Disparities of COVID-19 in Large US Metropolitan Areas
Genomic Surveillance of COVID-19 in a Healthcare Setting
Asymptomatic Transmission: The Achilles’ Heel of Current Strategies to Control Covid-19
Prevalence of Asymptomatic COVID-19 Infection
Reduction of COVID-19 secondary transmission in households by face mask use, disinfection, and social distancing
Early Spread of COVID-19 in New York City
Reducing Spread of COVID-19 Transmission through Aerosol and Droplets
Mental health & COVID-19
Impact of COVID-19 on the Mental Health of Healthcare Workers
Alcohol Dependence during COVID-19 Lockdowns
Depression Levels in the US during the COVID-19 Pandemic
The Implications of COVID-19 for Mental Health and Substance Use
Impact of COVID-19 on Mental Health in the General Population
Short and Long-term Mental Health Effects of COVID-19
The Impact of COVID-19 on Mental Wellbeing
Mental Health and the COVID-19 Pandemic
Natural Mood Regulation and Depression
Mental Health of Health Care Workers
Research on COVID-19 treatments
Delaying Second COVID Vaccine Dose May Prevent Deaths: Simulation Modeling Study
Ivermectin and Mild COVID-19
Aspirin Use for CVD and the Likelihood of COVID-19 Infection
Researchers recently published study results that evaluated whether pre-infection treatment with daily low-dose aspirin (75 mg) might have a potential beneficial effect on COVID-19 susceptibility and disease duration. Data from 10,477 people who had been tested for COVID-19 during the first COVID-19 wave in Israel from February 1, 2020 to June 30, 2020 was collected and analyzed.
The retrospective population-based cross-sectional study found that aspirin use to avoid the development of cardiovascular diseases in healthy individuals was associated with a 29% lower likelihood of COVID-19 infection, as compared to aspirin non-users. The proportion of patients treated with aspirin was significantly lower among the COVID-19-positive individuals, as compared to the COVID-19-negative ones. In addition, patients who had been treated with aspirin were less likely to develop COVID-19 infection than those who were not.
The authors observed an inverse association between the likelihood of COVID-19 infection, disease duration and mortality, and aspirin use for primary prevention.
Source: Merzon E, Green I, Vinker S, et al. The use of aspirin for primary prevention of cardiovascular disease is associated with a lower likelihood of COVID-19 infection. FEBS J. 2021, Feb 23.
Impact of COVID-19 Vaccination on Asymptomatic Infection
A retrospective cohort study of consecutive, asymptomatic adult patients (n=39,156) within a large US healthcare system indicates COVID-19 vaccination with an mRNA-based vaccine was associated with a reduced risk of developing asymptomatic SARS-CoV-2 infection as measured during pre-procedural molecular screening.
This real-world study included patients (mean age 54 years, 52.5% female) at several Mayo Clinic locations who underwent pre-procedural and pre-surgical SARS-CoV-2 molecular testing within 48-72 hours of their procedure, between December 17, 2020 to February 8, 2021. The primary exposure was vaccination with at least one dose of the Pfizer or Moderna SARS-C0V-2 vaccines prior to molecular screening. The primary outcome was relative risk of a positive SARS-CoV-2 molecular test. The study showed that 3.2% of the unvaccinated patients were positive, compared to 1.4% of those who had received a vaccine. After adjusting for confounding variables, the adjusted relative risk of asymptomatic infection comparing vaccinated versus unvaccinated was 0.35 (95% CI 0.26-0.47).
The authors conclude that “The results of this study demonstrate the impact of the vaccines on reduction in asymptomatic infections supplementing the randomized trial results on symptomatic patients.”
Reference: Tande AJ, Pollock BD, Shah ND, et al. Impact of the COVID-19 vaccine on asymptomatic infection among patients undergoing pre-procedural COVID-19 molecular screening. Clin Infect Dis. 2021 Mar 10.
Antibody Responses in Seropositive Persons after a Single Dose of SARS-CoV-2 mRNA Vaccine
A study examining the response of the first vaccine dose in persons with previous COVID-19 found that a single dose of mRNA vaccine elicited rapid immune responses in seropositive participants, with postvaccination antibody titers that were similar to or exceeded titers found in seronegative participants who received two vaccinations.
The study included 110 participants from the longitudinal PARIS (Protection Associated with Rapid Immunity to SARS-CoV-2) study. SARS-CoV-2 spike IgG was measured with the use of a previously two-step enzyme-linked immunosorbent assay and expressed as area under the curve (AUC).
Repeated sampling after the first dose indicates that the majority of seronegative participants had variable and relatively low SARS-CoV-2 IgG responses within 9 to 12 days after vaccination. In contrast, participants with SARS-CoV-2 antibodies at baseline before the first vaccine injection rapidly developed uniform, high antibody titers within days after vaccination.
The antibody titers of vaccinees with preexisting immunity were 10 to 45 times as high as those of vaccinees without preexisting immunity at the same time points after the first vaccine dose (e.g., 25 times as high at 13 to 16 days) and also exceeded the median antibody titers measured in participants without preexisting immunity after the second vaccine dose by more than a factor of 6. The study supports further investigation as to whether a single dose of mRNA vaccine provides effective protection in seropositive persons.
Source: Krammer F, Srivastava K, Alshammary H, et al. Antibody Responses in Seropositive Persons after a Single Dose of SARS-CoV-2 mRNA Vaccine. N Engl J Med. 2021, Mar 10.
Antibody Titers After a Single Vaccine Dose in Health Care Workers Previously Infected with SARS-CoV-2
FDA Issues Emergency Use Authorization for Third COVID-19 Vaccine
Real-world Effectiveness of COVID-19 Vaccine
Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine
Initial Phase Three Results of Two Adenoviral-Vector COVID-19 Vaccine Candidates
Kidney disease & COVID-19
AKI and Advanced Kidney Disease in the COVID-19 Pandemic: Proceedings From a NKF Symposium
Proteinuria and Outcomes in Hospitalized COVID-19 Patients
CKD: A Key Risk Factor for Severe COVID-19
COVID-19 Antibody Point-of-Care Testing in Dialysis and Kidney Transplant Patients
Prevalence of AKI in Patients Hospitalized with COVID-19 Infection
AKI in Hospitalized Patients with COVID-19
Kidney Disease or Injury Increases Mortality Risk for COVID-19 Patients in ICU
Outcomes among Patients Hospitalized With COVID-19 and AKI
Pre-existing Kidney Disease and COVID-19 Admitted to ICUs
suPAR and AKI in Patients with COVID-19
Dialysis & COVID-19
Humoral Response to the BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis
Experience with SARS-CoV-2 BNT162b2 mRNA Vaccine in dialysis patients
Seroprevalence of antibody to S1 spike protein following vaccination against COVID-19 in patients receiving hemodialysis: a call to arms
Durability of Humoral Immune Response to SARS-CoV-2 in Symptomatic Hemodialysis Patients
The Urgent Need to Vaccinate Dialysis Patients against COVID-19
Serologic Assessment of COVID-19 in a Belgian Hemodialysis Facility
Dialysis Care during the COVID-19 Pandemic
Impact of the COVID-19 Pandemic on Commercial Airlines: Implications for the Kidney Transplant Community
COVID-19 Incidence and Course of Illness: French National Cohort of Dialysis Patients
Estimating Shortages in Capacity to Deliver CKRT during the COVID-19 Pandemic
Kidney transplant & COVID-19
Antibody Response to COVID-19 mRNA Vaccine Series in Transplant Recipients
COVID-19 Outcomes for Patients on Immunosuppressive Drugs on Par with Non-Immunosuppressed Patients
COVID-19 Outcomes in Patients Waitlisted for Kidney Transplantation and Kidney Transplant Recipients
Back-to-School Safety Guidelines for Pediatric Solid Organ Transplant Recipients
COVID-19 in Kidney Transplant Recipients: A Single-Center Report from Belgium
Kidney Transplantation Safety during the COVID-19 Pandemic: A Simulation Study
Early Outcomes of outpatient management of kidney transplant recipients with COVID-19
Kidney Transplantation and COVID-19 Induced Pneumonia
COVID-19 and Kidney Transplantation at a NYC Hospital
Kidney Allograft Recipients and COVID-2019: A Single Center Report
Dietary Advice in HD Patients: Impact of a telehealth approach during the COVID-19 pandemic
Vitamin D Deficiency May Increase Risk for COVID-19
Obesity Linked to Higher Risk for COVID-19 Complications & Limited Vaccine Efficacy
Guidance & Strategies for Clinicians to Optimize Care in the ICU
- Recommendation # 9A With AKI requiring CRRT dose protein at 2.0-2.5 gm/kg/d
- Recommendation # 9B Monitor and replace micronutrients in AKD on CRRT (especially zinc, iron, selenium, Vit D, Vit C)
Selenium Status and Outcome Of COVID-19
Vitamin D Deficiency and Severe COVID-19
NKF Advocacy during the COVID-19 pandemic
NKF has identified and been actively advocating on several key areas of concern for our community in the context of the COVID-19 pandemic:
NKF is also working with several partners to implement policies that:
- Accelerate patients' access to home dialysis
- Ensure timely implementation of kidney care payment models
- Ensure kidney patients and transplant patients can access greater-than-30-day supplies of critical prescriptions including immunosuppressive drugs
- Ensure that vulnerable home dialysis, transplant patients, and living donors can receive needed blood draws in their homes
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