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
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.
Public health & COVID-19
Mental health & COVID-19
Research on COVID-19 treatments
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.
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.
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.
Kidney disease & COVID-19
Dialysis & COVID-19
Kidney transplant & COVID-19
- 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)
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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