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      Survival and predictive factors in dialysis patients with COVID-19 in Japan: a nationwide cohort study

      research-article
      1 , , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , COVID-19 Task Force Committee of the Japanese Association of Dialysis Physicians, the Japanese Society for Dialysis Therapy, and the Japanese Society of Nephrology
      Renal Replacement Therapy
      BioMed Central
      COVID-19, SARS-CoV-2, Dialysis, Peritoneal dialysis, Remdesivir

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          Abstract

          Background

          The Japanese Association of Dialysis Physicians, the Japanese Society for Dialysis Therapy, and the Japanese Society of Nephrology jointly established COVID-19 Task Force Committee and began surveying the number of newly infected patients.

          Methods

          This registry of the COVID-19 Task Force Committee was used to collect data of dialysis patients; a total of 1010 dialysis patients with COVID-19 were included in the analysis. Overall survival of patients was investigated with stratification by age group, complication status, and treatment. In addition, predictive factors for mortality were also investigated. The overall survival was estimated by Kaplan–Meier methods and compared by using log-rank test. Multivariate analysis was performed to identify the risk factor of mortality. For all statistical analyses, p < 0.05 was considered to be statistically significant.

          Results

          The mortality risk was increased with age ( p < 0.001). The mortality risk was significantly higher in patients with peripheral arterial disease (HR: 1.49, 95% CI 1.05–2.10) and significantly lower in patients who were treated with remdesivir (HR: 0.60, 95% CI 0.37–0.98). Multivariate analysis showed increased risk of mortality with increment in BMI, and increment in CRP, and decreased risk with increment in albumin.

          Conclusion

          Dialysis patients have a high severity of illness and a high risk of mortality in cases of COVID-19. Treatment with remdesivir might be effective in shortening the duration of hospitalization and reducing the risk of mortality.

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          Most cited references12

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          Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19

          Coronavirus disease 2019 (COVID-19) is a clinical syndrome caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with severe disease show hyperactivation of the immune system, which can affect multiple organs besides the lungs. Here, we propose that SARS-CoV-2 infection induces a process known as immunothrombosis, in which activated neutrophils and monocytes interact with platelets and the coagulation cascade, leading to intravascular clot formation in small and larger vessels. Microthrombotic complications may contribute to acute respiratory distress syndrome (ARDS) and other organ dysfunctions. Therapeutic strategies aimed at reducing immunothrombosis may therefore be useful. Several antithrombotic and immunomodulating drugs have been proposed as candidates to treat patients with SARS-CoV-2 infection. The growing understanding of SARS-CoV-2 infection pathogenesis and how it contributes to critical illness and its complications may help to improve risk stratification and develop targeted therapies to reduce the acute and long-term consequences of this disease.
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            Risk of venous thromboembolism in patients with COVID‐19: A systematic review and meta‐analysis

            Abstract Background Venous thromboembolism (VTE) is frequently observed in patients with coronavirus disease 2019 (COVID‐19). However, reported VTE‐rates differ substantially. Objectives We aimed at evaluating available data and estimating the prevalence of VTE in COVID‐19 patients. Methods We conducted a systematic literature search (MEDLINE, EMBASE, WHO COVID‐19 database) to identify studies reporting VTE‐rates in COVID‐19 patients. Studies with suspected high risk of bias were excluded from quantitative synthesis. Pooled outcome rates were obtained within a random effects meta‐analysis. Subgroup analyses were performed for different settings (intensive care unit (ICU) vs. non‐ICU hospitalization and screening vs. no screening) and the association of D‐dimer levels and VTE‐risk was explored. Results Eighty‐six studies (33,970 patients) were identified and 66 (28,173 patients, mean age: 62.6 years, 60% men, 20% ICU‐patients) were included in quantitative analysis. The overall VTE‐prevalence estimate was 14.1% (95%CI 11.6‐16.9), 40.3% (95%CI 27.0‐54.3) with ultrasound‐screening and 9.5% (95%CI 7.5‐11.7) without screening. Subgroup analysis revealed high heterogeneity, with a VTE‐prevalence of 7.9% (95%CI 5.1‐11.2) in non‐ICU and 22.7% (95%CI 18.1‐27.6) in ICU patients. Prevalence of pulmonary embolism (PE) in non‐ICU and ICU patients was 3.5% (95%CI 2.2‐5.1) and 13.7% (95%CI 10.0‐17.9). Patients developing VTE had higher D‐dimer levels (weighted mean difference 3.26 µg/ml (95%CI 2.76‐3.77) than non‐VTE patients. Conclusion VTE occurs in 22.7% of patients with COVID‐19 in the ICU, but VTE risk is also increased in non‐ICU hospitalized patients. Patients developing VTE had higher D‐dimer levels. Studies evaluating thromboprophylaxis strategies in patients with COVID‐19 are needed to improve prevention of VTE.
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              Presentation and Outcomes of Patients with ESKD and COVID-19

              The relative immunosuppression and high prevalence of comorbidities in patients with ESKD on dialysis raise concerns that they may have an elevated risk of severe coronavirus disease 2019 (COVID-19), but outcomes for COVID-19 in such patients are unclear.
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                Author and article information

                Contributors
                kankikuchi@nifty.com
                Journal
                Ren Replace Ther
                Ren Replace Ther
                Renal Replacement Therapy
                BioMed Central (London )
                2059-1381
                21 October 2021
                21 October 2021
                2021
                : 7
                : 1
                : 59
                Affiliations
                [1 ]Division of Nephrology, Shimoochiai Clinic, 2-1-6 Shimoochiai, Shinjuku-ku, Tokyo, 161-0033 Japan
                [2 ]GRID grid.26999.3d, ISNI 0000 0001 2151 536X, Division of Nephrology and Endocrinology, , The University of Tokyo Graduate School of Medicine, ; Tokyo, Japan
                [3 ]GRID grid.270560.6, ISNI 0000 0000 9225 8957, Department of Nephrology, , Tokyo Saiseikai Central Hospital, ; Tokyo, Japan
                [4 ]GRID grid.415793.d, ISNI 0000 0004 0378 850X, Kidney Center, , Shirasagi Hospital, ; Osaka, Japan
                [5 ]GRID grid.416428.d, ISNI 0000 0004 0595 8015, Nagoya Memorial Hospital, ; Nagoya, Japan
                [6 ]GRID grid.410818.4, ISNI 0000 0001 0720 6587, Department of Blood Purification, , Tokyo Women’s Medical University, ; Tokyo, Japan
                [7 ]GRID grid.265050.4, ISNI 0000 0000 9290 9879, Department of Nephrology, Faculty of Medicine,, , Toho University, ; Tokyo, Japan
                [8 ]GRID grid.410793.8, ISNI 0000 0001 0663 3325, Department of Nephrology, , Tokyo Medical University, ; Tokyo, Japan
                [9 ]Department of Nephrology, Seishokai Memorial Hospital, Tokyo, Japan
                [10 ]GRID grid.443768.a, ISNI 0000 0001 0048 1834, Faculty of Medical and Health Sciences, , Tsukuba International University, ; Tsuchiura, Japan
                [11 ]GRID grid.410802.f, ISNI 0000 0001 2216 2631, Department of General Internal Medicine, , Saitama Medical University, ; Iruma, Japan
                [12 ]GRID grid.410714.7, ISNI 0000 0000 8864 3422, Division of Nephrology, Department of Medicine, , Showa University School of Medicine, ; Tokyo, Japan
                Article
                378
                10.1186/s41100-021-00378-0
                8529564
                34697570
                ae93617b-b605-4318-8e8e-1266fb41e851
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 30 August 2021
                : 7 October 2021
                Categories
                Research
                Custom metadata
                © The Author(s) 2021

                covid-19,sars-cov-2,dialysis,peritoneal dialysis,remdesivir
                covid-19, sars-cov-2, dialysis, peritoneal dialysis, remdesivir

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