Pub Date : 2023-11-01DOI: 10.1016/j.semnephrol.2023.151478
Anita van Eck van der Sluijs MD, PhD , Pearl Pai MD, FRCP , Wenjuan Zhu MD , Gurbey Ocak MD, PhD
Cardiovascular diseases are highly prevalent among patients on dialysis. For these diseases, antiplatelets and antithrombotic therapies including heparin, vitamin K antagonists, and direct oral anticoagulants, are being used. However, the benefit–risk balance of these therapies could differ for dialysis patients compared with the general population. This review article focuses on the bleeding risk associated with the use of heparin, antiplatelets, vitamin K antagonists, and direct oral anticoagulants in patients receiving hemodialysis.
心血管疾病在透析患者中发病率很高。针对这些疾病，目前正在使用抗血小板和抗血栓疗法，包括肝素、维生素 K 拮抗剂和直接口服抗凝剂。然而，与普通人群相比，透析患者使用这些疗法的收益-风险平衡可能有所不同。这篇综述文章重点探讨了血液透析患者使用肝素、抗血小板药物、维生素 K 拮抗剂和直接口服抗凝剂的相关出血风险。
{"title":"Bleeding Risk in Hemodialysis Patients","authors":"Anita van Eck van der Sluijs MD, PhD , Pearl Pai MD, FRCP , Wenjuan Zhu MD , Gurbey Ocak MD, PhD","doi":"10.1016/j.semnephrol.2023.151478","DOIUrl":"10.1016/j.semnephrol.2023.151478","url":null,"abstract":"<div><div><span>Cardiovascular diseases are highly prevalent among patients on dialysis. For these diseases, antiplatelets<span> and antithrombotic therapies<span> including heparin, vitamin K antagonists, and </span></span></span>direct oral anticoagulants<span><span><span>, are being used. However, the benefit–risk balance of these therapies could differ for dialysis patients compared with the general population. This review article focuses on the bleeding risk associated with the use of heparin, </span>antiplatelets<span>, vitamin K antagonists<span>, and direct oral anticoagulants in patients receiving </span></span></span>hemodialysis.</span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151478"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139491969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.semnephrol.2023.151477
Thita Chiasakul MD, MSc , François Mullier PharmD, PhD , Thomas Lecompte MD, PhD , Philippe Nguyen MD, PhD , Adam Cuker MD, MS
Unfractionated heparin (UFH) and low-molecular-weight heparins (LMWHs) are commonly used to prevent clotting of the hemodialysis extracorporeal circuit and optimize hemodialysis adequacy. There is no consensus on the optimal dosing for UFH and LMWHs during hemodialysis. In clinical practice, semiquantitative clotting scoring of the dialyzer and venous chamber may help to guide UFH and LMWH dose adjustment. Laboratory monitoring has not been shown to improve clinical outcomes and is therefore not routinely indicated in most hemodialysis patients. It might, however, be considered in select patients, such as those with extremes of body weight or history of repeated clotting or bleeding. Methods for laboratory monitoring include the activated partial thromboplastin time, activated clotting time, and antifactor Xa assays for UFH and antifactor Xa assay for LMWHs. Target ranges for anticoagulation in hemodialysis have been suggested but not clearly defined. When utilizing these tests, issues such as availability, standardization, interfering factors, and interpretation must be considered. In this narrative review, we discuss the rationale and methods of monitoring anticoagulation in hemodialysis.
通常使用非减量肝素（UFH）和低分子量肝素（LMWH）来防止血液透析体外循环凝血，并优化血液透析的充分性。关于血液透析期间 UFH 和 LMWH 的最佳剂量，目前尚未达成共识。在临床实践中，对透析器和静脉腔进行半定量凝血评分有助于指导 UFH 和 LMWH 的剂量调整。实验室监测并未证明可改善临床效果，因此并不适用大多数血液透析患者。不过，对于特定患者，如体重超标或有反复凝血或出血史的患者，可以考虑进行实验室监测。实验室监测方法包括活化部分凝血活酶时间、活化凝血时间、UFH 的抗因子 Xa 检测和 LMWHs 的抗因子 Xa 检测。血液透析中的抗凝目标范围已经提出，但尚未明确定义。在使用这些检测时，必须考虑到可用性、标准化、干扰因素和解释等问题。在本综述中，我们将讨论血液透析中抗凝血监测的原理和方法。
{"title":"Laboratory Monitoring of Heparin Anticoagulation in Hemodialysis: Rationale and Strategies","authors":"Thita Chiasakul MD, MSc , François Mullier PharmD, PhD , Thomas Lecompte MD, PhD , Philippe Nguyen MD, PhD , Adam Cuker MD, MS","doi":"10.1016/j.semnephrol.2023.151477","DOIUrl":"10.1016/j.semnephrol.2023.151477","url":null,"abstract":"<div><div><span>Unfractionated heparin (UFH) and low-molecular-weight heparins (LMWHs) are commonly used to prevent clotting of the hemodialysis<span> extracorporeal<span><span> circuit and optimize hemodialysis<span><span> adequacy. There is no consensus on the optimal dosing for UFH and LMWHs during hemodialysis. In clinical practice, semiquantitative clotting scoring of the dialyzer and venous chamber may help to guide UFH and LMWH dose adjustment. Laboratory monitoring has not been shown to improve clinical outcomes and is therefore not routinely indicated in most hemodialysis patients. It might, however, be considered in select patients, such as those with extremes of body weight or history of repeated clotting or bleeding. Methods for laboratory monitoring include the activated </span>partial thromboplastin time, activated </span></span>clotting time, and antifactor Xa assays for UFH and antifactor Xa assay for LMWHs. Target ranges for </span></span></span>anticoagulation in hemodialysis have been suggested but not clearly defined. When utilizing these tests, issues such as availability, standardization, interfering factors, and interpretation must be considered. In this narrative review, we discuss the rationale and methods of monitoring anticoagulation in hemodialysis.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151477"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139642914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.semnephrol.2023.151481
Thomas Demuynck MD , Muriel Grooteman MD, PhD , Piet Ter Wee MD, PhD , Mario Cozzolino MD, PhD , Björn Meijers MD, PhD
Calcium is a key clotting factor, and several inorganic molecules that bind to calcium have been found to reduce the clotting propensity of blood. Citrate, a calcium chelator, is used as inhibitor of the coagulation cascade in blood transfusion. Also, it is used as an anaticoagulant during dialysis to maintain patency of the extracorporeal circuit, known as regional citrate anticoagulation (RCA). The amount of citrate should be chosen such that ionized calcium concentrations in the extracorporeal circuit are reduced enough to minimize propagation of the coagulation cascade. The dialytic removal of the calcium–citrate complexes combined with reduced ionized calcium concentrations makes necessary calcium supplementation of the blood returning to the patient. This can be achieved in different ways. In classical RCA, citrate and calcium are infused in the afferent and efferent tubing, respectively, whereas the dialysate does not contain calcium. This setup has been shown to be highly efficacious with a very low clotting propensity. Strict monitoring of blood electrolytes is required. Alternatively, the use of a high-calcium dialysate leads to calcium loading, obviating the need for a separate calcium infusion pump. The main advantages are simplified delivery of RCA and less fluctuation of systemic calcium concentrations. Currently, citric acid is sometimes added to the acid concentrate as a replacement for acetic acid. Differences and similarities between RCA and citrate-containing dialysate are discussed. RCA is an excellent alternative to heparin for patients at high risk of bleeding.
{"title":"Regional Citrate Anticoagulation: A Tale of More Than Two Stories","authors":"Thomas Demuynck MD , Muriel Grooteman MD, PhD , Piet Ter Wee MD, PhD , Mario Cozzolino MD, PhD , Björn Meijers MD, PhD","doi":"10.1016/j.semnephrol.2023.151481","DOIUrl":"10.1016/j.semnephrol.2023.151481","url":null,"abstract":"<div><div><span>Calcium is a key clotting factor, and several inorganic molecules that bind to calcium have been found to reduce the clotting propensity of blood. Citrate, a </span>calcium chelator<span><span><span>, is used as inhibitor of the coagulation cascade in blood transfusion. Also, it is used as an anaticoagulant during dialysis to maintain patency of the </span>extracorporeal circuit, known as regional citrate </span>anticoagulation (RCA). The amount of citrate should be chosen such that ionized calcium concentrations in the extracorporeal circuit are reduced enough to minimize propagation of the coagulation cascade. The dialytic removal of the calcium–citrate complexes combined with reduced ionized calcium concentrations makes necessary calcium supplementation of the blood returning to the patient. This can be achieved in different ways. In classical RCA, citrate and calcium are infused in the afferent and efferent tubing, respectively, whereas the dialysate does not contain calcium. This setup has been shown to be highly efficacious with a very low clotting propensity. Strict monitoring of blood electrolytes is required. Alternatively, the use of a high-calcium dialysate leads to calcium loading, obviating the need for a separate calcium infusion pump. The main advantages are simplified delivery of RCA and less fluctuation of systemic calcium concentrations. Currently, citric acid is sometimes added to the acid concentrate as a replacement for acetic acid. Differences and similarities between RCA and citrate-containing dialysate are discussed. RCA is an excellent alternative to heparin for patients at high risk of bleeding.</span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151481"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.semnephrol.2023.151474
Floris Vanommeslaeghe MD, PhD , Wim Van Biesen MD, PhD , Karlien François MD, PhD
Maintaining patency of the extracorporeal hemodialysis (HD) circuit is a prerequisite to perform HD. Unfractionated heparin and low-molecular-weight heparins are the most used anticoagulants in maintenance HD, but their administration comes with a major trade-off of bleeding complications. This narrative review article discusses technical factors impacting on HD circuit patency, such as tubings, dialyzer membranes, priming practices, and treatment settings. Strategies for monitoring extracorporeal circuit clotting during and after treatment are also reviewed, as these are essential tools for optimizing anticoagulation.
保持体外血液透析（HD）回路的通畅是进行 HD 的先决条件。非分叶肝素和低分子量肝素是维持性血液透析中最常用的抗凝剂，但在使用这些药物的同时也会出现出血并发症。这篇叙述性综述文章讨论了影响血液透析回路通畅性的技术因素，如管道、透析膜、引流方法和治疗设置。文章还回顾了治疗期间和治疗后监测体外循环凝血的策略，因为这些都是优化抗凝的重要工具。
{"title":"Detection and Scoring of Extracorporeal Circuit Clotting During Hemodialysis","authors":"Floris Vanommeslaeghe MD, PhD , Wim Van Biesen MD, PhD , Karlien François MD, PhD","doi":"10.1016/j.semnephrol.2023.151474","DOIUrl":"10.1016/j.semnephrol.2023.151474","url":null,"abstract":"<div><div><span>Maintaining patency of the extracorporeal </span>hemodialysis<span> (HD) circuit is a prerequisite to perform HD. Unfractionated heparin and low-molecular-weight heparins are the most used anticoagulants<span> in maintenance HD, but their administration comes with a major trade-off of bleeding complications. This narrative review article discusses technical factors impacting on HD circuit patency, such as tubings, dialyzer membranes, priming practices, and treatment settings. Strategies for monitoring extracorporeal circuit clotting during and after treatment are also reviewed, as these are essential tools for optimizing anticoagulation.</span></span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151474"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Infections are the second leading cause of death among patients with end-stage kidney disease, behind only cardiovascular disease. In addition, patients on chronic dialysis are at a higher risk for acquiring infection caused by multidrug-resistant organisms and for death resulting from infection owing to their likelihood of requiring treatment that involves invasive devices, their frequent exposure to antibiotics, and their impaired immunity. Vascular access is a major risk factor for bacteremia, hospitalization, and mortality among hemodialysis (HD) patients. Catheter-related bacteremia is the most severe central venous catheter (CVC)-related infection and increases linearly with the duration of catheter use. Given the high prevalence of CVC use and its direct association with catheter-related bacteremia, which adversely impacts morbidity and mortality rates among HD patients, several prevention measures aimed at reducing the rates of CVC-related infection have been proposed and implemented. As a result, a large number of clinical trials, systematic reviews, and meta-analyses have been conducted to assess the effectiveness, clinical applicability, and long-term adverse effects of such measures.
Peritoneal dialysis chronic treatment without the occurence of peritonitis is rare. Although most cases of peritonitis can be treated adequately with antibiotics, some cases are complicated by hospitalization or a temporary or permanent need to abstain from using the peritoneal dialysis catheter. Severe and long-lasting peritonitis can lead to peritoneal membrane failure, requiring the treatment method to be switched to HD. Some measures as patients training, early diagnosis, and choice of antibiotics can contribute to the successful treatment of peritonitis. Finally, medical directors are key leaders in infection prevention and are an important resource to implement programs to monitor and improve infection prevention practices at all levels within the dialysis clinic.
感染是终末期肾病患者的第二大死因，仅次于心血管疾病。此外，由于慢性透析患者可能需要使用侵入性设备进行治疗、经常接触抗生素以及免疫力下降，他们感染耐多药生物体以及因感染而死亡的风险较高。血管通路是血液透析（HD）患者发生菌血症、住院和死亡的主要风险因素。导管相关菌血症是最严重的中心静脉导管（CVC）相关感染，并随着导管使用时间的延长而呈线性增长。鉴于 CVC 的高使用率及其与导管相关菌血症的直接联系，对 HD 患者的发病率和死亡率产生了不利影响，因此提出并实施了多项旨在降低 CVC 相关感染率的预防措施。因此，已经开展了大量临床试验、系统综述和荟萃分析，以评估这些措施的有效性、临床适用性和长期不良影响。腹膜透析慢性治疗过程中很少发生腹膜炎。虽然大多数腹膜炎病例可通过抗生素得到充分治疗，但有些病例会因住院治疗或暂时或永久停用腹膜透析导管而变得复杂。严重和持续时间长的腹膜炎可导致腹膜功能衰竭，需要改用血液透析治疗。患者培训、早期诊断和抗生素选择等措施有助于腹膜炎的成功治疗。最后，医务主任是感染预防工作的主要领导者，也是在透析诊所内实施监控和改善各级感染预防措施的重要资源。
{"title":"Strategies to Prevent Infections in Dialysis Patients","authors":"Daniela Ponce PhD , Dorothea Nitsch PhD , Talat Alp Ikizler PhD","doi":"10.1016/j.semnephrol.2023.151467","DOIUrl":"10.1016/j.semnephrol.2023.151467","url":null,"abstract":"<div><div><span><span>Infections are the second leading cause of death among patients with end-stage kidney disease, behind only cardiovascular disease. In addition, patients on chronic dialysis are at a higher risk for acquiring infection caused by multidrug-resistant organisms and for death resulting from infection owing to their likelihood of requiring treatment that involves invasive devices, their frequent exposure to antibiotics, and their impaired immunity. </span>Vascular access is a major risk factor for </span>bacteremia<span><span>, hospitalization, and mortality among hemodialysis<span> (HD) patients. Catheter-related bacteremia is the most severe </span></span>central venous catheter<span> (CVC)-related infection and increases linearly with the duration of catheter use. Given the high prevalence of CVC use and its direct association with catheter-related bacteremia, which adversely impacts morbidity and mortality rates<span><span> among HD patients, several prevention measures aimed at reducing the rates of CVC-related infection have been proposed and implemented. As a result, a large number of clinical trials, </span>systematic reviews, and meta-analyses have been conducted to assess the effectiveness, clinical applicability, and long-term adverse effects of such measures.</span></span></span></div><div><span><span>Peritoneal dialysis </span>chronic treatment without the occurence of </span>peritonitis<span><span> is rare. Although most cases of peritonitis can be treated adequately with antibiotics, some cases are complicated by hospitalization or a temporary or permanent need to abstain from using the peritoneal </span>dialysis catheter<span><span>. Severe and long-lasting peritonitis can lead to peritoneal membrane failure, requiring the treatment method to be switched to HD. Some measures as patients training, </span>early diagnosis, and choice of antibiotics can contribute to the successful treatment of peritonitis. Finally, medical directors are key leaders in infection prevention and are an important resource to implement programs to monitor and improve infection prevention practices at all levels within the dialysis clinic.</span></span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 5","pages":"Article 151467"},"PeriodicalIF":2.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Infection-related glomerulonephritis is an immunologically mediated glomerular injury after an infection. Glomerulonephritis may occur with the infection or after a variable latent period. Poststreptococcal glomerulonephritis (PSGN) is the prototype of infection-related glomerulonephritis. The streptococcal antigens, nephritis-associated plasmin-like receptor and streptococcal exotoxin B, have emerged as major players in the pathogenesis of PSGN. Although PSGN is the most common infection-related glomerulonephritis in children, in adults, glomerulonephritis is secondary to bacteria such as staphylococci, viruses such as hepatitis C, and human immunodeficiency virus, and, rarely, parasitic infections. Supportive therapy is the mainstay of treatment in most infection-related glomerulonephritis. Treatment of the underlying infection with specific antibiotics and antiviral medications is indicated in some infections. Parasitic infections, although rare, may be associated with significant morbidity. Poststreptococcal glomerulonephritis is a self-limiting condition with a good prognosis. However, bacterial, viral, and parasitic infections may be associated with significant morbidity and long-term consequences. Epidemiologic studies are required to assess the global burden of infection-related glomerulonephritis. A better understanding of the pathogenesis of infection-related glomerulonephritis may unravel more treatment options and preventive strategies.
感染相关性肾小球肾炎是感染后免疫介导的肾小球损伤。肾小球肾炎可能在感染时发生，也可能在不同的潜伏期后发生。链球菌感染后肾小球肾炎（PSGN）是感染相关性肾小球肾炎的原型。链球菌抗原、肾炎相关浆蛋白样受体和链球菌外毒素 B 已成为 PSGN 发病机制中的主要角色。虽然 PSGN 是儿童中最常见的感染性肾小球肾炎，但在成人中，肾小球肾炎是继发于葡萄球菌等细菌、丙型肝炎和人类免疫缺陷病毒等病毒以及极少数寄生虫感染。支持疗法是大多数感染性肾小球肾炎的主要治疗方法。在某些感染情况下，可使用特异性抗生素和抗病毒药物治疗潜在感染。寄生虫感染虽然罕见，但可能会导致严重的发病。链球菌感染后肾小球肾炎是一种自限性疾病，预后良好。然而，细菌、病毒和寄生虫感染可能会导致严重的发病率和长期后果。需要进行流行病学研究，以评估与感染相关的肾小球肾炎的全球负担。更好地了解与感染相关的肾小球肾炎的发病机理，可能会发现更多的治疗方案和预防策略。
{"title":"Infection-Related Glomerulonephritis in Children and Adults","authors":"Arpana Iyengar MD, DNB, FRCP, PhD , Nivedita Kamath MD, DM , Jai Radhakrishnan MD, PhD , Blanca Tarragon Estebanez MD","doi":"10.1016/j.semnephrol.2023.151469","DOIUrl":"10.1016/j.semnephrol.2023.151469","url":null,"abstract":"<div><div>Infection-related glomerulonephritis is an immunologically mediated glomerular injury after an infection. Glomerulonephritis may occur with the infection or after a variable latent period. Poststreptococcal glomerulonephritis<span> (PSGN) is the prototype of infection-related glomerulonephritis. The streptococcal antigens<span>, nephritis-associated plasmin-like receptor and streptococcal exotoxin<span> B, have emerged as major players in the pathogenesis of PSGN. Although PSGN is the most common infection-related glomerulonephritis in children, in adults, glomerulonephritis is secondary to bacteria such as staphylococci, viruses such as hepatitis C, and human immunodeficiency virus, and, rarely, parasitic infections. Supportive therapy is the mainstay of treatment in most infection-related glomerulonephritis. Treatment of the underlying infection with specific antibiotics and antiviral medications is indicated in some infections. Parasitic infections, although rare, may be associated with significant morbidity. Poststreptococcal glomerulonephritis is a self-limiting condition with a good prognosis. However, bacterial, viral, and parasitic infections may be associated with significant morbidity and long-term consequences. Epidemiologic studies are required to assess the global burden of infection-related glomerulonephritis. A better understanding of the pathogenesis of infection-related glomerulonephritis may unravel more treatment options and preventive strategies.</span></span></span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 5","pages":"Article 151469"},"PeriodicalIF":2.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139502954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.semnephrol.2023.151471
Samira Bell MBChB, FRCP, MD , Griffith B. Perkins BSc (Adv), PhD , Urmila Anandh MBBS, MD , P. Toby Coates MBBS, FRACP, PhD
Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to a global pandemic that continues to be responsible for ongoing health issues for people worldwide. Immunocompromised individuals such as kidney transplant recipients and dialysis patients have been and continue to be among the most affected, with poorer outcomes after infection, impaired response to COVID-19 vaccines, and protracted infection. The pandemic also has had a significant impact on patients with underlying chronic kidney disease (CKD), with CKD increasing susceptibility to COVID-19, risk of hospital admission, and mortality. COVID-19 also has been shown to lead to acute kidney injury (AKI) through both direct and indirect mechanisms. The incidence of COVID-19 AKI has been decreasing as the pandemic has evolved, but continues to be associated with adverse patient outcomes correlating with the severity of AKI. There is also increasing evidence examining the longer-term effect of COVID-19 on the kidney demonstrating continued decline in kidney function several months after infection. This review summarizes the current evidence examining the impact of COVID-19 on the kidney, covering both the impact on patients with CKD, including patients receiving kidney replacement therapy, in addition to discussing COVID-19 AKI.
{"title":"COVID and the Kidney: An Update","authors":"Samira Bell MBChB, FRCP, MD , Griffith B. Perkins BSc (Adv), PhD , Urmila Anandh MBBS, MD , P. Toby Coates MBBS, FRACP, PhD","doi":"10.1016/j.semnephrol.2023.151471","DOIUrl":"10.1016/j.semnephrol.2023.151471","url":null,"abstract":"<div><div>Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to a global pandemic that continues to be responsible for ongoing health issues for people worldwide. Immunocompromised individuals such as kidney transplant recipients and dialysis patients have been and continue to be among the most affected, with poorer outcomes after infection, impaired response to COVID-19 vaccines, and protracted infection. The pandemic also has had a significant impact on patients with underlying chronic kidney disease (CKD), with CKD increasing susceptibility to COVID-19, risk of hospital admission, and mortality. COVID-19 also has been shown to lead to acute kidney injury (AKI) through both direct and indirect mechanisms. The incidence of COVID-19 AKI has been decreasing as the pandemic has evolved, but continues to be associated with adverse patient outcomes correlating with the severity of AKI. There is also increasing evidence examining the longer-term effect of COVID-19 on the kidney demonstrating continued decline in kidney function several months after infection. This review summarizes the current evidence examining the impact of COVID-19 on the kidney, covering both the impact on patients with CKD, including patients receiving kidney replacement therapy, in addition to discussing COVID-19 AKI.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 5","pages":"Article 151471"},"PeriodicalIF":2.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139417993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.semnephrol.2023.151472
Ifeoma I. Ulasi MBBS, MSc , Emmanuel A. Burdmann MD, PhD , Chinwuba K. Ijoma MD , Li-Fang Chou PhD , Chih-Wei Yang MD
Individuals, societies, and the environment are affected by neglected and emerging diseases. These diseases result in a variety of severe outcomes, including permanent disabilities, chronic diseases such as chronic kidney disease, and even mortality. Consequences include high health care expenditures, loss of means of support, social stigma, and social exclusion. The burden of these diseases is exacerbated in low- and middle-income countries owing to poverty, inadequate fundamental infrastructure, and the absence of health and social protection systems. The World Health Organization is committed to promoting the following public health strategies to prevent and control neglected tropical diseases: preventive chemotherapy; intensive case management; vector control; provision of safe drinkable water, sanitation, and hygiene; and veterinary public health. In addition, it promotes a One Health strategy, which is a collaborative, multisectoral, and interdisciplinary approach to achieving the greatest health outcomes by recognizing the interdependence of human beings, animals, plants, and their shared environment. This article provides knowledge and strategies for the prevention and treatment of neglected and emerging diseases, with a particular concentration on kidney diseases, as part of a comprehensive approach to One Health.
{"title":"Neglected and Emerging Infections of The Kidney","authors":"Ifeoma I. Ulasi MBBS, MSc , Emmanuel A. Burdmann MD, PhD , Chinwuba K. Ijoma MD , Li-Fang Chou PhD , Chih-Wei Yang MD","doi":"10.1016/j.semnephrol.2023.151472","DOIUrl":"10.1016/j.semnephrol.2023.151472","url":null,"abstract":"<div><div><span>Individuals, societies, and the environment are affected by neglected and emerging diseases. These diseases result in a variety of severe outcomes, including permanent disabilities, chronic diseases such as chronic kidney disease<span><span>, and even mortality. Consequences include high health care expenditures, loss of means of support, </span>social stigma<span>, and social exclusion. The burden of these diseases is exacerbated in low- and middle-income countries owing to poverty, inadequate fundamental infrastructure, and the absence of health and social protection systems. The World Health Organization is committed to promoting the following public health strategies to prevent and control </span></span></span>neglected tropical diseases<span><span>: preventive chemotherapy; intensive case management; vector control; provision of safe drinkable water, sanitation, and hygiene; and veterinary public health. In addition, it promotes a One Health strategy, which is a collaborative, multisectoral, and interdisciplinary approach to achieving the greatest health outcomes by recognizing the interdependence of human beings, animals, plants, and their shared environment. This article provides knowledge and strategies for the prevention and treatment of neglected and emerging diseases, with a particular concentration on </span>kidney diseases, as part of a comprehensive approach to One Health.</span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 5","pages":"Article 151472"},"PeriodicalIF":2.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139432593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.semnephrol.2023.151486
Joyita Bharati MD , Urmila Anandh MD , Camille N. Kotton MD , Thomas Mueller MD , Aakash K. Shingada DNB , Raja Ramachandran MD
Kidney transplant often is complicated by infections in the recipient from therapy-related and patient-related risk factors. Infections in kidney transplant recipients are associated with increased morbidity, mortality, and allograft dysfunction. There is a predictable timeline after kidney transplant regarding the types of pathogens causing infections, reflecting the net state of immunosuppression. In the early post-transplant period, bacterial infections comprise two thirds of all infections, followed by viral and fungal infections. Infections occurring early after kidney transplantation are generally the result of postoperative complications. In most cases, opportunistic infections occur within 6 months after kidney transplantation. They may be caused by a new infection, a donor-derived infection, or reactivation of a latent infection. Community-acquired pneumonia, upper respiratory tract infections, urinary tract infections, and gastrointestinal infections are the most common infections in the late period after transplantation when the net immunosuppression is minimal. It is crucial to seek information on the time after transplant, reflecting the net state of immunosuppression, previous history of exposure/infections, geography, and seasonal outbreaks. It is imperative that we develop regionally specific guidelines on screening, prevention, and management of infections after kidney transplantation.
{"title":"Diagnosis, Prevention, and Treatment of Infections in Kidney Transplantation","authors":"Joyita Bharati MD , Urmila Anandh MD , Camille N. Kotton MD , Thomas Mueller MD , Aakash K. Shingada DNB , Raja Ramachandran MD","doi":"10.1016/j.semnephrol.2023.151486","DOIUrl":"10.1016/j.semnephrol.2023.151486","url":null,"abstract":"<div><div><span><span><span>Kidney transplant often is complicated by infections in the recipient from therapy-related and patient-related risk factors. Infections in kidney transplant recipients are associated with increased morbidity, mortality, and </span>allograft<span> dysfunction. There is a predictable timeline after kidney transplant regarding the types of pathogens causing infections, reflecting the net state of </span></span>immunosuppression<span><span><span>. In the early post-transplant period, bacterial infections comprise two thirds of all infections, followed by viral and fungal infections. Infections occurring early after </span>kidney transplantation are generally the result of </span>postoperative complications<span><span>. In most cases, opportunistic infections occur within 6 months after kidney transplantation. They may be caused by a new infection, a donor-derived infection, or reactivation of a latent infection. Community-acquired pneumonia, </span>upper respiratory tract infections, urinary tract infections, and </span></span></span>gastrointestinal infections are the most common infections in the late period after transplantation when the net immunosuppression is minimal. It is crucial to seek information on the time after transplant, reflecting the net state of immunosuppression, previous history of exposure/infections, geography, and seasonal outbreaks. It is imperative that we develop regionally specific guidelines on screening, prevention, and management of infections after kidney transplantation.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 5","pages":"Article 151486"},"PeriodicalIF":2.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.semnephrol.2023.151466
Anthony Batte MBChB, MMed , Lubaba Shahrin MBBS, FCPS , Rolando Claure-Del Granado MD , Valerie A. Luyckx MD, PhD , Andrea L. Conroy PhD
Globally, there are an estimated 13.3 million cases of acute kidney injury (AKI) annually. Although infections are a common cause of AKI globally, most infection-associated AKI occurs in low- and lower-middle-income countries. There are marked differences in the etiology of infection-associated AKI across age groups, populations at risk, and geographic location. This article provides a global overview of different infections that are associated commonly with AKI, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus, malaria, dengue, leptospirosis, tick-borne illnesses, and viral hemorrhagic fevers. Further discussion focuses on infectious conditions associated with AKI including sepsis, diarrheal diseases and pregnancy, peripartum and neonatal AKI. This article also discusses the future of infection-associated AKI in the framework of climate change. It explores how increased investment in achieving the sustainable development goals may contribute to the International Society of Nephrology's 0 by 25 objective to curtail avoidable AKI-related fatalities by 2025.
据估计，全球每年有 1330 万例急性肾损伤（AKI）病例。虽然感染是全球 AKI 的常见病因，但大多数感染相关性 AKI 发生在低收入和中低收入国家。感染相关性 AKI 的病因在不同年龄组、高危人群和地理位置之间存在明显差异。本文概述了常见的与 AKI 相关的各种感染，包括严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）、人类免疫缺陷病毒、疟疾、登革热、钩端螺旋体病、蜱媒疾病和病毒性出血热。文章还重点讨论了与 AKI 相关的感染性疾病，包括败血症、腹泻疾病以及妊娠、围产期和新生儿 AKI。本文还讨论了气候变化框架下与感染相关的 AKI 的未来。文章探讨了在实现可持续发展目标方面增加投资如何有助于实现国际肾脏病学会的 "0 by 25 "目标，即到 2025 年减少可避免的 AKI 相关死亡。
{"title":"Infections and Acute Kidney Injury: A Global Perspective","authors":"Anthony Batte MBChB, MMed , Lubaba Shahrin MBBS, FCPS , Rolando Claure-Del Granado MD , Valerie A. Luyckx MD, PhD , Andrea L. Conroy PhD","doi":"10.1016/j.semnephrol.2023.151466","DOIUrl":"10.1016/j.semnephrol.2023.151466","url":null,"abstract":"<div><div><span><span>Globally, there are an estimated 13.3 million cases of acute kidney injury (AKI) annually. Although infections are a common cause of AKI globally, most infection-associated AKI occurs in low- and lower-middle-income countries. There are marked differences in the etiology of infection-associated AKI across age groups, populations at risk, and geographic location. This article provides a global overview of different infections that are associated commonly with AKI, including </span>severe acute respiratory syndrome coronavirus 2<span><span> (SARS-CoV-2), human immunodeficiency virus, malaria, dengue, </span>leptospirosis<span>, tick-borne illnesses, and viral hemorrhagic fevers. Further discussion focuses on infectious conditions associated with AKI including sepsis, diarrheal diseases and pregnancy, peripartum and neonatal AKI. This article also discusses the future of infection-associated AKI in the framework of climate change. It explores how increased investment in achieving the sustainable development goals may contribute to the International Society of </span></span></span>Nephrology's 0 by 25 objective to curtail avoidable AKI-related fatalities by 2025.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 5","pages":"Article 151466"},"PeriodicalIF":2.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139068524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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