Nephrology Dialysis Transplantation

Lu, Justin Y; Boparai, Montek S; Shi, Caroline; Henninger, Erin M; Rangareddy, Mahendranath; Veeraraghavan, Sudhakar; Mirhaji, Parsa; Fisher, Molly C; Duong, Tim Q

2023 Nephrology Dialysis Transplantation

doi: 10.1093/ndt/gfad020pmid: 36702551

Abstract Background Although COVID-19 patients who developed in-hospital AKI have worse short-term outcomes, their long-term outcomes have not been fully characterized. We investigated 90-day and one-year outcomes after hospital AKI grouped by time to recovery from AKI. Methods This study consisted of 3,296 COVID-19 patients with hospital AKI stratified by early recovery (<48 hours), delayed recovery (2-7 days), and prolonged recovery (>7-90 days). Demographics, comorbidities, laboratory values were obtained at admission and up to one-year follow-up. Incidence of major adverse cardiovascular event (MACE) and major adverse kidney event (MAKE), rehospitalization, recurrent AKI, and new-onset chronic kidney disease (CKD) were obtained 90-days post COVID-19 discharge. Results The incidence of hospital AKI was 28.6%. Of COVID-19 patients with AKI, 58.0% experienced early recovery, 14.8% delayed recovery and 27.1% prolonged recovery. Patients with longer AKI recovery time had higher prevalence of CKD (p<0.05) and were more likely to need invasive mechanical ventilation (p<0.001) and to die (p<0.001). Many COVID-19 patients developed MAKE, recurrent AKI, and new-onset CKD within 90 days, and these incidences were higher in the prolonged recovery group (p<0.05). Incidence of MACE peaked 20-40 days post-discharge, whereas MAKE peaked 80-90 days post-discharge. Logistic regression models predicted 90-day MACE and MAKE with 82.4±1.6% and 79.6.9±2.3% accuracy, respectively. Conclusion COVID-19 survivors who developed hospital AKI are at high risk for adverse cardiovascular and kidney outcomes, especially those with longer AKI recovery time and those with history of CKD. These patients may require long-term follow-up for cardiac and kidney complications. Graphical Abstract Open in new tabDownload slide long COVID, major adverse cardiovascular event, major adverse kidney event, PASC, predictive modeling Accepted manuscripts Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout. PDF This content is only available as a PDF. © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Cogley, Clodagh; Bramham, Jessica; Bramham, Kate; Smith, Aoife; Holian, John; O'Riordan, Aisling; Teh, Jia Wei; Conlon, Peter; Hale, Siobhan Mac; D'Alton, Paul

2023 Nephrology Dialysis Transplantation

doi: 10.1093/ndt/gfad021pmid: 36702532

Abstract Background People with chronic kidney disease (CKD) experience high levels of psychological distress, which is associated with higher mortality and adverse health outcomes. Little is known about the rates of a range of mental health difficulties or rates of suicide attempts in people with CKD. Methods Individuals with CKD (N = 268; age range 18-94 years, M = 49.96), on haemodialysis (n = 79), peritoneal dialysis (n = 46), transplant recipients (n = 84) and who were not on renal replacement therapy (RRT) (n = 59) were recruited through the Irish Kidney Association social media pages and three Irish hospitals. Participants completed surveys to gather demographics and mental health histories, the Hospital Anxiety and Depression Scale (HADS) and the Short-form-12 to measure health-related quality of life (HRQoL). Results 23.5% of participants self-reported they had received a mental health diagnosis, with depression (14.5%) and anxiety (14.2%) being the most common. 26.4% of participants had experienced suicidal ideation and 9.3% had attempted suicide. Using a clinical cut-off ≥8 on the HADS subscales, current levels of clinically significant anxiety and depression were 50.7% and 35.4%, respectively. Depression levels were slightly higher for those on haemodialysis compared to those with a transplant and those not on RRT. Depression, anxiety, and having a mental health diagnosis were all associated with lower HRQoL. Conclusions People with CKD in Ireland experience high levels of psychological distress, mental health difficulties, suicidal ideation and suicide attempts. The identification of and intervention for mental health difficulties in CKD should be prioritised in clinical care. Graphical Abstract Open in new tabDownload slide kidney disease, kidney failure, mental health, psychological distress, suicide Accepted manuscripts Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout. PDF This content is only available as a PDF. © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Murashima, Miho; Hamano, Takayuki; Abe, Masanori; Masakane, Ikuto

2023 Nephrology Dialysis Transplantation

doi: 10.1093/ndt/gfad019pmid: 36702533

Abstract Background Outcomes of a combination of peritoneal dialysis (PD) and once-weekly hemodialysis (PD+HD) have not been extensively studied. Methods This prospective cohort study on Japanese Society for Dialysis Therapy Renal Data Registry included those who transited from PD to PD+HD therapy or thrice-weekly HD from 2011 to 2018. Exposure was PD+HD therapy compared with thrice-weekly HD. The outcome was time to all-cause or cause-specific death. Associations between PD+HD therapy and outcomes were examined by Cox regression. Sensitivity analyses were performed by propensity score (PS) matching, PS matching with shared frailty model in which dialysis facilities were treated as a random effect, inverse probability weighting (IPW), PS adjustment, PS stratification, competing risk regression, and on-treatment analyses in which data were censored at the transition to thrice-weekly HD for those on PD+HD therapy. Results During a study period, 1001 subjects transited to PD+HD therapy and 2031 to thrice-weekly HD, respectively. During a median follow-up of 3.5 years, 575 subjects died. All-cause, cardiovascular, congestive heart failure-related, or infection-related mortality were not significantly different between those on PD+HD and those on thrice-weekly HD (HR: 0.95 [0.78-1.16], 1.26 [0.92-1.72], 1.24 [0.77-1.99], and 0.89 [0.57-1.39], respectively). Sensitivity analyses yielded similar results except that PD+HD therapy was associated with significantly lower all-cause mortality by PS adjustment and PS matching with the shared frailty model and lower infection-related mortality by PS adjustment and IPW. Conclusions PD+HD therapy was associated with similar or potentially lower mortality compared with thrice-weekly HD. Considering a flexible lifestyle, PD+HD therapy could be a great option. Graphical Abstract Open in new tabDownload slide combination of peritoneal dialysis and hemodialysis, hemodialysis, mortality Accepted manuscripts Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout. PDF This content is only available as a PDF. © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)