Pharmacotherapy for Patients with Chronic Kidney Disease during the COVID-19: A Narrative Review

Main Article Content

Mansour Adam Mahmoud

Abstract

Background: COVID-19 is considered the most challenging global pandemic. Patients with COVID-19 are more vulnerable to renal impairment especially those admitted to the Intensive Care Units (ICUs).

Objective: In this review we discuss the epidemiology, the pathophysiology, the clinical implications and specific COVID-19 therapy in CKD patients.

Results: The prevalence of CKD patients with COVID-19 varies between 0.7 to 47.6%. Patients with CKD ought to be encouraged to take extra precautions (isolation, distancing, wearing Personal Protective Equipment (PPE)) to limit the risk of exposure to the virus. Renin-Angiotensin System (RAS) and SARS-CoV-2 interactions, through the binding of the virus to ACE-2, have  produced speculations of both likely damage and advantage of RAS inhibitor use during the pandemic. Remidisivir should be avoided in CKD patients (Cr Cl<30ml/min) with COVID-19. In addition, the doses of nephrotoxic medications (chloroquine phosphate and dexamethasone) that are recommended to be used in the management of COVID-19 should be adjusted according to creatinine clearance and dialysis.

Conclusion: COVID-19 may worsen the impaired kidney function and increase mortality.                Care givers should pay especial attention to medications dosing in COVID-19 patient with CKD history.

Keywords:
SARS-CoV-2, COVID-19, treatment, chronic kidney disease, nephrology

Article Details

How to Cite
Mahmoud, M. A. (2021). Pharmacotherapy for Patients with Chronic Kidney Disease during the COVID-19: A Narrative Review. Journal of Advances in Medicine and Medical Research, 33(3), 1-10. https://doi.org/10.9734/jammr/2021/v33i330815
Section
Review Article

References

Mao R, Liang J, Shen J, Ghosh S, Zhu L-R, Yang H, et al. Implications of COVID-19 for patients with pre-existing digestive diseases. Lancet GastroenterolHepatol. 2020;5(5):426–8.

WHO Coronavirus Disease (COVID-19) Dashboard [Internet].
[cited 2020 Jun 28].
Available:https://covid19.who.int

Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270–3.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. 2020 28;395(10229):1054–62.

Chen TK, Knicely DH, Grams ME. Chronic kidney disease diagnosis and management: A review. JAMA. 2019;322(13):1294–304.

Roberto P, Francesco L, Emanuela C, Giorgia G, Pasquale N, Sara D. Current treatment of COVID-19 in renal patients: hope or hype? Intern Emerg Med. 2020;1–10.

Basile C, Era-Edta on behalf of the EWG of, Combe C, Era-Edta on behalf of the EWG of, Pizzarelli F, Era-Edta on behalf of the EWG of, et al. Recommendations for the prevention, mitigation and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres. Nephrol Dial Transplant. 2020;35(5):737–41.

Shimada N, Shimada H, Itaya Y, Tomino Y. The novel coronavirus disease in patients with end-stage kidney disease. TherApher Dial; 2020.

Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, et al. Management of patients on dialysis and with kidney transplantation during the SARS-CoV-2 (COVID-19) pandemic in Brescia, Italy. Kidney International Reports. 2020;5(5):580–5.

Adapa S, Chenna A, Balla M, Merugu GP, Koduri NM, Daggubati SR, et al. COVID-19 Pandemic causing acute kidney injury and impact on patients with chronic kidney disease and renal transplantation. J Clin Med Res. 2020;12(6):352–61.

Gagliardi I, Patella G, Michael A, Serra R, Provenzano M, Andreucci M. COVID-19 and the Kidney: From epidemiology to clinical practice. J Clin Med [Internet]. 2020;9(8).
[cited 2020 Oct 18]
Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464116/

Mohamed MMB, Lukitsch I, Torres-Ortiz AE, Walker JB, Varghese V, Hernandez-Arroyo CF, et al. Acute kidney injury associated with coronavirus disease 2019 in urban new orleans. Kidney360. 2020;1(7):614–22.

Volunteers A-2019-nCoV, Li Z, Wu M, Yao J, Guo J, Liao X, et al. Caution on kidney dysfunctions of COVID-19 patients. medRxiv. 2020;20021212.

Adamsick ML, Gandhi RG, Bidell MR, Elshaboury RH, Bhattacharyya RP, Kim AY, et al. Remdesivir in patients with acute or chronic kidney disease and COVID-19. J Am SocNephrol. 2020;31(7):1384–6.

Mou Z, Guan T, Chen L. Prevalence and outcomes in COVID-19 patients with AKI: A meta-analysis. medRxiv. 2020;20079038.

Ouyang L, Gong Y, Zhu Y, Gong J. Association of acute kidney injury with the severity and mortality of SARS-CoV-2 infection: A meta-analysis. Am J Emerg Med; 2020.

Khoshdel-Rad N, Zahmatkesh E, Shpichka A, Timashev P, Vosough M. Outbreak of chronic renal failure: Will this be a delayed heritage of COVID-19? J Nephrol [Internet]; 2020.
[cited 2020 Oct 23]
Available:https://doi.org/10.1007/s40620-020-00851-9

Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney International. 2020;97(5):829–38.

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. New England Journal of Medicine [Internet]; 2020.
[cited 2020 Apr 9]
Available:https://www.nejm.org/doi/10.1056/NEJMoa2002032

Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically Ill patients with COVID-19 in Washington State. JAMA. 2020;323(16):1612.

D’Marco L, Puchades MJ, Romero-Parra M, Gimenez-Civera E, Soler MJ, Ortiz A, et al. Coronavirus disease 2019 in chronic kidney disease. Clin Kidney J. 2020;13(3):297–306.

Wang X, Fang X, Cai Z, Wu X, Gao X, Min J, et al. Comorbid chronic diseases and acute organ injuries are strongly correlated with disease severity and mortality among COVID-19 patients: A systemic review and meta-analysis. Research (Wash D C) [Internet]; 2020
[cited 2020 Oct 23]
Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187729/

Sarnak MJ, Jaber BL. Pulmonary infectious mortality among patients with end-stage renal disease. Chest. 2001;120(6):1883–7.

Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. The Lancet. 2020;395(10224):565–74.

Wang K, Chen W, Zhou YS, Lian JQ, Zhang Z, Du P, et al. SARS-CoV-2 invades host cells via a novel route: CD147-spike protein. bioRxiv. 2020;988345.

Pan X, Xu D, Zhang H, Zhou W, Wang L, Cui X. Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: A study based on single-cell transcriptome analysis. Intensive Care Med. 2020;46(6):1114–6.

Wu H, Uchimura K, Donnelly EL, Kirita Y, Morris SA, Humphreys BD. Comparative analysis and refinement of human PSC-derived kidney organoid differentiation with single-cell transcriptomics. Cell Stem Cell. 2018;23(6):869-881.e8.

Li J, Li SX, Zhao LF, Kong DL, Guo ZY. Management recommendations for patients with chronic kidney disease during the novel coronavirus disease 2019 (COVID-19) epidemic. Chronic Diseases and Translational Medicine. 2020;6(2):119–23.

Meena P, Bhargava V, Rana DS, Bhalla AK, Gupta A. COVID-19 and the kidney: A matter of concern. Current Medicine Research and Practice. 2020;10(4):165–8.

Hardenberg J, Luft FC. COVID‐19, ACE2 and the kidney. ActaPhysiol (Oxf) [Internet]; 2020.
[cited 2020 Oct 27]
Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404369/

Chakraborty I, Maity P. COVID-19 outbreak: Migration, effects on society, global environment and prevention. Science of The Total Environment. 2020;728:138882.

Guan W, Liang W, Zhao Y, Liang H, Chen Z, Li Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. European Respiratory Journal [Internet]; 2020.
[cited 2020 Oct 23];55(5)
Available:https://erj.ersjournals.com/content/55/5/2000547

Aly MH, Rahman SS, Ahmed WA, Alghamedi MH, Shehri AAA, Alkalkami AM, et al.

Indicators of Critical Illness and Predictors of Mortality in COVID-19 Patients

[Internet]. Infection and Drug Resistance. Dove Press. 2020;13.
[cited 2020 Oct 23]. p. 1995–2000.
Available:https://www.dovepress.com/indicators-of-critical-illness-and-predictors-of-mortality-in-covid-19-peer-reviewed-article-IDR

White CA, Kappel JE, Levin A, Moran SM, Pandeya S, Thanabalasingam SJ. Management of advanced chronic kidney disease during the COVID-19 pandemic: Suggestions from the canadian society of nephrology COVID-19 rapid response team. Can J Kidney Health Dis [Internet]; 2020.
[cited 2020 Oct 23];7
Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372621/

Vaduganathan M, Vardeny O, Michel T, McMurray JJV, Pfeffer MA, Solomon SD. Renin-angiotensin-aldosterone system inhibitors in patients with COVID-19. N Engl J Med. 2020;382(17): 1653–9.

Zhang P, Zhu L, Cai J, Lei F, Qin JJ, Xie J, et al. Association of inpatient use of angiotensin-converting enzyme inhibitors and angiotensin ii receptor blockers with mortality among patients with hypertension hospitalized with COVID-19. Circ Res. 2020;126(12):1671–81.

Bean D, Kraljevic Z, Searle T, Bendayan R, Pickles A, Folarin A, et al. Treatment with ACE-inhibitors is associated with less severe disease with SARS-Covid-19 infection in a multi-site UK acute Hospital Trust; 2020.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA; 2020.

How COVID-19 Affects CKD Patients - CORE Kidney - Los Angeles, CA [Internet].
[cited 2020 Oct 23].
Available:https://www.uclahealth.org/core-kidney/how-covid-19-affects-ckd-patients-1275

Recommendations [Internet]. International Society of Nephrology.
[cited 2020 Oct 23].
Available:https://www.theisn.org/initiatives/covid-19/recommendations/

Xiong F, Tang H, Liu L, Tu C, Tian JB, Lei CT, et al. Clinical characteristics of and medical interventions for COVID-19 in hemodialysis patients in Wuhan, China. JASN. 2020;31(7):1387–97.

Watnick S, McNamara E. On the frontline of the COVID-19 outbreak: Keeping patients on long-term dialysis safe. Clin J Am SocNephrol. 2020;15(5):710–3.

CKD Evaluation and Management – KDIGO [Internet].
[cited 2020 Oct 27].
Available:https://kdigo.org/guidelines/ckd-evaluation-and-management/

ERA-EDTA Council, ERACODA Working Group, Chronic kidney disease is a key risk factor for severe COVID-19: A call to action by the ERA-EDTA, Nephrology Dialysis Transplantation. 2021;36(1):87–94.
Available:https://doi.org/10.1093/ndt/gfaa314

Ozturk S, Turgutalp K, Arici M, Odabas AR, Altiparmak MR, Aydin Z, et al. Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey. Nephrol Dial Transplant. 2020;35(12):2083-2095.
DOI: 10.1093/ndt/gfaa271.
PMID: 33275763
PMCID: PMC7716804