COVID-19 And Chronic Kidney Diseases

The SARS-Coronavirus-19 disease has emerged as a global health challenge and has engulfed almost all countries since it was first reported in Wuhan, China. Patients with CKD have not been spared from the wrath of this pandemic and are bearing the brunt of it along with the rest of the population. Most of the patients with CKD have underlying comorbidities like diabetes and hypertension and are at an increased risk of adverse outcomes. Some of the manifestations of COVID-19 include proteinuria, hematuria, AKI, and acute CKD, requiring various forms of renal replacement therapy. Multiple mechanisms proposed for this damage include direct invasion, cytokine storm, hemodynamic derangements, and many others that are still undergoing extensive research. Since SARS COV 2 enters the cells through ACE 2 receptors, there are concerns regarding the use of ACE inhibitors and ARBs in patients already on these drugs. There are concerns regarding the use of immunosuppressants in various immune-mediated kidney diseases (postponing planned doses of methylprednisolone/cyclophosphamide/rituximab). Hemodialysis patients are exposed to potential sources of coronavirus as they have to repeatedly report to hospitals for their dialysis sessions. Measures regarding safeguarding dialysis staff from COVID -19 are contentious issues, especially in resource-limited settings. Almost all renal transplant patients are on lifelong immunosuppressive agents, making them more vulnerable to infections. Therefore, CKD patients have unique issues in the management of COVID and CKD, which we need to understand to develop protocols for the management of these problems.