Abstract
Introduction: SARS-CoV-2 infection is a pandemic with a significant impact on the elderly population with multiple morbidities.
Objective: To develop evidence-informed recommendations for the prevention, diagnosis, and management of SARS CoV2 / COVID-19 infection in multimorbed elderly patients with chronic kidney disease, through a consensus of experts.
Methodology: Based on the evidence collected through a literature review in Pubmed, Embase and scientific societies, recommendations were formulated that were submitted to the consultation of experts in nephrology, geriatrics and palliative care. The quality of evidence was evaluated with tools based on the type of document. The approved recommendations were classified according to their direction and strength.
Results: Twenty-two experts declared their conflict of interest and filled out the consultation tool between August 02 and 10, 2020. The percentage of agreement for each recommendation ranged between 90.9 and 100%.Thirty-two recommendations are presented for the management of SARS-CoV-2 infection in multimorbed elderly patients with chronic kidney disease.
Conclusion: The recommendations formulated guide the decision-making of health professionals involved in the care of elderly patients with chronic kidney disease and other morbidities with SARS-CoV-2 infection.
References
Cuenta de Alto Costo (CAC). Boletín de información técnica especializada de la cuenta de alto costo. 2018.
Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: a Systematic Review and Meta-Analysis. Arch Acad Emerg Med. 2020;8(1):e35.
Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, et al. Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China. J Clin Virol [Internet]. 2020;127(March):104364. Available from: https://doi.org/10.1016/j.jcv.2020.104364
Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with. Morb Mortal Wkly Rep. 2020;69(15):458–64.
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. Lancet [Internet]. 2020;395(10229):1054–62. Available from: http://dx.doi.org/10.1016/S0140-6736(20)30566-3
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA [Internet]. 2020 May 26;323(20):2052–9. Available from: https://doi.org/10.1001/jama.2020.6775
Perico L, Benigni A, Remuzzi G. Should covid-19 concern nephrologists? why and to what extent? The emerging impasse of angiotensin blockade. Nephron [Internet]. 2020; Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L631369382
Rubin R. Finding Ways to Reduce Coronavirus Exposure During Dialysis. JAMA. 2020;1–3.
Palevsky PM, Radhakrishnan J, Townsend RR, Bakris GL, Forman JP. END-STAGE KIDNEY DISEASE. 2020;2019:1–18.
Sankrityayan H, Kale A, Sharma N, Anders HJ, Gaikwad AB. Evidence for Use or Disuse of Renin–Angiotensin System Modulators in Patients Having COVID-19 With an Underlying Cardiorenal Disorder. J Cardiovasc Pharmacol Ther. 2020;25(4):299–306.
Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY). 2020 Apr;12(7):6049–57.
Shahid Z, Kalayanamitra R, McClafferty B, Kepko D, Ramgobin D, Patel R, et al. COVID-19 and Older Adults: What We Know. J Am Geriatr Soc. 2020 Apr;
Kreutz R, Algharably EAE-H, Azizi M, Dobrowolski P, Guzik T, Januszewicz A, et al. Hypertension, the renin–angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19: European Society of Hypertension COVID-19 Task Force Review of Evidence. Cardiovasc Res [Internet]. 2020 Apr 15; Available from: https://doi.org/10.1093/cvr/cvaa097
Brouwers MC, Kerkvliet K, Spithoff K. The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines. BMJ [Internet]. 2016;352. Available from: https://www.bmj.com/content/352/bmj.i1152
Beverley J Shea et al. AMSTAR 2: a critical appraisal tool for syste- matic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;j4008.
Cochrane. Cochrane Risk of Bias Tool. 2011;
Wells G, Shea C, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available from: http://www.ohri.ca/programs/clinical_epidemiology/nosgen.pdf
The University Of Adelaide. CRITICAL APPRAISAL TOOLS. 2017.
Joanna Briggs Institute. The Joanna Briggs Institute Scientific Writer Handbook. 2018;29. Available from: http://joannabriggs-webdev.org/assets/docs/scientificWriters/JBI Scientific Writer Handbook_July 2018.pdf
Sanabria AJ, Rigau D, Rotaeche R, Selva A, Marzo-Castillejo M, Alonso-Coello P. Sistema GRADE: metodología para la realización de recomendaciones para la práctica clínica. Atención Primaria [Internet]. 2015;47(1):48–55. https://doi.org/10.1016/j.aprim.2013.12.013
South AM, Tomlinson L, Edmonston D, Hiremath S, Sparks MA. Controversies of renin-angiotensin system inhibition during the COVID-19 pandemic. Nat Rev Nephrol. 2020 Apr;
Francisco ALM De, Canga JLP. Coronavirus y Riñón ASPECTOS EPIDEMIOLOGICOS DEL COVID-19. 2020;24. Available from: file:///C:/Users/Zona Informatica/Downloads/nefrologia-dia-287 (1).pdf
Rico-Mesa JS, White A, Anderson AS. Outcomes in Patients with COVID-19 Infection Taking ACEI/ARB. Curr Cardiol Rep [Internet]. 2020 Apr 14;22(5):31. Available from: https://pubmed.ncbi.nlm.nih.gov/32291526
Li J, Wang X, Chen J, Zhang H, Deng A. Association of Renin-Angiotensin System Inhibitors With Severity or Risk of Death in Patients With Hypertension Hospitalized for Coronavirus Disease 2019 (COVID-19) Infection in Wuhan, China. JAMA Cardiol [Internet]. 2020 Apr 23; Available from: https://doi.org/10.1001/jamacardio.2020.1624
de Abajo FJ, Rodríguez-Martín S, Lerma V, Mejía-Abril G, Aguilar M, García-Luque A, et al. Use of renin–angiotensin–aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study. Lancet. 2020;1705–14.
Peng YD, Meng K, Guan HQ, Leng L, Zhu RR, Wang BY, et al. Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV. Zhonghua Xin Xue Guan Bing Za Zhi. 2020 Mar;48(0):E004.
Singh AK, Gupta R, Misra A. Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers. Diabetes Metab Syndr [Internet]. 2020 Apr 9;14(4):283–7. Available from: https://pubmed.ncbi.nlm.nih.gov/32283499
Villanueva I, Ramírez R, Montejo J, Rodelo J, Puello L, Vélez M, et al. COVID-19 e hipertensión arterial: ¿existe evidencia para suspender antagonista sistema renina angiotensina? 2020;7:1–13.
Instituto de Evaluación Tecnológica en Salud, Asociación colombiana de Infectología. Consenso colombiano de atención, diagnóstico y manejo de la infección por SARS-COV-2/COVID-19. Rev Colomb infectología. 2020;24:47.
Bian J, Zhao R, Zhai S, Li Z. Anti-RAS drugs and SARS-CoV-2 infection. Acta Pharm Sin B [Internet]. 2020 Apr 28;10.1016/j.apsb.2020.04.013. Available from: https://pubmed.ncbi.nlm.nih.gov/32363137
Kow CS, Zaidi STR, Hasan SS. Cardiovascular Disease and Use of Renin-Angiotensin System Inhibitors in COVID-19. Am J Cardiovasc Drugs [Internet]. 2020 Apr 13;1–5. Available from: https://pubmed.ncbi.nlm.nih.gov/32281055
Zhang P, Zhu L, Cai J, Lei F, Qin J-J, 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;
Vaduganathan M, Vardeny O, Michel T, Mcmurray J, Pfeffer M, Solomon S. Special Report Renin – Angiotensin – Aldosterone System Inhibitors in Patients with Covid-19. new Engl J o f Med. 2020;1653–9.
Massachusetts General Hospital. Guia de tratamiento COVID-19 Massachussett General Hospital. 2020;1–14.
Berger J, Jaikaransingh V, Hedayati S. End-Stage Kidney Disease in the Elderly: Approach to Dialysis Initiation, Choosing Modality, and Predicting Outcomes. Adv Chronic Kidney Dis. 2016;23(1):36–43.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
Vergano M, Bertolini G, Giannini A, Gristina GR, Livigni S, Mistraletti G, et al. SIAARTI recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances. Minerva Anestesiol. 2020;1–8.
Tripodoro V. Proyecto NECPAL CCOMS-ICO© para la identificacio n de personas con enfermedades cro nicas avanzadas y necesidades de atencion paliativa en la Ciudad de Buenos Aires, Argentina. 2016.
Gómez-Batiste X, Turrillas P, Tebé C, Calsina-Berna A, Amblàs-Novellas J. NECPAL tool prognostication in advanced chronic illness: a rapid review and expert consensus. BMJ Support Palliat Care. 2020 Apr;
Yomayusa N, Yama E, González C, Ariza A, Aroca G, Baquero R, et al. Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, diagnóstico y manejo de infección por SARS-CoV-2/COVID-19 en pacientes con Enfermedad Renal Crónica en diálisis. Rev Colomb Nefrol [Internet]. 2020;7(Supl.2). Available from: https://revistanefrologia.org/index.php/rcn/article/view/474
Sociedad Latinoamericana de Nefrología e Hipertensión. Recomendaciones para el manejo de pacientes portadores de enfermedad renal frente a la epidemia de coronavirus ( COVID-19 ). 2020;(March):1–10. Available from: https://mega.nz/folder/WQJSmIZS#1EULt-lqeKvt1jbYSbuKqA/file/vYxXHRwR
NICE. COVID-19 rapid guideline: dialysis service delivery (NG160). NICE Guidel 2020 [Internet]. 2020;(March). Available from: https://www.nice.org.uk/guidance/ng160
Lidoriki I, Frountzas M, Schizas D. Could nutritional and functional status serve as prognostic factors for COVID-19 in the elderly? Med Hypotheses [Internet]. 2020 Jun 2;144:109946. Available from: https://pubmed.ncbi.nlm.nih.gov/32512494
Chowdhury R, Peel NM, Krosch M, Hubbard RE. Frailty and chronic kidney disease: A systematic review. Arch Gerontol Geriatr [Internet]. 2017;68:135–42. Available from: http://www.sciencedirect.com/science/article/pii/S016749431630187X
Kallenberg MH, Kleinveld HA, Dekker FW, van Munster BC, Rabelink TJ, van Buren M, et al. Functional and Cognitive Impairment, Frailty, and Adverse Health Outcomes in Older Patients Reaching ESRD-A Systematic Review. Clin J Am Soc Nephrol [Internet]. 2016/06/24. 2016 Sep 7;11(9):1624–39. Available from: https://pubmed.ncbi.nlm.nih.gov/27342598
Sy J, Johansen KL. The impact of frailty on outcomes in dialysis. Curr Opin Nephrol Hypertens [Internet]. 2017 Nov;26(6):537–42. Available from: https://pubmed.ncbi.nlm.nih.gov/28901990
Lee S, Lee S, Harada K, Bae S, Makizako H, Doi T, et al. Relationship between chronic kidney disease with diabetes or hypertension and frailty in community-dwelling Japanese older adults. Geriatr Gerontol Int. 2017 Oct;17(10):1527–33.
NICE. COVID-19 rapid guideline: critical care in adults. Natl Inst Heal Care Excell. 2020;(March):2020.
Montero-Odasso M, Hogan DB, Lam R, Madden K, MacKnight C, Molnar F, et al. Age Alone is not Adequate to Determine Healthcare Resource Allocation during the COVID-19 Pandemic. Can Geriatr J. 2020;23(1):152–4.
Chong E, Chia JQ, Law F, Chew J, Chan M, Lim WS. Validating a Standardised Approach in Administration of the Clinical Frailty Scale in Hospitalised Older Adults. Ann Acad Med Singapore. 2019 Apr;48(4):115–24.
Dueñas E., Rojas A., Altamar G. Triage del adulto mayor con covid 19 en centro hospitalario. 2020.
Le Maguet P, Roquilly A, Lasocki S, Asehnoune K, Carise E, Saint Martin M, et al. Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study. Intensive Care Med. 2014 May;40(5):674–82.
Kemenesi G, Kornya L, Tóth GE, Kurucz K, Zeghbib S, Somogyi BA, et al. Nursing homes and the elderly regarding the COVID-19 pandemic: situation report from Hungary. GeroScience [Internet]. 2020;2:1–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32426693%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC7232926
Naicker S, Yang CW, Hwang SJ, Liu BC, Chen JH, Jha V. The Novel Coronavirus 2019 epidemic and kidneys. Circulation [Internet]. 2020;97(5):824–8. Available from: https://doi.org/10.1016/j.kint.2020.03.001
DeFilippis EM, Ranard LS, Berg DD. Cardiopulmonary Resuscitation During the COVID-19 Pandemic: A View from Trainees on the Frontline. Circulation. 2020;1–8.
Crook P. Cardiopulmonary resuscitation in the COVID-19 era – Will the risk-benefit shift in resource-poor settings? Resuscitation [Internet]. 2020;151:118. Available from: https://doi.org/10.1016/j.resuscitation.2020.04.016
Chong E, Chan M, Tan HN, Lim WS. COVID-19: Use of the Clinical Frailty Scale for Critical Care Decisions. J Am Geriatr Soc [Internet]. 2020/05/13. 2020 Jun;68(6):E30–2. Available from: https://pubmed.ncbi.nlm.nih.gov/32359076
Resuscitation Council (UK). Resuscitation Council UK Statement on COVID-19 in relation to CPR and resuscitation in acute hospital settings. 2020;
Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen psychiatry [Internet]. 2020 Mar 6;33(2):e100213–e100213. Available from: https://pubmed.ncbi.nlm.nih.gov/32215365
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17(5).
Ho CS, Chee CY, Ho RC. Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic. Ann Acad Med Singapore. 2020;49(1):1–3.
Holmes EA, O’Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry [Internet]. 2020;7(6):547–60. Available from: http://www.sciencedirect.com/science/article/pii/S2215036620301681
Lima CKT, Carvalho PM de M, Lima I de AAS, Nunes JVA de O, Saraiva JS, de Souza RI, et al. The emotional impact of Coronavirus 2019-nCoV (new Coronavirus disease). Psychiatry Res [Internet]. 2020;287:112915. Available from: http://www.sciencedirect.com/science/article/pii/S0165178120305163
Goodman-Casanova JM, Dura-Perez E, Guzman-Parra J, Cuesta-Vargas A, Mayoral-Cleries F. Telehealth Home Support During COVID-19 Confinement for Community-Dwelling Older Adults With Mild Cognitive Impairment or Mild Dementia: Survey Study. J Med Internet Res. 2020 May;22(5):e19434.
Wu Z, Zhang Z, Wu S. Focus on the Crosstalk Between COVID-19 and Urogenital Systems. 2020;
NYC Health. Sex and COVID-19 Fact Sheet. 2020;
Ramírez R, Villanueva B, Gomez F. ¿Cuáles son las recomendaciones sobre sexualidad en el paciente adulto mayor multimorbido con enfermedad renal crónica, en la pandemia del Covid-19? Colomb Nefrol. 2020;7.
Ministerio De Salud y Protección Social. ABC sobre las relaciones sexuales y la enfermedad por Coronavirus (covid-19). 2020.
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