Review

. 2022 Nov;18(11):724-737.

doi: 10.1038/s41581-022-00618-4. Epub 2022 Aug 24.

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

Duvuru Geetha^#¹, Andreas Kronbichler^#², Megan Rutter³, Divya Bajpai⁴, Steven Menez⁵, Annemarie Weissenbacher⁶, Shuchi Anand⁷, Eugene Lin^{8

9}, Nicholas Carlson^{10

11}, Stephen Sozio⁵, Kevin Fowler¹², Ray Bignall¹³, Kathryn Ducharlet^{14

15}, Elliot K Tannor^{16

17}, Eranga Wijewickrama^{18

19}, Muhammad I A Hafidz²⁰, Vladimir Tesar²¹, Robert Hoover²², Deidra Crews⁵, Charles Varnell^{23

24

25}, Lara Danziger-Isakov²⁶, Vivekanand Jha^{27

28

29}, Sumit Mohan³⁰, Chirag Parikh⁵, Valerie Luyckx^{31

32

33}

Affiliations

¹ Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. gduvura@jhmi.edu.
² Department of Medicine, University of Cambridge, Cambridge, UK.
³ Department of Lifespan and Population Health, University of Nottingham, Nottingham, UK.
⁴ Department of Nephrology, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, India.
⁵ Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁶ Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria.
⁷ Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Standford, California, USA.
⁸ Department of Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
⁹ Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA.
¹⁰ Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
¹¹ Department of Research, The Danish Heart Foundation, Copenhagen, Denmark.
¹² Principal, Voice of the Patient Inc, St. Louis, Missouri, USA.
¹³ Division of Nephrology and Hypertension, Nationwide Children's Hospital and Department of Paediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.
¹⁴ Department of Renal Medicine, Eastern Health Clinical School, Monash University, Melbourne, Australia.
¹⁵ Department of Nephrology and Palliative Care, St Vincent's Hospital Melbourne, Australia and Department of Medicine, University of Melbourne, Parkville, Australia.
¹⁶ Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
¹⁷ Renal Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
¹⁸ Consultant Nephrologist and Professor in the Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
¹⁹ University Medical Unit, National Hospital of Sri Lanka and National Institute of Nephrology, Dialysis & Transplantation, Colombo, Sri Lanka.
²⁰ Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
²¹ Department of Nephrology, Charles University, Prague, Czech Republic.
²² Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
²³ Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²⁴ James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²⁵ Department of Paediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA.
²⁶ Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA.
²⁷ George Institute for Global Health, New Delhi, India.
²⁸ School of Public Health, Imperial College, London, UK.
²⁹ Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
³⁰ Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
³¹ Associate Scientist, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
³² Honorary Associate Professor, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
³³ Nephrologist, University Childrens Hospital, Zurich, Switzerland.

^# Contributed equally.

PMID: 36002770
PMCID: PMC9400561
DOI: 10.1038/s41581-022-00618-4

Review

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

Duvuru Geetha et al. Nat Rev Nephrol. 2022 Nov.

. 2022 Nov;18(11):724-737.

doi: 10.1038/s41581-022-00618-4. Epub 2022 Aug 24.

Authors

Affiliations

¹ Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. gduvura@jhmi.edu.
² Department of Medicine, University of Cambridge, Cambridge, UK.
³ Department of Lifespan and Population Health, University of Nottingham, Nottingham, UK.
⁴ Department of Nephrology, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, India.
⁵ Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁶ Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria.
⁷ Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Standford, California, USA.
⁸ Department of Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
⁹ Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA.
¹⁰ Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
¹¹ Department of Research, The Danish Heart Foundation, Copenhagen, Denmark.
¹² Principal, Voice of the Patient Inc, St. Louis, Missouri, USA.
¹³ Division of Nephrology and Hypertension, Nationwide Children's Hospital and Department of Paediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.
¹⁴ Department of Renal Medicine, Eastern Health Clinical School, Monash University, Melbourne, Australia.
¹⁵ Department of Nephrology and Palliative Care, St Vincent's Hospital Melbourne, Australia and Department of Medicine, University of Melbourne, Parkville, Australia.
¹⁶ Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
¹⁷ Renal Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
¹⁸ Consultant Nephrologist and Professor in the Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
¹⁹ University Medical Unit, National Hospital of Sri Lanka and National Institute of Nephrology, Dialysis & Transplantation, Colombo, Sri Lanka.
²⁰ Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
²¹ Department of Nephrology, Charles University, Prague, Czech Republic.
²² Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
²³ Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²⁴ James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²⁵ Department of Paediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA.
²⁶ Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA.
²⁷ George Institute for Global Health, New Delhi, India.
²⁸ School of Public Health, Imperial College, London, UK.
²⁹ Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
³⁰ Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
³¹ Associate Scientist, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
³² Honorary Associate Professor, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
³³ Nephrologist, University Childrens Hospital, Zurich, Switzerland.

^# Contributed equally.

PMID: 36002770
PMCID: PMC9400561
DOI: 10.1038/s41581-022-00618-4

Erratum in

Author Correction: Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions.
Geetha D, Kronbichler A, Rutter M, Bajpai D, Menez S, Weissenbacher A, Anand S, Lin E, Carlson N, Sozio S, Fowler K, Bignall R, Ducharlet K, Tannor EK, Wijewickrama E, Hafidz MIA, Tesar V, Hoover R, Crews D, Varnell C, Danziger-Isakov L, Jha V, Mohan S, Parikh C, Luyckx V. Geetha D, et al. Nat Rev Nephrol. 2022 Nov;18(11):738. doi: 10.1038/s41581-022-00635-3. Nat Rev Nephrol. 2022. PMID: 36127498 Free PMC article. No abstract available.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce.

PubMed Disclaimer

Conflict of interest statement

D.G. is a consultant to ChemoCentryx, Aurinia Inc and GSK, and received support from the Johns Hopkins Center for Innovative Medicine. A.K. is a consultant to Vifor, Otsuka, Delta4, Catalyst Biosciences and UriSalt, and received funding from Vifor and Otsuka. M.R. is funded by a Versus Arthritis Clinical Research Fellowship. S.A. has a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK127138); Ascend Clinical Laboratory funded sample testing for S.A.’s work on SARS-CoV-2 seroepidemiology among patients on dialysis. E.L. received a consulting fee from Acumen, LLC, a federal contractor, and funding from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (K08 DK118213) and from the University Kidney Research Organization. V.T. is a consultant for AbbVie, Amgen, Baxter, Bayer, Boehringer Ingelheim, Calliditas, ChemoCentryx and Fresenius Medical Care, Omeros and Travere. V.T. is also a speaker for Bayer and Boehringer Ingelheim, and received travel expenses from AbbVie. D.C. was supported by grant 1 K24 HL148181 from the National Heart, Lung and Blood Institute, National Institutes of Health (NIH), and received research grant funding from Somatus Medical, Inc. and Baxter International, for unrelated work. N.C. received lecture fees Bristol Myers Squibb, and funding from The Danish Heart Foundation. V.J. received grant funding from GSK, Baxter Healthcare and Biocon, and honoraria from Bayer, AstraZeneca, Boehringer Ingelheim, NephroPlus and Zydus Cadilla, under the policy of all monies being paid to the organization. S.M. received grants from the NIH (DK126739, DK114893, DK130058, MD014161, DK116066) and the Kidney Transplant collaborative as well as personal fees from Kidney International Reports and HSAG, outside the submitted work. C.P. is a member of the advisory board of and owns equity in RenalytixAI, serves as a consultant for Genfit and Novartis, and is supported by NIH grants R01HL085757, UH3DK114866, U01DK106962 and R01DK093770. V.L. received funding from the Swiss Kidney Foundation. All other authors declare no competing interests.

Figures

**Fig. 1. Shortage of personal protective equipment across countries by income status.**
Data on country income derived from World Bank data. The graphs show the results of a global online survey of haemodialysis units, which was aimed at determining patterns and access to resources associated with haemodialysis care during the COVID-19 pandemic. As shown, LICs had the greatest shortage of personal protective equipment (PPE) at the peak of the pandemic (a) and the greatest use of PPE beyond manufacturer’s shelf life (b), the latter representing a need to continue using out-of-date PPE owing to a shortage of supply. HIC, high-income countries; LIC, low-income countries; LMIC, lower-middle-income countries; UMIC, upper-middle-income countries.

**Fig. 2. Factors contributing to COVID-19-related health inequities.**
A number of factors have resulted in COVID-19 health inequities, ranging from those that affect individuals (such as age and co-morbidities) to factors at the global level.

**Fig. 3. Strategies to address challenges during a pandemic.**
PD, peritoneal dialysis; PIRRT, prolonged intermittent renal replacement therapy; PPE, personal protective equipment.

See this image and copyright information in PMC

References

1. Chan L, et al. AKI in hospitalized patients with COVID-19. J. Am. Soc. Nephrol. 2021;32:151–160. doi: 10.1681/ASN.2020050615. - DOI - PMC - PubMed
1. Brogan M, Ross MJ. The impact of chronic kidney disease on outcomes of patients with COVID-19 admitted to the intensive care unit. Nephron. 2022;146:67–71. doi: 10.1159/000519530. - DOI - PMC - PubMed
1. Pereira MR, et al. COVID-19 in solid organ transplant recipients: initial report from the US epicenter. Am. J. Transpl. 2020;20:1800–1808. doi: 10.1111/ajt.15941. - DOI - PMC - PubMed
1. Singhala M, et al. Emergency production and collection of dialysate for CVVHD during the COVID-19 pandemic. Kidney Int. Rep. 2021;6:2200–2202. doi: 10.1016/j.ekir.2021.05.026. - DOI - PMC - PubMed
1. Combe C, et al. At least 156 reasons to prioritize COVID-19 vaccination in patients receiving in-centre haemodialysis. Nephrol. Dial. Transpl. 2021;36:571–574. doi: 10.1093/ndt/gfab007. - DOI - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

Affiliations

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical