“It is now recognised that patients with kidney disease are at increased risk of severe COVID-19 and that acute kidney injury is a common and serious complication of severe COVID-191. Patients who develop acute kidney injury have an increased length of stay in hospital and risk of death. Current evidence indicates that up to half of patients who have acute kidney injury do not completely recover their kidney function2. Patients with kidney transplants maybe at increased risk of COVID-19 due to the immunosuppressive medication they are taking. In Leeds, the MIC is developing a number of different research projects which include evaluating the feasibility for remote blood testing for patients with kidney disease and also to improve our understanding of kidney disease at a cellular level.”
Dr Andrew Lewington, Associate Clinical Director and Renal Theme Lead for NIHR Leeds In-Vitro Diagnostic Co-Operative
In UK there are currently about 3 million patients with chronic kidney disease. Chronic kidney disease is a silent disease with very few symptoms until patients develop kidney failure and require dialysis. There are about 65,000 patients in the UK who have developed kidney failure with 55% of these having a kidney transplant and the rest on dialysis. During the COVID-19 pandemic patients with kidney disease have been identified as being at higher risk of developing complications of COVID-19 infection. Many patients who receive dialysis have to attend outpatient facilities with other patients which puts them at a higher risk of contracting infection. Strategies to prevent infection are therefore of paramount importance particularly as patients with kidney disease were not represented in the original COVID-19 vaccination studies. There is an urgent need for research to understand the effectiveness of vaccination in this patient group. Such research is being supported by Kidney Research UK.
During the pandemic, Dr Andrew Lewington has supported the development of new guidelines for the management of patients with kidney disease. He was an expert reviewer for the NICE Guideline NG175 “COVID-19 rapid guideline: acute kidney injury in hospital” Published 06 May 2020 and was a lead author of the Renal Association Clinical Practice Guideline “Renal Replacement Therapy for Critically Unwell Adult Patients: Guidelines for best practice and service resilience during COVID-19”
In his role as Renal theme lead for the NIHR Leeds In-Vitro Diagnostic Co-operative (MIC) Dr Lewington is collaborating on two projects aimed at improving the care of patients with kidney disease. The first project will develop the capability for patients with kidney transplants to have important blood tests performed at home, rather than having to attend the hospital all the local GP. The project is exploring the feasibility of patients taking their own blood samples utilising a finger prick test similar to that performed in patients with diabetes to monitor their blood sugar. The blood sample can then be safely sent through the post to the local biochemistry department for analysis. This will allow patients to continue to shield as necessary during the current pandemic and longer term will provide patients the opportunity to receive remote care. The initial part of the study has been funded by Kidney Research Yorkshire and will develop the lab-based assays to evaluate the accuracy of blood samples collected from home.
In the second project, Dr Lewington is working in collaboration with Dr Scarlet Brockmoeller, Professor Phil Quirke (University of Leeds) and Oxford Nanoimaging (ONI) on an NIHR i4i funded research study. The study is evaluating a super-resolution imaging technology for the diagnosis of kidney disease. This may ultimately provide a better understanding of the pathophysiology of rare kidney disease and shine a light on potential targets for the development of new treatments.
During the pandemic it has been a humbling experience to see how the whole of the UK nephrology community has pulled together to support the care of patients with kidney disease. It is hoped that as a result of the pandemic there will be increased awareness of kidney disease and renewed stimulus to support much needed research to improve the prevention and treatment for patients.
References
1. Ya-Fei Liu et al. The chronic kidney disease and acute kidney injury involvement in COVID-19 pandemic: A systematic review and meta- analysis. PLOS One 2021;16(1)
2. Kant et al. The COVID-19 nephrology compendium: AKI, CKD, ESKD and transplantation. BMC Nephrol 2020;21:449
