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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">COVID-19&#47;SARS-CoV-2 infection is a serious health problem with an unprecedented social and political response&#46; The clinical expression of this new disease has been defined in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; few articles have been published on this infection in patients with chronic kidney disease with or without renal replacement therapy &#40;RRT&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A group from China published an interesting report of their experience at a haemodialysis centre&#46; None of their 37 positive cases with a mean age of 66 years &#40;55-81&#41; had serious pneumonia&#46; The six deaths from COVID-19 were attributed to other causes &#40;cardiovascular and hyperkalaemia&#41;&#44; with a death&#47;infection rate of 16&#37;&#46; The authors considered this outcome less aggressive than expected in these frail patients&#44; and it was attributed to their abnormal cellular immunity and inability to develop a &#8220;cytokine storm&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The Sociedad Espa&#241;ola de Nefrolog&#237;a &#40;S&#46;E&#46;N&#46;&#41; &#91;Spanish Society of Nephrology&#93; has created a registry of COVID-19 cases&#46; In the report of April 11&#44; included 868 patients&#44; mean age 67 years &#177;15&#44; on RRT&#46; A 72&#37; developed pneumonia and approximately 5&#37; required mechanical ventilation &#40;10&#37; were admitted ti intensive care unit &#40;ICU&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This represented a death&#47;infection rate of 22&#46;7&#37; &#40;69&#46;5&#37; haemodialysis&#44; 3&#46;5&#37; peritoneal dialysis and 26&#46;8&#37; kidney transplanted patients&#41; &#8212; i&#46;e&#46; 7&#37; higher than reported by the group from China&#44; possibly differences in epidemiology and comorbidity &#8211; were not reported&#44; plus they presented a larger number of cases&#46; Comparison of this death&#47;infection rate with the Spanish Ministry of Health data&#44; which includes all cases in Spain&#44; reveals that this rate is approximately 12&#37; higher in patients on RRT&#46; These data are dynamic and of debatable reliability since it is process subject to constant change&#44; however the definitive numbers might be close to the data presented&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Patients with kidney diseases have an abnormal immune response&#46; The main factors involved are the toxicity of uraemia&#44; abnormal kidney metabolism of immune system molecules and the effects of RRT &#40;materials used in dialysis&#44; fluids&#44; immunosuppressant drugs&#44; etc&#46;&#41;&#46; Various forms of dysfunction have been reported in uraemic patients&#58; monocyte senescence&#44; B and T cell lymphopenia&#44; deficient activation of lymphocytes secondary to increased apoptosis&#44; reduced co-stimulation signal on the part of antigen-presenting cells&#44; epigenetic changes in white blood cells and haematopoietic stem cells&#44; and an accumulation of inflammatory cytokines &#40;IL-1&#946;&#44; IL-18&#44; IL-6&#44; IL-8 and TNF&#945;&#41;&#46; These&#44; along with an increase in oxidative stress&#44; are the cause of a situation of chronic inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">An article by Ma et al&#46; found that the count of T cell&#44; T helper &#40;Th&#41; cells&#44; cytotoxic killer T cells&#44; natural killer &#40;NK&#41; cells and B lymphocytes were lower in haemodialysis patients with COVID-19 than in patients with COVID-19 without chronic kidney disease&#44; and healthy controls&#46; In addition&#44; IL-4&#44; IL-6 and TNF&#945; levels were lower in patients with COVID-19 on haemodialysis than in all other comparator groups&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Moreover&#44; prior studies with related viruses &#40;SARS and MERS&#41; in the general population have found that the serious cases presented very high cytokine levels&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> a pathophysiological condition known as a &#8220;cytokine storm&#8221;&#46; This excessive response results in suppression of immunological activity&#44; cardiovascular instability&#44; metabolic acidosis and massive cell damage&#44; which is characteristic of many septic states and it is independent of the aetiology&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Some drugs &#40;IL-7&#44; steroids&#44; anakinra and others&#41; have been used to mitigate this exaggerated immune response&#59; and&#44; in kidney patients we have extracorporeal blood &#40;EBPTs&#41; to combat sepsis&#44; especially with the use high-adsorption membranes such as CytoSorb&#174;&#44; AN69 or oXiris&#174;&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">While the quantity and quality of scientific evidence for making recommendations on the use of EBPTs in sepsis is insuffcient and non uniform&#44; it is important to stress that most studies have been conducted in patients with bacterial sepsis&#46; In cases of serious viral infection&#44; such as influenza A infection&#44; it has been found to be beneficial&#46; It has been found to have the potential to remove Ebola virus with a system of lectin affinity plasmapheresis&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">As COVID-19 research continues&#44; from a clinical perspective efforts must continue to be made to join forces to acquire knowledge and gain experience at a faster-than-usual pace&#46; One contribution that nephrologists might make would be to promote and assist with early use of l continuous extracorporeal purification techniques in seriously ill patients in the general population&#44; as well as in nephrology patients&#46; Nephrologists might also share their knowledge and experience in managing the hypercoagulability of COVID-19 patients that could interfere with blood purification techniques&#46; Finally&#44; the information obtained at the different centres that have tested these techniques and other treatments should be orchestrated and shared swiftly by international scientific associations&#46;</p></span>"
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Letter to the Editor
Is the immune hyporesponsiveness of uraemic patients a protective factor for severe COVID-19 pneumonia?
¿Es la hiporrespuesta inmune de la uremia un factor de protección contra la neumonía grave por COVID-19?
Enrique A. Florit
Corresponding author
kiqueflorit@gmail.com

Corresponding author.
, Fritz Diekmann
Instituto de Nefrología y Urología (ICNU), Hospital Clinic, Barcelona, Spain
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    "titulo" => "Is the immune hyporesponsiveness of uraemic patients a protective factor for severe COVID-19 pneumonia&#63;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">COVID-19&#47;SARS-CoV-2 infection is a serious health problem with an unprecedented social and political response&#46; The clinical expression of this new disease has been defined in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; few articles have been published on this infection in patients with chronic kidney disease with or without renal replacement therapy &#40;RRT&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A group from China published an interesting report of their experience at a haemodialysis centre&#46; None of their 37 positive cases with a mean age of 66 years &#40;55-81&#41; had serious pneumonia&#46; The six deaths from COVID-19 were attributed to other causes &#40;cardiovascular and hyperkalaemia&#41;&#44; with a death&#47;infection rate of 16&#37;&#46; The authors considered this outcome less aggressive than expected in these frail patients&#44; and it was attributed to their abnormal cellular immunity and inability to develop a &#8220;cytokine storm&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The Sociedad Espa&#241;ola de Nefrolog&#237;a &#40;S&#46;E&#46;N&#46;&#41; &#91;Spanish Society of Nephrology&#93; has created a registry of COVID-19 cases&#46; In the report of April 11&#44; included 868 patients&#44; mean age 67 years &#177;15&#44; on RRT&#46; A 72&#37; developed pneumonia and approximately 5&#37; required mechanical ventilation &#40;10&#37; were admitted ti intensive care unit &#40;ICU&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This represented a death&#47;infection rate of 22&#46;7&#37; &#40;69&#46;5&#37; haemodialysis&#44; 3&#46;5&#37; peritoneal dialysis and 26&#46;8&#37; kidney transplanted patients&#41; &#8212; i&#46;e&#46; 7&#37; higher than reported by the group from China&#44; possibly differences in epidemiology and comorbidity &#8211; were not reported&#44; plus they presented a larger number of cases&#46; Comparison of this death&#47;infection rate with the Spanish Ministry of Health data&#44; which includes all cases in Spain&#44; reveals that this rate is approximately 12&#37; higher in patients on RRT&#46; These data are dynamic and of debatable reliability since it is process subject to constant change&#44; however the definitive numbers might be close to the data presented&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Patients with kidney diseases have an abnormal immune response&#46; The main factors involved are the toxicity of uraemia&#44; abnormal kidney metabolism of immune system molecules and the effects of RRT &#40;materials used in dialysis&#44; fluids&#44; immunosuppressant drugs&#44; etc&#46;&#41;&#46; Various forms of dysfunction have been reported in uraemic patients&#58; monocyte senescence&#44; B and T cell lymphopenia&#44; deficient activation of lymphocytes secondary to increased apoptosis&#44; reduced co-stimulation signal on the part of antigen-presenting cells&#44; epigenetic changes in white blood cells and haematopoietic stem cells&#44; and an accumulation of inflammatory cytokines &#40;IL-1&#946;&#44; IL-18&#44; IL-6&#44; IL-8 and TNF&#945;&#41;&#46; These&#44; along with an increase in oxidative stress&#44; are the cause of a situation of chronic inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">An article by Ma et al&#46; found that the count of T cell&#44; T helper &#40;Th&#41; cells&#44; cytotoxic killer T cells&#44; natural killer &#40;NK&#41; cells and B lymphocytes were lower in haemodialysis patients with COVID-19 than in patients with COVID-19 without chronic kidney disease&#44; and healthy controls&#46; In addition&#44; IL-4&#44; IL-6 and TNF&#945; levels were lower in patients with COVID-19 on haemodialysis than in all other comparator groups&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Moreover&#44; prior studies with related viruses &#40;SARS and MERS&#41; in the general population have found that the serious cases presented very high cytokine levels&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> a pathophysiological condition known as a &#8220;cytokine storm&#8221;&#46; This excessive response results in suppression of immunological activity&#44; cardiovascular instability&#44; metabolic acidosis and massive cell damage&#44; which is characteristic of many septic states and it is independent of the aetiology&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Some drugs &#40;IL-7&#44; steroids&#44; anakinra and others&#41; have been used to mitigate this exaggerated immune response&#59; and&#44; in kidney patients we have extracorporeal blood &#40;EBPTs&#41; to combat sepsis&#44; especially with the use high-adsorption membranes such as CytoSorb&#174;&#44; AN69 or oXiris&#174;&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">While the quantity and quality of scientific evidence for making recommendations on the use of EBPTs in sepsis is insuffcient and non uniform&#44; it is important to stress that most studies have been conducted in patients with bacterial sepsis&#46; In cases of serious viral infection&#44; such as influenza A infection&#44; it has been found to be beneficial&#46; It has been found to have the potential to remove Ebola virus with a system of lectin affinity plasmapheresis&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">As COVID-19 research continues&#44; from a clinical perspective efforts must continue to be made to join forces to acquire knowledge and gain experience at a faster-than-usual pace&#46; One contribution that nephrologists might make would be to promote and assist with early use of l continuous extracorporeal purification techniques in seriously ill patients in the general population&#44; as well as in nephrology patients&#46; Nephrologists might also share their knowledge and experience in managing the hypercoagulability of COVID-19 patients that could interfere with blood purification techniques&#46; Finally&#44; the information obtained at the different centres that have tested these techniques and other treatments should be orchestrated and shared swiftly by international scientific associations&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Florit EA&#44; Diekmann F&#46; &#191;Es la hiporrespuesta inmune de la uremia un factor de protecci&#243;n contra la neumon&#237;a grave por COVID-19&#63;&#46; Nefrologia&#46; 2021&#59;41&#58;223&#8211;224&#46;</p>"
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Article information
ISSN: 20132514
Original language: English
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