Patient receives dialysis at Mount Sinai Hospital in New York City.
Mount Sinai
Sonia Toure remembers the exact moment when her life changed forever. She was on a Zoom call in mid-March with her work colleagues when she coughed. It was a deep, strange-sounding cough that startled everyone. Later that night she got a 103-degree fever and pain shot all over her body.
"These were not body aches," she recalls. "My body hurt so bad it felt like I was beaten by a group of people. I could barely walk to the bathroom or catch my breath."
Toure, a 54-year-old project coordinator for the CUNY Research Foundation in New York, was sick 12 days before she went to the hospital. By then she lost her sense of taste and smell, and nausea and vomiting had kicked in. She had called the city's 311 emergency phone number for advice, but they told her to stay home and ride it out. On the twelfth day, she was feeling extremely ill, so she called an Uber to drive her to Mount Sinai Hospital. She was admitted with pneumonia, acute kidney injury and for two weeks drifted in and out of reality.
"Luckily, I didn't need a ventilator," Toure recalls, "but in three days I needed emergency kidney dialysis. My creatinine levels went to a high of 14 within a week until my kidneys ultimately failed."
Formerly a strong and healthy woman with no underlying health conditions, Toure has beaten Covid-19 after a four-week hospital stint, but the disease has ravaged her kidneys and long-term health prospects. She lives with severe edema and now takes trips to the dialysis center three to four times a week. In the months ahead, she is planning a living donor kidney transplant. Her 21-year-old son plans to donate his kidney to keep her alive.
Toure's tale demonstrates a harsh reality. Severe coronavirus patients are often as much in need of dialysis machines as they are ventilators. Many of the ones who recover from Covid-19 have some form of residual kidney damage that can last for months, years or even permanently.
A study from Mount Sinai Hospital System in New York is a microcosm of the trend. Forty-six percent of patients that were admitted to the hospital with Covid-19 since the beginning of the pandemic had some form of acute kidney injury; of those, 17% required urgent dialysis.
Surprisingly, 82% of patients that got an acute kidney injury had no history of kidney issues; 18% did. More than a third of patients that survived did not recover the same kidney function they had before contracting the virus.
The study, conducted Feb. 24–May 30, tracked a population of nearly 4,000 patients with a median age of 64. Mount Sinai used an AI tool it co-developed in collaboration with RenalytixAI, called KidneyIntelX, that rates a person's chances of getting kidney disease.
Unfortunately, this is a phenomenon being seen throughout the U.S. and around the world, says Dr. Alan Kliger, co-chair of the American Society of Nephrology Covid-19 Response Team. Since late February he has been working with the CDC to share trends on how the virus is affecting the kidneys in patients at hospitals across the country. "What we have observed is that approximately 10% to 50% of patients with severe Covid-19 that go into intensive care have kidney failure that requires some form of dialysis."
There are several ways this viral disease can make kidneys fail, Dr. Kliger notes. Some evidence shows immune systems go into overdrive and produce inflammatory cytokines, known as cytokine storms, which can hurt the kidneys as well as other organs. In other cases, biopsies have shown that the virus directly attacks the kidney by entering through ACE-2 receptors the coronavirus can hook to and then infect cells. In other cases, patients become so seriously ill from Covid-19 it can trigger sepsis, which can lead to multiple organ failure. Finally, there is also evidence that ventilators can reduce blood flow through the kidney in patients with severe lung disease due to Covid-19 and that in turn can hurt the organ.
Another epidemic in the making
This is yet another public health crisis that will sweep the nation, experts predict. Pre-pandemic, the U.S. was spending about $100 billion annually to treat the nearly 40 million Americans suffering from chronic kidney disease who need dialysis and organ transplants. It was the ninth-leading cause of death in the nation due to the rise of rise in obesity and Type 2 diabetes, according to the Centers for Disease Control and Prevention. In response, President Donald Trump launched the Advancing America Kidney Health Initiative last year.
Now kidney disease is surging, exacerbated by the surge in Covid-19 cases throughout the country.
"The next epidemic will be chronic kidney disease in the U.S. among those who recovered from the coronavirus," says Dr. Steven Coca, associate professor of nephrology at Mount Sinai Health System and co-founder of RenalytixAI. "Since the start of the coronavirus pandemic we have seen the highest rate of kidney failure in our lifetimes. It's a long-term health burden for patients, the medical community -- and the U.S. economy."
The next epidemic will be chronic kidney disease in the U.S. among those who recovered from the coronavirus.
Dr. Steven Coca
associate professor of nephrology at Mount Sinai Health System and co-founder of RenalytixAI
In response, medical experts are using AI technology to identify biomarkers in Covid patients — including multiple plasma biomarkers and urine proteomics and RNA sequences — with the highest risk of kidney injury. "This will help us do some predictive analysis. We are hoping RNA sequencing may give us some clues," Dr. Coca says.
Using KidneyIntelX — a diagnostic that has received a FDA breakthrough device designation, uses machine learning algorithms to assess the combination of blood-based biomarkers, electronic health records information and other genomic information to identify progressive kidney disease in patients — Mount Sinai Health System is conducting a multicenter study with other leading medical centers in the U.S. to assess kidney complications in recovered Covid-19 patients. The goal is to get a wider view of the trend.
Kidney transplant surgery.
BSIP | Universal Images Group | Getty Images
Investigative teams expected to participate in the study include experts from Mount Sinai, Yale, University of Michigan, Johns Hopkins and Rutgers.
Initial research findings are expected to be reported in late 2020.
In addition, Mount Sinai Health System's high-performance serologic SARS-CoV-2 testing will be used to quantitatively assess a patient's antibody levels to COVID-19 over time, providing valuable insights into the interaction between immune response and kidney-related complications in this patient population.
"The goal is to assess the risk of kidney disease and kidney failure," says Tom McLain, president and chief tk officer of RenalytixAI.
Thankfully, not all severe Covid-19 patients get permanent kidney damage. Steve Lazos, is a case in point. He had a serious case of the coronavirus in mid-March and was hospitalized at Northshore Hospital with pneumonia at the height of the crisis in New York City. "My kidneys took a hit," he recalls " but luckily they rebounded and got back to normal. It was a slow recovery."
Studying this health issue is critical now. According to Neville Sanjana, PhD., a biology professor at NYU and scientist at the NYU Langone's Genome Center who is working on Covid-19 research using the Crispr gene editing tool. What he has found at his lab is that the coronavirus virus has mutated and it is now more infectious than the original strain and it can affect all types of human cells and human organs.
People that already have kidney problems including those on dialysis are among the most vulnerable now during this pandemic. According to Dr.Kliger, "this is a group more likely to get the virus, have complications or die. As government officials discuss how to deploy testing nationwide this population must be a priority."
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