ASPN has been actively monitoring the developments related to COVID-19 and the emerging outbreaks within the United States and elsewhere.  We are committed to the health and wellbeing of our membership and the patients and families you serve.

The PAS 2020 meeting has been cancelled due to the coronavirus pandemic.  The PAS program office should communicate directly with you about hotel reservations (which should be automatically canceled if you made a reservation through the PAS website) and refunding your conference fee if you have already registered for the meeting.

Members of our Clinical Affairs Committee have put together pertinent guidance below, on caring for renal patients.   This will be placed and updated on the ASPN Website.

General COVID-19 updates

Information for Dialysis Centers

Link to ASN dialysis webinar from 4/2/20 (PDF of slide sis also available on this site)


The Children's Hospital Association Hosted a Webinar Presented by the CDC on Preparing Dialysis Units for Covid-19

CDC Dialysis Recommendations: Interim additional guidance for infection prevention and control recommendations for patients with suspected or confirmed COVID-19 in outpatient hemodialysis facilities: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/dialysis.html


American Society of Nephrology- COVID-19 Information for Providers of Dialysis Service- webinar:

Slides: https://www.asn-online.org/g/blast/files/ASN_COVID-19_webinar_combined_slides_03.11.2020_Final.pdf

Webinar: https://www.asn-online.org/ntds/



Webinar Recording Available: COVID-19 Informational Webinar for Providers of Dialysis Services

On March 11, 2020, ASN conducted an informational webinar focusing on new COVID-19 guidance for dialysis facilities from CDC and a presentation on managing patients with COVID-19 who require dialysis. This 60-minute webinar explored the possible implications for patients receiving renal replacement therapy and the staff who care for them. The webinar featured presentations from Shannon Novosad, MD, of CDC, and Suzanne Watnick, MD, FASN, and Liz McNamara, MN, RN, of Northwest Kidney Centers.

The webinar recording and slides have been posted on the NTDS website, which also has links to all updated materials from CDC.


ASN COVID-19 AKI Webinar (featuring Dr. Goldstein)

Slides

Full webinar available at: https://www.asn-online.org/covid-19/

Kidney Transplant Information

From American Society for Transplantation for transplant recipients: Coronavirus disease 2019: frequently asked questions.

American Society of Transplantation: COVID-19: FAQs for Organ Transplantation (geared more towards transplant providers): https://www.myast.org/sites/default/files/COVID19%20FAQ%20Tx%20Centers%20030220-1.pdf

US Department of Health and Human Services: Information for transplant programs and OPOs regarding 2019 novel Coronavirus: https://optn.transplant.hrsa.gov/news/information-for-transplant-programs-and-opos-regarding-2019-novel-coronavirus/

Association of organ procurement organizations: COVID-19 bulletin (information regarding organ procurement) https://www.aopo.org/information-about-covid-19-coronavirus-is-being-released-rapidly-we-will-post-updates-as-we-receive-them/

Please see the UNOS website for updates regarding making patients temporarily inactive due to COVID-19, and temporarily inactivating your program’s waiting less if you will be unable to provide transplant services in the coming weeks or months

UNOS Webinar: Organ Donation and Transplant Town Hall

UNOS website: rCOVID-19 Transplant Refusal Codes

American Society of Transplant Surgeons COVID-19 Strike Force (recommendations surrounding prioritizing transplants)

UCSF: COVID-10 Frequently Asked Questions for Pediatric Immunocompromised Host Clinicians

The Transplantation Society COVID-19 Dashboard

The Transplantation Society Global Transplantation Covid Report March 2020

NephJC Covid-19 Transplant Info

The Transplantation Society’s Transplant Infectious Disease Update on COVID-19

American Society of Transplantation COVID-19 FAQs

UNOS: COVID-19 Weekly Organ Recovery and Usage MAP (RUM)

UNOS: Covid-19 News and Resources for Transplant Patients

AST Recommendations and Guidance for Organ Donor Testing

Research and Commentary Articles

The Novel Coronavirus 2019 Epidemic and Kidneys (Naicker et al, Kidney International)

Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China (Dong at al, Pediatrics)

Covid-19 in children: initial characterization of the pediatric disease

Successful recovery of covid-19 pneumonia in a renal transplant recipient with long-term immunosuppression (only 1 adult patient, but there is very limited data on this topic)

COVID-19: A Global Transplant Perspective on Successfully Navigating a Pandemic

Epidemiology and Clinical Features of Coronavirus 2019 in Children, Choi et al, Clinical and Experimental Pediatrics

Kidney Disease in the Time of COVID-19: Major challenges to Patient Care, Rabb, The Journal of Clinical Investigation

Detection of Covid-19 in Children in Early January 2020 in Wuhan, China, Liu et al. NEJM

Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19, Vaduganathan et al, NEJM

Coronavirus Disease 2019 (COVID-19) Infection and Renin Angiotensin System Blockers, Bavishi C et al, JAMA Cardiology

Hydroxychloroquine and Azithromycin as a Treatment of COVID-19: Results of an Open-Label Non-Randomized Clinical Trial,  Gautret P et al. International Journal of Antimicrobial Agents

Early Description of Coronavirus 2019 Disease in Kidney Transplant Recipients in New York, JASN

Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19), A review, Sanders et al, JAMA

Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized with COVID-19 in the New York City Area.  Richardson et al.  JAMA

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systemic Review.  Castagnoli et al, JAMA Pediatrics

Multicenter Initial Guidance on Use of Antivirals for Children with COVID-19/SARS-CoV-2 

How COVID-19 has Changed the Management of Glomerular Diseases.  Bomback et al, CJASN

Guidance: Paediatric Multisystem Inflammatory Syndrome Temporally Associated with COVID-19- Royal College of Paediatrics and Child Health

Children with Covid-19 in Pediatric Emergency Departments in Italy- Parri et al, NEJM

Outpatient Management of the Kidney Transplant Recipient During the SARS-CoV-2 Virus Pandemic

CDC MMWR: Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration- United States, 2020

ACE2, COVID-19, and ACE Inhibitor and ARB Use during the Pandemic: The Pediatric Perspective.  Hypertension, South, Brady, and Flynn

Characteristics and Outcomes of Children with COVID-19 Infection Admitted to US and Canadian PICUs, Shekerdemian et al, JAMA Pediatrics

Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia.  Pei at al, JASN

Asymptomatic Seroconversion of Immunoglobulins to SARS-CoV-2 in a Pediatric Dialysis Unit.  Haines et al.  JAMA.

The Severity of COVID-19 in Children on Immunosuppressive Medication, Marlais et al, The Lancet

Organ Procurement and Transplantation During the COVID-19 Pandemic, Loupy et al, The Lancet

Acute Kidney Injury in Patients Hospitalized with COVID-19. Jirsch et al, Kidney International

Collections of Articles

Research Projects that are Enrolling COVID-19 Positive Pediatric Nephrology Patients

Research project through ERKNet on behalf of Dr. Kjell Tullus and Dr. Marina Vivarelli

We have launched a global study where we invite all paediatric nephrologist in the world to include data from anonymized children with COVID-19.

The survey can be accessed here.


From Dr. McBryde at the NIH:

This is another de-idenitfied registry of children with COVID-19:

‘The website for the registry is: https://www.pedscovid19registry.com/. The site contains information on the provision of de-identified data, IRB oversight, and case report forms for data submission. There are, I believe, information related to authorship guidelines, as well.

While the data is heavily focused on pediatric malignancies, the data collection form does include children who are immunosuppressed and have a number of organ system diseases, including renal disorders. Hopefully, this registry will be a good first step to describing COVID-19 in pediatric patients, and provide some hypothesis generation for future investigations into specific disorders and medication exposures.

Telemedicine/Billing/Coding

General Workforce Issues

AMA: Article on Caring for our Caregivers during COVID

AAP CME Offer: In the midst of the COVID-19 crisis, the AAP is expanding its online education to all members. Pedialink, the AAP's online education portal, is offering all courses free of charge to all levels of membership for the time being. Login at Pedialink. On the Continuing Education tab, go to CME Finder and choose online courses. Any member can choose a course from this list where they can register through ShopAAP at no charge.

American Board of Pedaitrics: Information Regarding Board Certification, MOC Requirements, and MOCA-Peds during the COVID-19 Pandemic

Wellness Resources

Hypertension

Recommendations for home BP monitoring (with many thanks to Dr. Tammy Brady):

Each of the following 3 home devices has strengths and weaknesses, but all were tested in children and passed the testing.  Information about the validation testing is below

Welch Allyn ProBP2000: tested in 35 children as part of a larger study, used K4 as diastolic

Omron: tested in almost 200 children, but the participants were normotensive and the validation protocol used was less stringent

A&D: tested in 85 children with a reasonable protocol, grade B for SBP, grade A for DBP

https://www.stridebp.org/bp-monitors

This video describes preparing an individual for blood pressure measurement:

https://www.youtube.com/watch?v=T9J3RE4Eins&feature=youtu.be

Renin-angiotensin system blockers and the COVID-19 pandemic (Hypertension)

Patient Information/Wellness

Clinical Affairs & Practice Management Committee: Position Statement on COVID-19 and ACE Inhibitor and Angiotensin Receptor Blocker Use in Children with Hypertension and Kidney Disease

March 16th, 2020

The purpose of this statement is to clarify what is known about the potential risks, if any, to pediatric nephrology patients from treatment with ACE inhibitors or angiotensin receptor blockers (ARBs). As with the original SARS-CoV, the ACE2 enzyme has been confirmed as the SARS-CoV-2 binding site in the lungs1. ACE2 is an important part of the renin-angiotensin-aldosterone system2,3, thus there has been recent speculation that patients who take ACE inhibitors and ARBs may be at increased risk of the infection and COVID-19. However, this is solely based on experimental studies in animals showing increased ACE2 expression in several organs, and there is additional experimental evidence based upon SARS-CoV and other models of acute lung injury that these medications may actually lessen severity of COVID-194. There is currently no evidence that patients on these medications are at a higher risk of SARS-CoV-2 or COVID-19. Indeed, stopping ACE inhibitors and ARBs without good medical evidence can have significant health consequences for our patients.

Many health care providers, patients, and their families are understandably worried about continuing to use these medications during the pandemic. At this time, in line with the Position Statements from other hypertension, cardiovascular, and kidney organizations and after weighing the risks and benefits, the American Society of Pediatric Nephrology strongly recommends that patients continue to take their ACE inhibitors and ARBs, until new evidence to the contrary becomes available. We further recommend that appropriate medical management continue to be provided to patients on these medications who test positive for SARS-CoV-2 and those who have COVID-19, including discontinuation of ACE inhibitors and ARBs when medically indicated. The American Society of Pediatric Nephrology via the Clinical Affairs & Practice Management Committee will continue to work diligently to monitor this evolving situation and to inform its members, partners, and patients and their families of updated recommendations on this important topic. We fully support the ongoing research efforts into this important question and encourage the inclusion of children in such clinical trials or observational studies.

1Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell 2020; ePub; doi: 10.1016/j.cell.2020.02.052
2Simoes e Silva AC, Flynn JT. The renin-angiotensin-aldosterone system in 2011: role in hypertension and chronic kidney disease. Pediatr Nephrol 2012; 27:1835-1845
3South AM, Shaltout HA, Washburn LK, et al. Fetal programming and the angiotensin-(1-7) axis: a review of the experimental and clinical data. Clinical Science 2019; 133:55-74
4Kuba K, Imai Y, Rao S, et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat Med 2005;11:875-9

Other organizations:
European Society of Cardiology Council on Hypertension
European Society of Hypertension
Hypertension Canada
Canadian Cardiovascular Society and the Canadian Heart Failure Society
The Renal Association, UK
The International Society of Hypertension

Pending statements:
ASN

Renin-angiotensin system blockers and the COVID-19 pandemic (Hypertension)

AHA/ACC position statement

NephJC Website- peer reviewed information regarding ACEi/ARB

Education