Glomerular Diseases and Immunosuppression Practices in Latin America During the COVID-19 Pandemic: Analysis from GlomCon Latin America Working Group (LGlomCon)
Bibliographic record
Abstract
Background: As COVID-19 spreads across the world, nephrologists are facing difficult decisions regarding the management of active glomerular diseases (GD). We aimed to report how COVID-19 pandemic may have changed the use of immunotherapies among nephrologists In Latin America (LA) for the treatment of glomerulopathies. Methods: Descriptive analysis extracted from an online survey carried out among nephrologists, renal pathologists and other health workers treating kidney diseases between May 20-27, 2020 from sixteen Spanish speaking LA countries divided into 6 categories. We present the results for the GD and immunosuppression category. Results: 430 responses were obtained of which 360 (84%) were considered for analysis. The participants were mainly nephrologists 276 (86%), renal pathologists 13 (4%) and physicians in training 11 (3%). 213 (59%) of the respondents treat patients with GD. For patients at risk but without COVID-19 infection, the induction immunosuppression for GD treatment was not changed by 54.1% of the respondents while 24.2% gave only a fraction of it and 21.7% deferred the induction treatment. For maintenance immunosuppression, the same regimen was maintained by 74.2% of the respondents, 24.3% decreased it and 1.5% suspended it completely. In case of relapse or flare, 53.6% used standard increase of immunosuppression, 39.7% increased it but at lower levels than usual and 6.7% continued the maintenance regimen. For patients already on immunosuppression diagnosed with COVID-19 infection, 42% would decrease immunosuppressive regimens for mild disease, 62.3% in case of moderate disease and 70.8% would consider completely discontinuing immunosuppression in case of severe disease. Conclusions: Over 40% of the respondents in LA are already prescribing lower than recommended doses of immunosuppression for induction, relapses or flares as a preventive strategy in the context of COVID-19 pandemic. How this change in practice would affect the renal outcomes remains to be seen. The experience in the treatment of GD in patients with concurrent COVID-19 infection remains limited.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".