Marimar Contreras Nieves

All Publications

• Noninvasive Diagnosis of Acute Tubulointerstitial Nephritis in Clinical Practice. Journal of the American Society of Nephrology : JASN Contreras Nieves, M., Anand, S. 2025

  View details for DOI 10.1681/ASN.0000000694

  View details for PubMedID 40202800

• Safety and Effectiveness of Nirmatrelvir-Ritonavir in Patients With Advanced Kidney Dysfunction and COVID-19. American journal of kidney diseases : the official journal of the National Kidney Foundation Contreras Nieves, M., Anand, S., Thomas, I. C., Geldsetzer, P., Fung, E., Tamura, M. K., Montez-Rath, M. E. 2025

  Abstract

  Nirmatrelvir-ritonavir prevents COVID-19 hospitalization among high-risk adults, but safety concerns limit its use in advanced kidney dysfunction. This study examined safety and effectiveness outcomes from its off-label use in patients with advanced kidney dysfunction.Retrospective matched cohort study.Patients with estimated glomerular filtration rate (eGFR) 15-30 mL/min/1.73m2 and COVID-19 between January 2022 and January 2023 cared for in Veterans Health Administration facilities.Treatment with nirmatrelvir-ritonavir, no treatment with nirmatrelvir-ritonavir or molnupiravir, or treatment with molnupiravir.Incidence of cardiac events, stroke, acute kidney injury, liver injury, hypertension, and infection-related death, respiratory failure, pneumonia, severe infection, and hospitalization within 30-60 days of diagnosis with COVID-19.Logistic regression for propensity matching, standardized mean differences for assessment of covariate balance, and conditional logistic regression for estimation of relative risk ratios comparing exposures for each outcome.Among 4,020 patients with eGFR 15-30 mL/min/1.73m2 and COVID-19, 117 (2.9%) were treated with nirmatrelvir-ritonavir (mean age 75.6 [SD 12.2] years and eGFR 24.9 [SD 4.0] mL/min/1.73m2). Compared with no treatment with either nirmatrelvir-ritonavir or molnupiravir, treatment with nirmatrelvir-ritonavir was not detectably associated with different risks of cardiovascular events (e.g., heart failure (RR 1.0 [95% CI, 0.7-1.2]), liver injury (RR 1.2 [95% CI, 0.7-1.7]), or acute kidney injury (RR 1.0 [95% CI, 0.8-1.2]), but was associated with a lower risk of acute respiratory failure (RR 0.5 [95% CI, 0.2-0.7]) and pneumonia (RR 0.6 [95% CI, 0.3-0.8]). Compared with treatment with molnupiravir, treatment with nirmatrelvir-ritonavir was not detectably associated with different risks of cardiovascular events, acute respiratory failure, or pneumonia, but was associated with a higher risk of acute kidney injury. Sensitivity analyses among patients with eGFR 15-35 ml/min/1.73m2 yielded similar findings.Retrospective analysis, predominantly men in the study cohort.Nirmatrelvir-ritonavir use in the setting of advanced kidney dysfunction was associated with a reduced risk of acute respiratory failure and pneumonia, and no detectable differences in non-respiratory adverse outcomes compared with no treatment with either nirmatrelvir-ritonavir or molnupiravir.

  View details for DOI 10.1053/j.ajkd.2025.02.603

  View details for PubMedID 40204015

• Kidney disease hotspots and water balance in a warming world. Current opinion in nephrology and hypertension Contreras Nieves, M., Powers, A., Anand, S., Vlahos, P. 2023

  Abstract

  PURPOSE OF REVIEW: Geographically localized areas with a high prevalence of kidney disease exist currently in several regions of the world. Although the exact cause is unclear, environmental exposures accelerated by climate change, particularly heat exposure and ground water contamination, are hypothesized as putative risk factors. Aiming to inform investigations of water-related exposures as risk factors for kidney disease, we excavate the history of major water sources in three regions that are described as hotspots of kidney disease: the low-lying coastal regions in El Salvador and Nicaragua, the dry central region in Sri Lanka, and the Central Valley of California.RECENT FINDINGS: Historic data indicate that these regions have experienced water scarcity to which several human-engineered solutions were applied; these solutions could be hypothesized to increase residents' exposure to putative kidney toxins including arsenic, fluoride, pesticides, and cyanobacteria. Combined with heat stress experienced in context of climate change, there is potential for multistressor effects on kidney function. Climate change will also amplify water scarcity, and even if regional water sources are not a direct risk factor for development of kidney disease, their scarcity will complicate the treatment of the relatively larger numbers of persons with kidney disease living in these hotspots.SUMMARY: Nephrologists and kidney disease researchers need to engage in systematic considerations of environmental exposures as potential risk factors for kidney disease, including water sources, their increasing scarcity, and threats to their quality due to changing climate.

  View details for DOI 10.1097/MNH.0000000000000938

  View details for PubMedID 37889529