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Study of COVID-19 Pandemic in Representative Dialysis Population Across Mumbai, India: An Observational Multicentric
Rushi Deshpande1, Sudhiranjan Dash2, M M Bahadur3
1Department of Nephrology at Jaslok Hospital and Research Center, Mumbai, Maharashtra; Reliance HN Hospital, Mumbai, Maharastra.
Insights
The COVID-19 pandemic significantly impacted hemodialysis patients, with a 6.4% prevalence and 12% mortality. Elderly patients with comorbidities faced poorer prognoses, highlighting the need for enhanced safety measures in dialysis units.
Area of Science:
- Infectious Diseases
- Nephrology
- Public Health
Background:
- The COVID-19 pandemic poses significant risks, particularly to vulnerable populations like the elderly and those with comorbidities.
- Hemodialysis patients are at increased risk of COVID-19 infection due to patient, environmental, and procedural factors.
- Limited data exists on COVID-19 prevalence and outcomes specifically within the hemodialysis population.
Purpose of the Study:
- To determine the prevalence and characteristics of COVID-19 infection in hemodialysis patients in Mumbai.
- To identify risk factors associated with poor outcomes in this population.
- To assess the impact of COVID-19 on healthcare workers in dialysis units.
Main Methods:
- A cross-sectional study was conducted across multiple hemodialysis centers in Mumbai.
- Data collected included patient demographics, comorbidities, COVID-19 status, and outcomes.
- Healthcare worker infections and the efficacy of hydroxychloroquine chemoprophylaxis were also evaluated.
Main Results:
- COVID-19 prevalence was 6.4% among hemodialysis patients, with a 12% mortality rate.
- Elderly patients and those with comorbidities had a poorer prognosis.
- Patients with COPD, requiring ICU care, or ventilation had worse outcomes, while cardiovascular disease did not predict poor outcomes.
- 1.5% of non-COVID hemodialysis patients died due to lack of dialysis access.
- 4.1% of healthcare workers contracted COVID-19, with all recovering; hydroxychloroquine chemoprophylaxis showed no statistically significant benefit.
Conclusions:
- Hemodialysis patients, especially the elderly with comorbidities, are at high risk for severe COVID-19 outcomes.
- Lack of dialysis access is a critical issue contributing to mortality.
- Enhanced infection control measures, treating all patients as potential COVID-19 suspects, are crucial in resource-limited dialysis settings.
- Further research is needed to optimize care for this vulnerable group.
Abstract:
COVID-19 has emerged as a pandemic of significance with potential to cause significant morbidity and mortality worldwide. Elderly with or without following comorbidities i.e Diabetes, hypertension, cardiac disease, chronic respiratory illnesses, chronic liver disease, CKD, malignancy and immunocompromised hosts are at increased risk of developing complicated course. Hemodialysis population hence are at increased risk for contracting the infection due to patient characteristics, environmental characteristics and procedural lapses. The current study was aimed at describing prevalence and characteristics of COVID19 in hemodialysis population across different HD centers across Mumbai. We found a prevalence rate of COVID19 in 6.4%, with 9 patients (12%) died during the study period. A fair proportion of Non covid HD patients (1.5%) also died due to lack of access to dialysis. At baseline, mean age of presentation was 54.5 years. On routine test 80% were asymptomatic at presentation. Patients with COPD, requiring ICU care and those on ventilation faired poorly. Contrary to assumption patients with underlying cardiovascular disease didn't show poor outcome. Total of 4.1% health care workers turned positive during the study period with mean age of 31 years and median of 28years. Out of them 5 (45.4%) were symptomatic. All recovered from the illness without any sequelae. Seventy two percent of healthcare workers were on Hydroxy-chloroquine chemoprophylaxis didn't reach statistical significance in preventing the infection. In our study elderly age with comorbidities had poor prognosis. We proposed extra healthcare measures to be taken in the dialysis unit presuming all as COVID suspect in the resource limited settings.
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