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Clinical Course and Outcome of ESRD Patients on Maintenance Hemodialysis Infected with COVID-19: A Single-Center
Samia Kazmi1, Ashar Alam2, Beena Salman2
1Department of Internal Medicine, The Indus Hospital and Health Network, Karachi, Sindh, Pakistan.
Insights
COVID-19 significantly increases mortality in End-Stage Renal Disease (ESRD) patients. Older age and specific lab markers like leukocytosis and lymphopenia are key risk factors for poor outcomes in this vulnerable population.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 infection poses a significant threat to patients with End-Stage Renal Disease (ESRD), leading to increased disease burden and higher mortality rates.
- Understanding the specific risk factors and outcomes for ESRD patients with COVID-19 is crucial for clinical management.
Purpose of the Study:
- To investigate the mortality rate and identify risk factors associated with COVID-19 infection in patients with End-Stage Renal Disease (ESRD).
- To analyze the clinical characteristics and laboratory parameters correlating with adverse outcomes in ESRD patients diagnosed with COVID-19.
Main Methods:
- A retrospective single-center cohort study was conducted involving 43 ESRD patients diagnosed with COVID-19.
- Data on patient demographics, comorbidities, clinical presentation, and laboratory parameters were collected.
- Statistical analyses, including chi-square tests and logistic regression, were used to assess the association of risk factors with mortality.
Main Results:
- The overall mortality rate in the studied ESRD patients with COVID-19 was 25.6%.
- Elderly patients (aged >65) and those with leukocytosis, lymphopenia, hypoalbuminemia, and elevated lactate dehydrogenase (LDH) showed significantly higher mortality.
- Multivariate analysis indicated that advanced age (>65) and high total white blood cell count (TLC) were independent predictors of mortality.
Conclusions:
- The mortality rate for COVID-19 in ESRD patients at this center was 25.6%.
- Older age, leukocytosis, lymphopenia, hypoalbuminemia, and elevated LDH are significant risk factors associated with mortality in this population.
- These findings highlight the vulnerability of ESRD patients to severe COVID-19 outcomes and underscore the importance of monitoring these specific clinical and laboratory markers.
Background:
In an ESRD subset of patients, COVID-19 infection is associated with increased disease burden and higher mortality rates.
Methods:
We conducted a retrospective single-center cohort study in which 43 ESRD patients had a diagnosis of COVID-19. Association of risk factors with mortality was assessed by chi-square test and logistic regression analysis. Data were collected on a structured performa which included variables like age, gender, comorbid conditions, drug history, clinical presentation, hemodynamic status and laboratory parameters. Outcome variables were recovery and death. All patients received standard treatment for COVID-19 according to hospital protocols, along with hemodialysis and continuous renal replacement therapy (CRRT) when needed.
Results:
Those most affected were found to be male, 25 (58.1%), while the number of females affected was 18 (41.9%). The most frequent comorbid condition was hypertension (HTN), seen in 35 (81.4%) patients; however, thromboembolic complications were very few in these patients. The mortality rate in our study was 25.6%, and the population most susceptible to poor outcomes in the ESRD subgroup was elderly people (45.5%), while younger patients recovered the most from COVID-19 (53.1%). Hypoalbuminemia, leukocytosis, lymphopenia and raised LDH were also found to be associated with death in ESRD patients suffering from COVID-19 (81.8, 72.7, 100 and 100%, respectively). In multivariate logistic regression analysis, we found that the odds ratio of dying from COVID-19 was 19.5 times higher in patients aged >65 years as compared to patients aged 18-50 years (p=0.039). Similarly, patients with a high TLC were 24.1 times more likely to die than patients with a normal TLC (p=0.008).
Conclusion:
In our center, the mortality rate of ESRD patients affected with COVID-19 disease was 25.6%, and older age, leukocytosis, lymphopenia, hypoalbuminemia and high LDH were significantly associated with mortality.
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