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COVID-19: Clinical Course and Outcome of hospitalized Hemodialysis Patients: Single-center Experience
Maulin Shah1, Mital Parikh2, Samir Patel3
1Consultant Nephrologist, Associate Professor;Corresponding.
Insights
Coronavirus disease 2019 (COVID-19) in maintenance hemodialysis (MHD) patients shows high mortality, especially with critical illness. Older age, low oxygen, anemia, and mechanical ventilation are poor prognostic factors for COVID-19 in MHD patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Limited data exists on coronavirus disease 2019 (COVID-19) outcomes in maintenance hemodialysis (MHD) patients.
- Understanding clinical manifestations and prognostic factors is crucial for this vulnerable population.
Purpose of the Study:
- To identify clinical characteristics of COVID-19 in MHD patients.
- To determine prognostic factors influencing outcomes.
- To assess the impact of treatment strategies on survival.
Main Methods:
- Retrospective analysis of medical records for MHD patients hospitalized with COVID-19.
- Data collected from June 1, 2020, to November 30, 2020.
- Inclusion criteria: patients on MHD with confirmed COVID-19.
Main Results:
- 69 MHD patients admitted; median age 51. Common symptoms: fatigue, fever, cough, dyspnea.
- Disease severity: 35% mild, 45% severe, 20% critical. 54 patients survived 4 weeks post-discharge.
- Nonsurvivors (15) were older, had lower oxygen saturation, hemoglobin, and higher LDH, IL-6, D-dimer. Remdesivir and anticoagulants improved survival (p<0.05).
Conclusions:
- One-third of MHD patients experienced mild COVID-19; critical illness led to high mortality.
- Poor prognostic factors include older age, male gender, short dialysis vintage, low admission oxygen saturation, anemia, leucocytosis, and mechanical ventilation.
- C-reactive protein, ferritin, and lymphopenia were not significant prognostic markers in this cohort, unlike in the general population.
Background:
There is a paucity of data regarding the consequences of coronavirus disease 2019 (COVID-19) infection in patients with maintenance hemodialysis (MHD). Our objective was to identify the clinical manifestations and prognostic factors and to assess the impact of treatment schemes on the outcomeMaterials and methods: Here we present retrospectively collected data from medical records of patients on MHD hospitalized with COVID-19 infection from 1st June to 30th November 2020Result: Around 69 patients were admitted with a median age of 51 years. About 81% had hypertension, 41% had diabetes, and 24% had body mass index (BMI) ≥ 23 kg/m2 . Of all who died, 73.33% had dialysis vintage of <12 months (p = 0.06). Common presenting symptoms were fatigue (67%), fever (58%), cough (42%), and dyspnea (35%). Milder, severe, and critical disease was found in 35, 45, and 20% of patients, respectively. About 54 patients were living 4 weeks after discharge. Around 15 patients died, that includes all who received invasive ventilatory support. Nonsurvivors were older and had lower oxygen saturation on admission, lower hemoglobin (Hb), and worst lactate dehydrogenase (LDH), interleukin (IL)-6, and D-dimer values than survivors, which were statistically significant. Use of remdesivir and anticoagulant improves chances of survival (p-value 0.035 and 0.034, respectively) Conclusion: About one-third of patients had mild disease. Those with critical disease displayed high mortality. Older age, male gender, short dialysis vintage, lower oxygen saturation on admission, anemia, leucocytosis, higher inflammatory markers [except C-reactive protein (CRP)], bilateral lung opacity, and requirement of the mechanical ventilator are poor prognostic factors. CRP, ferritin, and lymphopenia are not good prognostic markers unlike in the general population. These findings need to be verified in larger cohorts.
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