RESUMEN
Abstract Background: The reported incidence and fatality rate of the severe acute respiratory syndrome coronavirus 2 in patients receiving chronic dialysis are higher than in the general population. We sought to study the outcomes following coronavirus disease 2019 (COVID-19) diagnosis in patients undergoing chronic hemodialysis (HD) or peritoneal dialysis (PD) in a single center in Brazil. Methods: Of the 522 patients on dialysis evaluated between March 1, 2020, and October 1, 2021, those presenting symptoms or with a history of close contact with COVID-19 patients were tested with reverse-transcription polymerase chain reaction of samples from nasopharyngeal swabs. Results: Of the 522 patients, 120 were positive for COVID-19 infection, of which 86% were on HD and 14% in the PD program. The incidence per 10,000 inhabitants was higher in the HD group than in the PD group (2,423.5 vs. 1,752.5). The mortality per 10,000 inhabitants (470.5 vs. 927.8) and the fatality rate (19.4 vs. 52.9%, p = 0.005) were higher in the PD group. The PD group also had a higher need for hospitalization, intensive care, and mechanical ventilation. Conclusions: We advise caution when considering strategies to transfer patients from HD to the PD program to minimize the risk of COVID-19 for patients on HD.
Resumo Antecedentes: A incidência e a taxa de letalidade da síndrome respiratória aguda grave por coronavírus 2 relatadas em pacientes em diálise crônica são mais elevadas do que na população em geral. Procuramos estudar os desfechos após o diagnóstico da doença por coronavírus 2019 (COVID-19) em pacientes submetidos à hemodiálise crônica (HD) ou diálise peritoneal (DP) em um único centro no Brasil. Métodos: Dos 522 pacientes em diálise avaliados entre 1º de Março de 2020 e 1º de Outubro de 2021, aqueles que apresentaram sintomas ou tiveram histórico de contato próximo com pacientes com COVID-19 foram testados com reação em cadeia da polimerase de transcrição reversa por meio de amostras de esfregaços nasofaríngeos. Resultados: Dos 522 pacientes, 120 foram positivos para infecção por COVID-19, dos quais 86% estavam em HD e 14% no programa de DP. A incidência por 10.000 habitantes foi maior no grupo HD do que no grupo DP (2.423,5 vs. 1.752,5). A mortalidade por 10.000 habitantes (470,5 vs. 927,8) e a taxa de letalidade (19,4 vs. 52,9%, p = 0,005) foram mais elevadas no grupo DP. O grupo DP também apresentou uma maior necessidade de hospitalização, terapia intensiva e ventilação mecânica. Conclusões: Recomendamos cautela ao considerar estratégias de transferência de pacientes do programa de HD para o de DP a fim de minimizar o risco de COVID-19 para pacientes em HD.
RESUMEN
ABSTRACT Background: The reported incidence and fatality rates of SARS-CoV-2 infection in patients receiving maintenance dialysis are higher than those of the general population. Objective: This study sought to characterize the clinical characteristics and outcomes following COVID-19 infection in this population in a single center in Brazil. Methods: Out of 497 dialysis patients evaluated between March 1st, 2020 and February 1st, 2021, those presenting symptoms or history of close contact with COVID-19 patients were tested. Disease severity was categorized as mild, moderate, or severe. Results: Out of the 497 patients, 8.8% tested positive for COVID-19. These patients were predominantly male (59%), mean age 57.5 ± 17. Hospitalization was required for 45.4% of patients and 15.9% received mechanical ventilation. Symptoms such as fever, cough, dyspnea and asthenia were more frequent in the severe group. Neutrophil to lymphocyte ratio, C- reactive protein, glutamic oxalacetic transaminase and lactic dehydrogenase were significantly higher in the severe group, while hemoglobin and lymphocyte counts were significantly lower. Chest CT >50% of ground glass lesions was the risk factor associated with severe disease and need for hospitalization. The incidence of a thromboembolic event was of 22.7% in this population. The incidence, mortality, and case fatality rates were 954.4/10,000 patients, 151.8/10,000 patients, and 15.9%, respectively. Conclusions: The incidence, mortality and case fatality rates in our cohort were significantly higher than those reported for the general population. To institute appropriate control measures and early vaccination in dialysis facilities is imperative to prevent the spread of COVID-19 infection.