ABSTRACT
Background: The COVID-19 pandemic has led to an increase in critically ill patients with renal failure, with many requiring renal replacement therapies. Unfortunately, many of them are too critically ill to tolerate intermittent hemodialysis. In the setting of limited resources, we did bedside acute intermittent peritoneal dialysis for critically ill COVID-19 patients with hemodynamic instability with or without ventilator support admitted to our intensive care unit. Objective: The aim of the study was to determine the outcome of intermittent peritoneal dialysis in critically ill COVID-19 patients. Methods: Our retrospective observational study included 91 patients with critically ill SARS-CoV2 infection and renal failure admitted to the intensive care unit of our hospital from July 2020 to September 2021, who underwent acute intermittent peritoneal dialysis. Results: The demographic, laboratory, and treatment parameters were compared between survivors and non-survivors. Variables, like increased mean age (49.88 vs. 59.07 years), presence of diabetes mellitus (36.4% vs. 63.8%), increased lung involvement (57.3% vs. 75.0%), mechanical ventilation (15.2% vs. 70.7%), systolic (84.3 vs. 77.5 mm of Hg) and diastolic (59.09 vs. 42.93 mm of Hg) blood pressures, were associated with poor outcomes. The use of hypertonic PD (63.6% vs. 37.9%), better urea reduction ratios (44.33 vs. 39.84), and increased PD cycles (66.52 vs. 44.26) were associated with a better outcome. Complications, like haemorrhage and peritonitis, occurred in 10.9%. Conclusion: PD is a cost-effective bedside RRT that can be considered an effective option in critically ill COVID-19 patients. Good urea clearance, hemodynamic stability, and minimal resource requirements are also the features that favour peritoneal dialysis.
ABSTRACT
Introduction: Solid Organ Transplants (SOT) is at increased risk of Coronavirus Disease 2019 (COVID-19) infection, which may result in acute graft dysfunction and even death. While the disease has been well studied in the general population, it is not the case in renal transplant recipients. The poor immunological response of the vaccine in postrenal transplant patients, the emergence of newer strains, and the possibility of a third wave in India, makes it even more important to know more about the course and outcome of the disease in post renal transplant patients. Aim: To evaluate the demographics, clinical presentation, biochemical profile, course of hospitalisation in post kidney transplant patients with COVID-19. Materials and Methods: This retrospective observational study study with 18 patients was conducted in Madurai Medical College, Tamil Nadu, India for duration of four months, from May 2021 to August 2021 and data collection from May 2021 to July 2021 and data analysis in August 2021. All post kidney transplant patients having evidence of COVID-19 were included. Detailed clinical history, biochemical profile, radiological findings, treatment, and final outcomes were collected and compared. Non parametric statistical tests were used, in addition to Chi-square test and odds ratio. Kaplan-Meier plot was used for survival analysis. Results: The most common presentation was fever 15 (83.3%), followed by cough 10 (55.6%). C-reactive Protein (CRP) {65 mg/L (11.48-94.48)}, D-dimer {0.72 mcg/mL (0.59-1.1)}, serum creatinine {3.5 mg/dL (2.12-5.93)}, and platelet count {200,000 cells/cu.mm (1.75-2.22)} and showed statistically significant (p<0.05) association with the outcome. About 15 (83.3%) patients developed Acute Kidney Injury (AKI). Seven patients (38.9%) had stage three AKI necessitating haemodialysis, of which six did not survive. The median survival time was 22 days, with 95% confidence interval (19.792-24.208), with case fatality rate of 33.3% Conclusion: Postkidney transplant patients are at high risk of contracting COVID-19. CRP, D-dimer, serum creatinine, platelet counts, and arterial oxygen saturation may serve as prognostic markers. Dialysis may be required in view of high incidence of AKI and acute graft dysfunction, though the outcome seems dismal in such patients. Hence, the need for early hospitalisation and more effective treatment protocol is essential to improve outcome.
ABSTRACT
Objective: Novel coronavirus disease-19 is spreading rapidly, and therefore, optimal management of the disease in endstage kidney disease patients requiring hemodialysis is not fully explained. We report the clinical characteristics and the short-term outcomes in patients with end-stage renal disease who require hospitalization for coronavirus disease-19 and who underwent hemodialysis. Methods: In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of 116 consecutive end-stage kidney disease patients hospitalized with laboratory-confirmed coronavirus disease-19 who underwent at least 1 hemodialysis session in our hospital between June 26 and August 10, 2020. Baseline clinical features, laboratory data, and treatment given were compared between survivors and non-survivors to identify risk factors associated with mortality. Results: Among the 116 patients who were enrolled in our study, males constituted 81% (n = 94). Many had underlying comorbidities, of which hypertension (90.4%) was the most common. The most common symptoms were fever (76.1%), dyspnoea (61.2%), cough (58.6%), and diarrhea (18.1%). In total, 66.4% of patients had arteriovenous fistula or grafts. Inflammatory markers like C-reactive protein and serum ferritin were significantly higher in non-survivors group. Multivariate logistic regression analysis revealed that dialysis vintage less than 6 months was the most important predictor for mortality. Mortality was 27.5% in our cohort. Conclusion: Mortality among hospitalized end-stage kidney disease patients who underwent hemodialysis was higher when compared to the general population. The presence of comorbid conditions like hypertension, diabetes mellitus, and pre-existing pulmonary disease had a poor prognosis. Patients having central venous catheters as their dialysis access had a poor prognosis. Dialysis vintage less than 6 months was the most important predictor of mortality.