Subject(s)
Acute Kidney Injury , COVID-19 , Humans , Acute Kidney Injury/etiology , COVID-19/complications , SARS-CoV-2 , Male , AgedABSTRACT
BACKGROUND AND AIMS The incidence of acute renal failure (ARF) is frequent and has an implication in the morbidity and mortality of SARS-CoV-2 infection. METHOD A retrospective descriptive study of patients admitted for SARS-CoV-2 infection during the first (G1) and second (G2) waves who presented with ARF. They correspond to the period from March to May 2020 (G1) and from August to December 2020 (G2). We compare populations, outcomes and treatments. RESULTS A total of 73 patients in the first wave (G1), with a cumulative incidence (CI) of 28.3% (G1), compared with 58 patients in the second wave (G2), with a CI of 8% (G2). The mean age was higher in G2 [65.8 ± 15 years (G1);75.3 ± 14 (G2);P <.05], with no difference regarding sex [63% (G1);54% (G2)]. In G2, there was a higher proportion of patients with cardiovascular disease [23% (G1);57% (G2)], hypertension [56% (G1);83% (G2)]. The baseline glomerular filtration rate (GFR) being similar for both groups (CKD EPI: 69 mL/min/1.73² (G1);P = .27). In the first wave, the mean days from admission to ARF was 3.1 days ± 4.2, and 42% of the patients were diagnosed at admission (31 patients). In the second, it was 2.9 days ± 5.7, of which 60% at admission (35 patients). The most prevalent cause was prerenal in both. Higher proportion in G1 of KDIGO stage 3 (G1: 30% versus G2: 17%) and renal replacement therapy (RRT) (G1: 9 versusG2: 2 patients). Only 3 patients remained in RRT in G1 and 1 patient in G2. In G1, 64% recovered their GFR [mean time (MT): 7.5 ± 8 days], and the percentage of deaths was 34%. In G2, 72% recovered GFR (MT: 16 ± 25 days), and 19% of patients died. CONCLUSION Despite a lower age and comorbidity of the first wave patients, the severity and lethality was higher. There were no differences in the proportion of patients who recovered their baseline renal function, although the recovery time was longer in the second wave.Table 1.Characteristics of kidney failure and treatmentsGroup 1Group 2Baseline CKD G1-240 (61%)36 (63%)P = .245 G316 (26%)18 (32%) G4-59 (14%)3 (5%)ARF severity (KDIGO) KDIGO 1 and 251 (70%)48 (83%)P = 0.08 KDIGO 322 (30%)10 (17%)Cause of ARF Prerenal38 (52%)39 (67%)P = 0.121 Sepsis25 (25%) 11 (19%) Obstructive2 (3%)4 (7%) Others8 (11%)4 (7%) Haematuria8 (11%)16 (27%)P = 0.74 ICU18 (25%)3 (5%)P = 0.03 OTI16 (22%)3 (5%)P = 0.007 RRT9 (12%)2 (3%)P = 0.069 ARF recovery time7.5 ± 816 ± 25P = 0.04 Total Patients7358 Group 1: ARF patients on first wave of SARS CoV2. Group 2: ARF patients on the second wave of SARS CoV2. Baseline CKD, baseline chronic kidney disease;ICU, intensive care unit;OTI, orotracheal intubation;and RRT, renal replacement therapy. ARF recovery time: days from renal failure to recovery of baseline renal function.
ABSTRACT
Dialysis patients are a risk group for SARS-CoV-2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-CoV-2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID-19 (almost 1,000 patients in 100,000h). In the form of a diary, we present the actions undertaken, the incidence of COVID-19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit. We started with 90 patients on HD: 37 (41.1%) had COVID-19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV-2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-CoV-2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID-19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID-19.