ABSTRACT
The Kidney Disease Quality of Life (KDQOL) survey is a review of patients’ quality of life (QOL) on hemodialysis. Lower survey scores in depression, burden of disease, and treatment satisfaction are associated with worse compliance to treatment and poorer outcomes. KDQOL surveys were extracted from and stratified by year, with duplicate entries removed. Annual mean scores for each component of the survey were calculated for each clinic. The KDQOL data represents the mean scores for 2017-2019 compared to the first three quarters of 2021. 2020 was excluded due to sampling challenges and high patient turnover creating potentially inaccurate data. Mean scores were compared by Student’s t-test with Bonferroni adjustment for multiplicity. Phosphorus and PTH levels were used as a surrogate for treatment compliance. Patients reported lower QOL scores during the COVID-19 pandemic compared to pre-pandemic (baseline). All KDQOL metrics were significantly lower in 2021 compared to the mean of three years prior to the pandemic. A two sample Student’s T test was used to determine the change in mean score for each category: Physical Component Score (t(2)= 14.5, p=0.009), Mental Component Score (t(2)= 36.7, p=0.0004), Burden of Kidney Disease (t(2)= 6.1, p=0.01), Symptoms of Kidney Disease (t(2)= 22.8, p=0.0009), Effects of Kidney Disease (t(2)= 8.8, p=0.006). Phosphorus was significantly higher in 2021 compared to the mean of 2018 and 2019 when calculated via t-test (t(31)= -2.72, p=0.01). Parathyroid Hormone quarterly data was evaluated via t-test for 2018 to 2020 vs. the first three quarters of 2021 (t(12)= -7.15, p=0.01) Using the KDQOL survey to measure patients’ QOL, we found that all measures were significantly lower in 2021 following the pandemic. Using markers of bone metabolism as measures of treatment compliance, phosphorus and PTH levels were also significantly higher in 2021. In ESRD patients who survived the trauma of the pandemic, QOL is perceived to be worse and is likely affecting compliance. Social workers and staff need to be aware of these trends to provide the appropriate counselling and resources to meet the needs of these patients.
ABSTRACT
Background: AKI has historically plagued those with ARDS and during the pandemic especially so with large resultant mortality rates. During the past year those centers so equipped offered ECMO to treat severe COVID pneumonia. We compared the non COVID ARDS requiring ECMO with patients with COVID pneumonia requiring ECMO. The aim of the study was to understand the difference in the renal outcomes and its effects of mortality and thereby help in prognostication. Methods: This is a single center retrospective study where patients with COVID pneumonia needing ECMO in between March 2020 to April 2021 were compared with non COVID ARDS patients needing ECMO between April 2013 to April 2021. The 2 groups were compared and risk ratio calculated for the incidence of AKI, the need for Renal replacement therapy (RRT) and the mortality associated with it. Results: After excluding the patients who did not meet the criteria, 26 COVID patients treated with ECMO were compared with 22 patients with non COVID ARDS treated with ECMO. The median age of COVID group was higher (48 years vs 36 years) and the median number of days needing ECMO for the COVID group was higher (13 days vs 31 days). Incidence of AKI and the AKI needing RRT were similar in the 2 groups. The overall mortality in patients with COVID pneumonia was higher. Patients with COVID who developed AKI had 1.32 times the risk of mortality, which increased to 1.62 when RRT was needed. Conclusions: This is a first study comparing the renal outcomes of COVID ARDS requiring ECMO and non COVID ARDS requiring ECMO. Even though the median age and the median number of the days on ECMO were higher for the COVID group, surprisingly the incidence of AKI and those needing RRT were similar. But there was a significantly higher mortality when patients on ECMO developed AKI and even higher for those on RRT. This could be attributed to the cytokine storm seen with causing a multiorgan dysfunction which can manifest in the form of AKI. Presence of AKI needs to be identified early and can be used for the prognostication in COVID pneumonia.
ABSTRACT
Background: COVID-19 infection secondary to the SARS-CoV2 virus was defined by the WHO as a global pandemic. While the disease initially affects the respiratory system, a multi-systemic organ dysfunction of varying degrees has been described. Renal failure has been recognized as a significant part of the pathophysiology. Elmhurst Hospital Center (EHC) was described as the 'epicenter of the epicenter' in New York City. Methods: A retrospective chart review was undertaken of COVID positive adult patients (polymerase chain reaction testing of a nasopharyngeal sample) admitted to EHC from 3/7/20 - 4/7/20. Demographics, clinical characteristics, biomarkers, and outcomes were examined. AKI was determined by the KDIGO definition. Exclusion criteria: <18 years old, pregnant, ESRD, patients expired within first 5 days Results: The average age was 59 years, 77.95% were Male;55% had hypertension (HTN), 40% had diabetes (DM). Hispanics made up the most significant portion of the demographic with 62.05%, followed by Asians (24.1%). AKI occurred in 44.1% of patients and was associated with HTN ((p=0.011) but not DM (p=0.289). AKI was associated with an increased use of mechanical ventilation (p<0.001), and increased mortality (p<0.001). Hypertension (p=0.007), older age (p=0.003), and DM (p=0.018) were significantly associated with mortality. Ethinicity was not associated with mortality (p=0.231). Admission CPK did not have a significant association with AKI (0.065) or death (p=0.19). Conclusions: Both HTN and DM are associated with increased mortality. AKI is significantly associated with increased respiratory failure requiring mechanical ventilation and mortality. Diabetes and admission CPK were not associated with AKI.
ABSTRACT
Background: Early in March, NYC Hospitals became inundated, especially safety net public hospitals, The physicians at Elmhurst Hospital Center (EHC) encountered countless cases of respiratory failure often accompanied by AKI. Autopsy studies from China described an interstitial nephritis, with macrophage infiltrates and complement deposition along with fibrotic changes. We report our experience with COVID-19 and AKI. Methods: We reviewed the charts of 137 SARS-CoV-2 positive patients (PCR of a nasopharyngeal sample) admitted to EHC 3/7/2020 - 4/7/2020. We categorized patients as having KDIGO defined AKI vs no AKI within the first seven days of admission. Comorbidities, renal associated markers and inflammatory markers were anlayzed. Clinical outcomes were assessed. Exclusion criteria: <18 years old, pregnant, ESRD, mortality prior to day 7 of hospitalization. Welch T test and Chi square were used for AKI vs non-AKI Results: Age was similar in both groups as was gender (male 74% vs 79%) and incidence of diabetes. Early AKI developed in 35% of whom 55% needed RRT;85% of the AKI patients required mechanical ventilation vs 11.2% of the non-AKI group. Inflammatory markers (WBC, CRP, LDH);urine protein and urine white cells (but not CPK) were significantly higher in the AKI group. Procalcitonin and D-dimers as maximum levels became significant. We found that 20% of those not with early AKI developed late-onset AKI. Mortality was 76.7% in the AKI and 17.9% in the non-AKI group. Conclusions: Early AKI developing in the first week of hospitalization was associated with overwhelming respiratory failure. The accompanying higher inflammatory markers, elevated urine WBCs and protein could implicate interstitial nephritis as an underlying pathology as described earlier.