Hemodialysis patients amid covid-19 pandemic: A comparison between first and second wave

BACKGROUND AND AIMS: Data about HD patients and how to best dialyze them during the COVID-19 pandemic are scarce. The aim of the study is to describe the organizational model and clinical outcomes of patients confirmed COVID-19 needing renal replacement therapy, admitted in a COVID Hospital in Southern Italy during the first and second pandemic wave. METHOD: All the consecutive patients requiring chronic HD, during the first and second wave were considered. Due to local resources, we have implemented an organizational model based on the HD bedside with Genius system. The machine was prepared in the Dialysis Unit and then transferred to the COVID Hospital. After treatment, the monitor was sterilized and carefully cleaned with chlorine wipes and retransferred into the dialysis Unit to be prepared for the next dialysis. Demographic data, clinical symptoms at presentation, and laboratory results were extracted by the electronic medical record. Patients hospitalized during the first wave (FW) and second wave (SW) were compared. RESULTS: From March 10 through December 31 2020, we enrolled a cohort of 40 patients (37.5% F), with COVID-19 infection requiring HD;11 (27.5%) during first and 29 (72.5%) during second wave. The phenotype and clinical symptoms at the admission were not different between two groups. Compared to FW, the SW patients were younger (70.1±9.5 vs 77.3±5.9 years;p<0.03) with lower dialysis vintage (35±18 vs 60±48 months;p<0.05), and lower Charlson Comorbidity Index scores (2.8±1.8 vs 5.09±2.0;p<0.05). No differences were observed between the first and second wave as far as inflammatory markers IL6 (51.9±44.8 vs 55.45±40.52 pg/mL;ns) and C-reactive protein (4.74±3.8 vs 6.70±5.44 mg/L;ns) as well as the hospital stay (21.1±10 vs 24.4.8±10 days;ns) and in-hospital mortality (28.1% vs 18.2%;ns). Overall, 354 bedside treatments were performed;mean session time and mean weekly sessions were 3.64±0.40 hours, and 3.4±0.45 HD/week, with no differences between FW and SW patients. CONCLUSION: Our data show that the higher spread of Sars-cov2 during the second wave has infected younger and less comorbid HD patients, with no significant differences in clinical and laboratory parameters. Our organizational model based on the HD bedside with the Genius system, allowed a personalized treatment with efficacy and safety for the patients and staff.

Efficacy of hydroxychloroquine in a group of subjectswith SARS-CoV 2 infection

Introduction and Aim of the study: Hydroxychloroquine has beenauthorized in the therapy of patients with COVID-19. Many publications have not clarified the real efficacy of the drug. Really, thedrug was widely used during the pandemic. A single-center observational cohort study was conducted to evaluate the effectiveness of hydroxychloroquine therapy in a group of subjects admittedin the sub-intensive therapy of the COVID Unit Hospital F. Miulli(Acquaviva delle Fonti, Bari, Italy) from 17 march to 17 may 2020.Materials and Methods: The data contained in the medicalrecords were studied. The sample was divided into two groups withrespect to therapy with or without hydroxychloroquine'. Clinicaland laboratory data were analyzed.Results: A total of 174 patients hospitalized (60.4% males),mean age 68 yrs, with diagnosis of SARS-CoV2, were analyzed.118 patients were treated with hydroxychloroquine. The treatment group consisted of 66.1% males, mean age 63 years. Thetwo groups were homogeneous in comorbidity and in the severityof clinical presentation of SARS-CoV2 infection. The death ratewas significantly higher in the group of untreated than in thosereceiving hydroxychloroquine, 40% vs 2.6% respectively. Therewere no significant differences on QTc prolongation between thetwo groups (467+47 ms control group, 446 + 35 ms, treatmentgroup).Discussion and Conclusions: The data of our study, although referring to a reduced sample, show the effectiveness of hydroxychloroquine in reducing mortality in subjects suffering fromSARS-CoV2 infection.

Two-step analysis of the COVID19 pandemic:has the virus reduced its lethality?

Background and Aim of the study: In the course of the epidemic,COVID 19 disease first appeared severely and then with a gradualreduction in symptoms. Aim of the study was to compare the clinical characteristics of patients hospitalized in two different periodsfrom March to May.Materials and Methods: 174 patients, 161 subjects admitted inthe period March 17 / April 17 and 13 subjects admitted in theperiod April 17 / May 17, at the Covid Unit of F. Miulli Hospital inAcquaviva delle Fonti (Ba), were studied.Results: From the comparison of the two periods, there is a clearreduction in hospitalizations (161 vs 13). The number of asymptomatic or mildly complicated patients is significantly greater inthe second group. The rate of patients hospitalized with severepneumonia (19.9%) or ARDS (6.8%) in the first period is higherthan the patients of the second period (7.7% and 0%). In March/ April, 3.1% of patients needed ICU admission while no patientwas admitted to ICU in the past thirty days. The length of stay wasalso significantly higher in the first period (21 ± 8 days vs 8 ± 2days) as well as mortality (14% vs 11%). IL 6, d-dimers and fibrinogen values were lower (but not statistically significant) in theApril / May period.Discussion and Conclusions: Our sample, although of limitedsize, shows a significant difference in the clinical evolution of theCOVID 19 infection in the two study periods. The reduction inlength of stay, severe respiratory failure and mortality indicate alikely attenuation in coronavirus virulence in the last month of thepandemic spread.

Immunological features in Covid-19 patients at admissionand clinical outcome: What can we expect?

Introduction and Aim of the study: The unexpected COVID-19pandemic began in December 2019 in Wuhan and rapidly spreadworldwide, continues to challenge the medical community. The understanding of host characteristics at presentation could lead theway towards a better management. We analyzed data collectedform a cohort of patients admitted for Sars-CoV-2 infection to evaluate the determinants of disease severity.Materials and Methods: Data were collected retrospectively frommedical records of patients admitted at F. Miulli General HospitalCOVID department from February to May 2020. CD3, CD4, CD8,CD19, CD56, WBC, lymphocytes on admission were analyzed inrespect of on the basis of outcomes and need for resuscitation or not. A descriptive analysis was performed (t-test for continuousdata with normal distribution).Results: We studied 127 patients, 80 M, 47 F, mean age 66±15years. A statistically significant higher in CD3 (p <0.01-0.01), CD4(p<0.01-0.04), CD8 (p <0.01-0.0.05) and lower in lymphocytescount (p <0.01-0.001) decrease was observed in patients withfatal outcome and in ones who need for resuscitation (in bracketsthe respective p values). WBC counts only show a significant reduction in the recovery analysis (p<0.01-0.11).Conclusions: Our results confirm that a different immunologic profile can predict the clinical course of the disease. These evidencescould help to assess an individualize therapeutic management ofCOVID19 patients.