ABSTRACT
Introduction: Several months into the coronavirus disease 2019 (COVID-19) pandemic, there remains a paucity of data on the behavior of the disease in patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (MHD). Here, we describe the clinical presentations, biochemical profile, and outcomes of 183 such patients from a large tertiary-care center in South India. Materials and Methods: This prospective, observational study, included all patients with COVID-19 and ESKD who received at least one session of hemodialysis at our center, from the start of the outbreak to July 9, 2020. Clinical features at presentation, laboratory and radiological data, and outcomes were analyzed. Results: A total of 183 patients were included in the analysis. Patients who had symptoms at presentation accounted for 49.18% of the cohort, with the most common symptoms being fever (87.1%), cough (67.7%), and breathlessness (63.4%). Factors independently associated with mortality on univariate analysis included age ≥60 years, having symptoms at presentation, neutrophil-lymphocyte ratio >6, C-reactive protein >20 mg/L, serum lactate dehydrogenase >250 IU/L, CT (computed tomography) Grades 3 and 4, and the need for respiratory support. However, on multivariate logistic regression analysis, the only factor that retained significance was an age >60 years. Conclusions: This analysis confirms the previous reports of higher COVID-19-related mortality in the dialysis population and identifies older age, higher inflammatory markers, and greater degrees of radiological lung involvement to correlate with increased mortality.
ABSTRACT
BACKGROUND: There are scarce data regarding the use of remdesivir in patients with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) and end-stage renal disease as US Food and Drug Administration cautions against its use in patients with an estimated glomerular filtration rate <30 ml/min/1.73m2 unless the potential benefits outweigh the potential risks. We studied the compassionate use and safety profile of remdesivir in patients with end-stage renal disease and moderate to severe SARS-CoV-2 infection. METHODS: We conducted an observational prospective study in 48 dialysis-dependent patients with SARS-CoV-2 infection who received remdesivir as part of institutional treatment protocol. During the treatment period, 100 mg of remdesivir was given 4 hours before hemodialysis sessions. Liver function tests, inflammatory markers such as serum C-reactive protein, serum ferritin and lactate dehydrogenase levels, and oxygen requirement before and after remdesivir treatment were compared. RESULTS: There were no events of significant liver function test alterations with the administration of 2 to 6 doses of remdesivir. A significant decline in serum C-reactive protein level (P < 0.001) was noted. More than two thirds (68.57%) of patients showed an improvement in oxygen requirement. Early administration of remdesivir within 48 hours of hospital admission shortened the duration of hospitalization by a mean of 5.5 days (P = 0.001). CONCLUSION: Remdesivir was well tolerated and found safe in our study. If initiated within 48 hours of hospitalization, it reduces recovery time. Assessing the mortality benefits of remdesivir in these patients requires a randomized controlled trial with a larger population.