ABSTRACT
Introduction: Covid-19 affects multiple organs including the kidneys. Mortality from covid-19 is found in those with co-morbid conditions, including end-stage kidney disease. Patients on maintenance hemodialysis appear vulnerable to SARS-CoV 2 infection due to uremia-related immune system dysfunction which consist in both impaired immune defense and pro-inflammatory stated, increased comorbidity burden, frequent hospital admissions and the risk of cross-contamination in the dialysis centers. Mortality risk is associated with covid-19 severity. In non-covid hemodialysis patients, age, diabetes, hypertension, coronary artery disease, smoking history, and frequency of hemodialysis were correlated with mortality. Little is known on the impact of covid-19 in these hemodialysis patients and their clinical and laboratory features. Method(s): This is a retrospective study of adult patients on chronic hemodialysis admitted for covid-19 from March 2020 to December 2021 in a tertiary public hospital in Manila. Data extracted included demographic profile, clinical characteristics, etiology of chronic kidney disease, baseline chest x-ray, and laboratory tests such as white blood cell count, erythrocyte sedimentation rate, c-reactive protein, serum albumin, alanine transaminase, aspartate aminotransferase, lactate dehydrogenase, d-dimer, and ferritin. Also included were the frequency of hemodialysis, covid-19 severity and outcome, whether discharged or died. Descriptive statistics, comparative analysis, and one-way ANOVA were used to analyze the data. Cramer's V was used to test the association of covid severity to a nominal variable. Result(s): The study included 48 patients. There were 19 moderate patients (39.58%), 14 severe patients (29.17%) and 15 critical patients (15%). Among the included patients, 77% improved and were discharged from the hospital. However, 10 patients (20%) expired, particularly those who had severe pneumonia upon hospitalization and critical covid-19. Among the variables analyzed, only elevated lactate dehydrogenase (LDH) significantly predicted the risk for critical covid-19 (p=0.0204). One unit of increase in LDH increases the relative risk for developing critical covid-19 by one-fold. An increase in LDH increases the chance of having critical covid-19 than having moderate covid-19. Conclusion(s): An elevated LDH in hemodialysis patients was associated with risk of developing critical covid-19. A majority of end-stage renal disease patients on maintenance hemodialysis died from cirtical covid-19 with mortality rate of 20% which was higher than that observed in general population. Other variables has no association between the composite outcome or mortality and risk factors previously identified in the general population such as age, diabetes, hypertension, coronary artery disease and history of smoking. No conflict of interestCopyright © 2023