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
INTRODUCTION: In this observational study, we describe the change in the clinical profile and outcome of Corona Virus Disease 2019 (COVID-19) over the course of the outbreak, among patients requiring dialysis, including chronic haemodialysis therapy. METHODS: This is a single-centre prospective observational study of patients with COVID-19 (as confirmed by RT-PCR) and renal failure requiring haemodialysis. Their clinical profiles and outcomes were analysed, vis-à-vis the changing disease severity. FINDINGS: A total of 483 patients were included, of whom 416 had end-stage renal disease and were on maintenance haemodialysis. Patients who were symptomatic at presentation had significantly higher levels of Neutrophil-lymphocyte ratio (NLR) (p < 0.001), C-reactive protein (CRP) (p < 0.001), lactate dehydrogenase (LDH) (p < 0.001), higher degrees of lung involvement (p < 0.001) and required more respiratory support (p < 0.001). The overall mortality observed was 18.8%. In the late phases of the outbreak, there was a significant increase in disease severity without a statistically significant increase in mortality. Predictors of mortality on univariate analysis were age, diabetes mellitus, acute on chronic kidney disease, presence of symptoms on admission, NLR, CRP, LDH, computed tomography (CT) chest grades 3 and 4, and need for respiratory support; however, only age and the renal syndrome of acute on chronic kidney disease retained significance on multivariate analysis (p0.003 and p0.019, respectively). CONCLUSION: Among patients on haemodialysis, higher mortality was observed in patients who were older, and among those with acute on chronic kidney disease. In the late phase of the outbreak, there was a statistically significant increase in disease severity without a corresponding increase in mortality.