COVID-19: Clinical Course and Outcome of hospitalized Hemodialysis Patients: Single-center Experience.

BACKGROUND: There is a paucity of data regarding the consequences of coronavirus disease 2019 (COVID-19) infection in patients with maintenance hemodialysis (MHD). Our objective was to identify the clinical manifestations and prognostic factors and to assess the impact of treatment schemes on the outcomeMaterials and methods: Here we present retrospectively collected data from medical records of patients on MHD hospitalized with COVID-19 infection from 1st June to 30th November 2020Result: Around 69 patients were admitted with a median age of 51 years. About 81% had hypertension, 41% had diabetes, and 24% had body mass index (BMI) ≥ 23 kg/m2 . Of all who died, 73.33% had dialysis vintage of <12 months (p = 0.06). Common presenting symptoms were fatigue (67%), fever (58%), cough (42%), and dyspnea (35%). Milder, severe, and critical disease was found in 35, 45, and 20% of patients, respectively. About 54 patients were living 4 weeks after discharge. Around 15 patients died, that includes all who received invasive ventilatory support. Nonsurvivors were older and had lower oxygen saturation on admission, lower hemoglobin (Hb), and worst lactate dehydrogenase (LDH), interleukin (IL)-6, and D-dimer values than survivors, which were statistically significant. Use of remdesivir and anticoagulant improves chances of survival (p-value 0.035 and 0.034, respectively) Conclusion: About one-third of patients had mild disease. Those with critical disease displayed high mortality. Older age, male gender, short dialysis vintage, lower oxygen saturation on admission, anemia, leucocytosis, higher inflammatory markers [except C-reactive protein (CRP)], bilateral lung opacity, and requirement of the mechanical ventilator are poor prognostic factors. CRP, ferritin, and lymphopenia are not good prognostic markers unlike in the general population. These findings need to be verified in larger cohorts.

Safety and Tolerability of Remdesivir in Patients with End-stage Renal Disease on Maintenance Hemodialysis.

Introduction: The use of remdesivir is not recommended in patients with end-stage renal disease (ESRD) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection unless potential advantage offset disadvantage due to limited safety data. Our objective was to assess the safety of remdesivir in patients with end-stage renal failure and evaluate the outcome of this vulnerable group. Methodology: We carried out a retrospective observational study in dialysis-dependent ESRD patients with SARS-CoV-2 infection who received a standard 5-day course of remdesivir (powder form) from June 2020 to December 2020. Oxygen requirement, hemogram, inflammatory markers, and liver function tests before and after remdesivir treatment were compared. Result: We found thirty-nine such patients with mean age of patients 58.79 ± 12.13 years. Diabetes mellitus, hypertension, and cardiac diseases were present in 58.97, 87.17, and 23.07% of patients, respectively. Mean oxygen saturation on admission was 85.41% (±7.73). There were no events of hepatotoxicity, altered behavior, or infusion reaction. There was statistically significant improvement in total leukocyte count, absolute lymphocyte counts, and C-reactive protein (p value <0.001, 0.01, and 0.02, respectively) post remdesivir treatment. A total of 60% of patients had improved oxygenation while 13% of patients had no change in oxygen requirement after completion of remdesivir course. Mortality in our study was 28.21%. We did not find any significant benefit of early remdesivir administration (3-6 days of illness) on mortality or days of hospitalization. Conclusion: The use of remdesivir in end-stage kidney disease is safe. Improvement in oxygenation was significant when baseline oxygen requirement was less. It requires prospective controlled trials with larger population to assess its impact on mortality. How to cite this article: Shah MK, Parikh M, Prajapati D, Kute VB, Bhende P, Prajapati A, et al. Safety and Tolerability of Remdesivir in Patients with End-stage Renal Disease on Maintenance Hemodialysis. Indian J Crit Care Med 2022;26(5):619-625.