ABSTRACT
Introduction: COVID-19 disease has been declared as a pandemic since February 2020. Resulting from this, home peritoneal dialysis training programme was implemented. However, infectious complications was one of our major concerns. Material(s) and Method(s): This is a single centre, observational, retrospective study. We recruited patients who were newly enrolled into the peritoneal dialysis programme from January 2020 until March 2021 and follow up them for 6 months duration. Patients' demographic data, baseline characteristic, clinical outcome were collected through electronic health record (eHIS) and data were analysed using SPSS version 23. Result(s): A total of 133 patients were enrolled into the peritoneal dialysis programme. The median age of the patients was 55(42-65) years old. Most of the patients were on CAPD, 87(65.4%), and 76(57.1%) of them were on self-care peritoneal dialysis (PD). During this observational period, 29(21.8%) patients underwent hospital based training, while a total of 104(78.2%) patients underwent home based training. The PD peritonitis rate for hospital based training was 1 episode per 55.8 patient months while home based training group was 1 episode per 25.4 patient month. The survival free to 1st PD peritonitis for home based training was 83.7% over 6 months. The exit site infection rate was 1 episode per 73.1 patient month. Conclusion(s): Home based PD training should be encouraged especially during Covid-19 pandemic period, but standardised training protocol should be implemented to improve the clinical outcome of our patients.
ABSTRACT
Introduction: COVID-19 still poses a high morbidity and mortality in chronic kidney disease. We aim to determine the risk factors for mortality amongst hospitalised COVID-19 patients with kidney disease. Material(s) and Method(s): This is an observational cohort study involving all COVID-19 patients with kidney disease in the first quarter of 2021. Relevant data was extracted from the electronic medical records and statistical analysis was conducted using SPSS version 26. Result(s): Of 414 COVID-19 patients, 165 (39.9%) had kidney disease [25.5% end stage kidney disease (ESKD), 4.2% chronic kidney disease (CKD) and 70.3% acute kidney injury (AKI)). 56 of them died, giving an inpatient mortality rate of 33.9% in patients with kidney disease compared to 17.1% from all COVID-19 admissions. ESKD had the highest mortality rate at 42.9% followed by AKI, 31% and CKD, 28.6% (p=0.365). Majority of patients with kidney disease who died, were older (66 +/- 10.4 vs 54 +/- 14.6, p<0.001), male (78.6% vs 61.5%, p=0.035) and had category 5 infection (28.6% vs 19.3%;p=0.009). 66.1% were on mechanical ventilation while 51.8% were managed in the intensive care unit. Multiple logistic regression predicted older age, premorbid CKD & ESKD, raised peak serum sodium, admission category of illness 4 & 5, mechanical ventilation and unknown epidemiology link to increase mortality risk in patients with COVID-19 infection with kidney disease. Conclusion(s): COVID-19 mortality rate remains high amongst those with ESKD, CKD and AKI. Future studies should evaluate the incidence and outcome post vaccination.
ABSTRACT
Introduction: Arteriovenous fistula (AVF) delivers the best treatment dose prescribed for hemodialysis. KDOQI guideline 2006 advocate the adoption of ultrasound mapping for pre access creation. However, this is not translated to routine practice due to scarce resources. In this study, we wish to study the efficiency of clinical assessment in determining the suitable vessels for AVF creation and the access survival. Methods: This is a single tertiary nephrology center, prospective study of a series of patients who were referred to our AVF outsource program that was funded by Ministry of Health. This program diverting non Covid-19 CKD 5 or new ESKD patients that have opted for hemodialysis to private facilities for AVF creation due to the limitation of available operating theatre slot in government hospital attributed by Covid-19 pandemic. Those assessed by our nephrologists and trainees in a specially created outsourcing clinic that deemed suitable for assess creation will be outsource to the private institutions. Clinician assessment of suitability of the vessels and the outcome of AVF creations at 6 months were captured and analyzed. Results: A total of 147 patients were identified, reviewed, and outsourced, with the mean age of 54-year-old, male predominant (n: 94). 65% of the cohort has diabetes mellitus as their primary disease followed by hypertension at 17%. 37.4% of the cohort are CKD 5 patients who are not on dialysis, while 10.8% on peritoneal dialysis and 51.7% were on hemodialysis. 87% of the patients were AVF naïve whereas 13% had prior history of failed AVF. Out these, 15.6% of patients did not have access created (1 passed away, 7 needed complex grafts, 13 have small vessels, 2 needed two stages surgeries). Of the remaining 124 patients (84.4%), 2 received AVGs and 122 received AVFs. From the first subsequent vascular review by the surgeons, the concordance for the vascular access creation suitability with our assessment was 91.1%. Subsequently, the concordance for vascular access that was successfully created was 84.3% with site of creation agreement at 61%. At 6 months post AV access creation, 13 patients (10.5%) have primary failures whereas 11 patients (9%) had secondary failure. 21 patients (17%) unfortunately passed away during the study period and were excluded. At 6 months, 60% of the patients have functional AV access. In addition, for the 26 patients that have deemed no suitable vessels for AV access creation from prior vascular review before referred to our program, 84.6% has AV access created subsequently. Their outcome in 6 months includes: 36.3% have functional AV access, 18% have primary failure, 22.7% have secondary failure and another 22.7% passed away. Conclusions: We have demonstrated a careful clinical assessment of a patient’s vascular access by a nephrologist led team provides a high and consistent level of accuracy as to successfulness of the vascular creation. The omittance of routine vascular mapping in our protocol provide considerable cost and time saving which echoes the latest guideline by KDOQI 2019. Patients who failed assessment prior still warrant a repeat clinical assessment if they are considering hemodialysis as the life plan of kidney replacement therapy. No conflict of interest