ABSTRACT
Thrombosis is a known complication of SARS-CoV-2 infection, particularly within a severely symptomatic subset of patients with COVID-19 disease, in whom an aggressive host immune response leads to cytokine storm syndrome (CSS). The incidence of thrombotic events coinciding with CSS may contribute to the severe morbidity and mortality observed in association with COVID-19. This review provides an overview of pharmacologic approaches based upon an emerging understanding of the mechanisms responsible for thrombosis across a spectrum of COVID-19 disease involving an interplay between immunologic and pro-thrombotic events, including endothelial injury, platelet activation, altered coagulation pathways, and impaired fibrinolysis. © 2022
ABSTRACT
Background: Studies have shown that 7.9% of patients miss one to two hemodialysis session per month and 35% miss hemodialysis at least once every three months.1 During current COVID-19 pandemic there has been a decrease in utilization of emergency medical services due to fear of contagion. We hypothesized that patients undergoing incenter hemodialysis might have increased compliance with their dialysis prescription to avoid emergency department visits or hospitalizations. We therefore evaluated the effects of the COVID-19 pandemic on patient adherence to their dialysis prescription. Methods: This is a retrospective analysis of in-center hemodialysis patients treated in the seven American Renal Associates (ARA) dialysis facilities in Dallas, Texas. COVID-19 was declared a pandemic on March 11, 2020 and pandemic related changes were mandated in ARA hemodialysis facilities on March 13, 2020. We used existing clinical data and examined patient compliance with their dialysis prescription between January 1 to March 14, 2020 (pre-COVID) and March 15 to May 18, 2020 (COVID). Results: The study enrolled 754 eligible patients. Significantly fewer patients missed a single treatment in the COVID vs pre-COVID periods (35.5% vs 49.9%;p<0.001). The percentage of patients who were hospitalized was lower during COVID vs pre-COVID (12.5% vs. 19.6%;p<0.001). The percentage of patients who shortened hemodialysis time was lower during COVID vs pre-COVID (36.2% vs. 40.9%;p=0.06) although not statistically significant. Finally, significantly more patients achieved a weight within1 kg of their estimated dry weight at the end of the dialysis sessions COVID vs. pre-COVID (28.5% vs. 34.5%, p=0.01). Conclusions: These data suggest that during current COVID-19 pandemic, hemodialysis patients have become more adherent to their dialysis prescription. Retrospective studies have suggested that patients are avoiding seeking medical care due to fear of contacting the SARS-CoV-2 virus1. Our data suggest that similarly, hemodialysis patients have significantly increased their adherence to hemodialysis prescription in order to avoid hospital visits. Additional studies are ongoing to determine the causes for the observed improved compliance.