ABSTRACT
Background: The mortality of kidney transplant recipients (KTR) affected with coronavirus disease-2019 (COVID-19) is reported to be higher than the general population. There is a scarcity of data on the pattern and outcome of COVID-19 in KTRs in developing country like India. Materials and Methods: It was a retrospective study conducted in a tertiary care center in North India. The detailed data on the Covid-19 affected KTR admitted to our center from March 2020 to March 2021 was obtained from computerized records. Clinical and biochemical characteristics of the survivors and nonsurvivors were studied. The factors affecting the mortality in this cohort were analyzed. Results: Of the 35 participants, 25 (71.4%) were males. The mean age was 53.06 & PLUSMN;11.84 years. Overall, mortality was 17.1% (Six out of 35). There was a significant difference in the oxygen saturation at presentation, computed tomography severity scores, level of inflammatory markers, level of serum albumin, and the absolute lymphocyte count (ALC) between the survivors and nonsurvivors (P < 0.05). On univariate regression analysis, serum C-reactive protein, ferritin, albumin, and ALC were found to be significantly predicting mortality in COVID-19 affected KTR. Conclusions: Mortality rate in COVID-19 affected KTR is higher than in the general population. Clinical, biochemical, and radiological parameters can be helpful in predicting the adverse outcome.
ABSTRACT
Background: COVID19 rapidly spread globally, imposing the need for change in nephrology practices guided by the recommendations, issued by scientific associations Methods: We conducted a nationwide virtual educational initiative with an inbuilt technological platform to enable live sharing of experiences of new modes for nephrology practice during COVID 19 pandemic, based on the adoption of current recommendations and evidences to enable indigenous, adaptive experiences of 404 nephrologists with approximately 8,000-man hours of cumulative clinical experience. The four zones across the country were represented by an individual educational task force member Results: There was a uniform consensus that suspected patients need to be treated similar to a COVID 19 positive patient, with dialysis facility provided in isolation area, to mitigate direct risk to both healthcare providers and patients and indirect risk of contamination of the hospital system. Multiple screening procedures and prohibition of eatables in dialysis area is the new mandate. Role and importance of CRRT, PIRRT and peritoneal dialysis was highlighted. Femoral catheterization is the preferred route. The experience of Tenckhoff catheter technique in peritoneal dialysis in 38 patients was discussed. Higher dose of anticoagulants is being utilised for extracorporeal procedures to reduce risk of enhanced risk of thrombus formation in COVID 19. The varied, emerging clinical presentation, including asymptomatic cases has made COVID 19 testing compulsory at most of the institutions. The nephrologists were informed about the emerging evidence for the need to continue the ongoing ARBs or ACE inhibitors. Renal transplantation with careful precautionary practice is being performed with modulation of dose of immunosuppressive agents in COVID 19 positive patients Conclusions: Safe and efficient delivery of nephrology care practices needs a uniform acceptance. Even minor liberties and deviations from established safe practice protocols could compromise the safety of the health care workers.