ABSTRACT
Background: Dialysis patients, with frequent co-morbidities, advanced age and frailty, visiting treatment facilities frequently are perhaps more prone to SARS-Cov-2 infection and related death - the risk-factors and dynamics of which are unknown. The aim of this study was to investigate the hospital outcomes in SARS-CoV-2 infected dialysis patients. Methods: This prospective, observational, multi-centre study collected data on SARS-CoV-2 infected HD patients between 29/02/2020 and 15/05/2020. Data was collected on demographics, comorbidities, WHO performance status, clinical symptoms, laboratory parameters, hospital management and outcomes. Treatment was predominantly supportive, unless patients were part of an approved clinical trial. The study was approved by NHS Research Ethics Committee 20/SW/0077 and Heath Research Authority IRAS 283130. Results: Of 1737 HD patients at the 3 renal centres, 224 (13%) were COVID-19 positive over the study period. The characteristics of the COVID-19 HD patients were: mean age 65.8;59% male;38% Caucasian;81% hypertension;54% diabetes;25% chronic lung disease;29% ischaemic heart disease and 22% cerebrovascular disease. The most common symptoms at presentation were fever (62%) and cough (53%). About 143 (64%) patients were managed as an inpatient and 81 (36%) as an outpatient. Of 9 patients that required mechanical ventilation: 6 died, 1 patient was discharged and 2 are still under clinical care. Overall 51 patients died (23%), 154 (69%) were discharged alive and 19 (8%) were still under clinical care as of 15/05/2020. Preliminary analyses suggested that those that died were significantly older (p=0.0028), more likely to have ischaemic heart disease (p=0.003), cerebrovascular disease (p=0.019), smoking history (p=0.006), WHO performance status 3-4 (p=0.004), higher neutrophil: lymphocyte ratio at presentation (p=0.0001) and higher CRP at presentation (p=0.0021). Conclusions: This large cohort of COVID-19 positive haemodialysis demonstrates a high case fatality ratio, which increased significantly with age, cardiovascular disease, smoking history, frailty and markers of inflammation.
ABSTRACT
Background: During the COVID-19 pandemic in 2020, high rates of acute kidney injury (AKI) in critically unwell patients are being reported, leading to increased demand for renal replacement therapy (RRT). There are considerable challenges providing RRT for large numbers of patients with COVID-19 and alternatives to continuous veno-venous hemodiafiltration therapies (CVVHDF) in intensive care units (ICU) are needed in both high and low-resource settings. Peritoneal dialysis (PD) can be initiated immediately after percutaneous insertion of the catheter, but there are concerns about impact on ventilation and RRT efficacy. We describe our recent experience of percutaneous catheter insertion and peritoneal dialysis in patients in ICU with COVID-19 infection. Methods: Patients were selected according to local protocol and catheters inserted percutaneously using Seldinger technique by two experienced operators. Sequential Organ Failure Assessment score (SOFA) and ventilation requirements were recorded at time of insertion, and at 24 hours after insertion. Procedure complications, proportion of RRT provided by PD, renal recovery and RRT parameters during PD were assessed. Results: Percutaneous PD catheters were successfully inserted in 32/39 (82.1%) patients after median of 10.0 (IQR 13.0, 19.0) days on ICU. No adverse events following insertion were reported, SOFA scores and ventilation requirements were comparable before and after insertion and adequate RRT parameters were achieved. Median proportion of RRT provided by PD following catheter insertion was 90.2% (IQR 77.5, 100). Conclusions: PD provides a safe and effective alternative to CVVHDF in selected patients with AKI and COVID-19 infection requiring ventilation on intensive care.