ABSTRACT
Background: There is evidence that in patients with residual kidney function (RKF) could benefit switch thrice to twice weekly sessions. In patients without RKF, the evidence is limited. We evaluate the clinical and psychosocial impact of the Covid-19 pandemic in Mexico City. Methods: At the beginning of the Covid-19 pandemic, the on-line posdilutional hemodiafiltration (OL-HDF) sessions were adjusted from 3 to 2 times per week. 2 months later, we determine hemoglobin, urea, serum creatinine, sodium, potassium, calcium, phosphate, albumin, ferritin and C reactive protein. Likewise psychological evaluation using Hamilton test were carried out and characteristic of sessions were collected. We divide in two groups according to thrice versus twice weekly schedule Results: 25 patients were evaluated, 16 (64%) were female, mean age was 42.04±18.02 years, 21 (84%) did not have RKF. The length session between thrice vs twice were 181.74± 9.94 vs 196 ± 9.19 (p<0.001). When we analyzed the anuric patients we found a significant difference in post-session systolic and diastolic blood pressure when compared between groups (p = 0.014). We did not find difference in dry weight (p = 0.5). We found significance difference between total substitution volume between groups (24.43±10.9 L vs 26.5± 12.48 L, p =0.042) and no difference in Kt/V (1.67 ± 0.25 VS 1.73 ± 0.34, p = 0.35). We found significance difference between groups in serum creatinine (8.68±3.55 vs 10.04±2.94, p=0.03) in the rest of molecules we did not find difference. 32 and 44% of the patients developed depression and anxiety, respectively. 36% of patients lost their jobs and 80% use public transport. There was a moderate correlation between anxiety episodes and economic limitation due to Covid-19 (r = 0.40 p = 0.04). There was no significant inverse correlation between pharmacological adherence and economic limitation (r = -0.29 p = 0.29). Conclusions: Change of the schedule in patients without RFK did not show significant differences in terms of biochemical parameters, on the other hand, improvement in replacement volumes. We considered a safe strategy to reduce the risk of transmission among our population. Pharmacological and attending adherence to sessions was not modified despite the psychological findings due to the Covid-19 pandemic.
ABSTRACT
Background: Although severe acute respiratory syndrome coronavirus (SARSCoV- 2) infection is primarily a respiratory disease, other organs are also affected. Several pathological studies confirm that SARS-CoV-2 invades kidney tissue causing endothelial damage, glomerular and vascular changes, extensive acute tubular injury and podocyte viral infection. AKI in COVID-19 appears to be frequent, with an AKI incidence of up to 46%, and a 20% requirement for renal replacement therapy (RRT). Patients with AKI show a trend towards worse outcomes and increased mortality. Information on Latin- American population is scarce. Methods: We created a cohort to describe the incidence, risk factors, and outcomes associated with AKI in hospitalized patients with COVID-19 in Mexico City, excluding patients with a known chronic kidney disease. AKI was defined and classified according to KDIGO guidelines. Results: We included 127 patients. 11 patients (8.66%) met the criteria for severe COVID-19, and were more likely to have AKI (81.82% vs. 54.31%, p=0.078). Of the 72 (56.69%) patients that had AKI, 48% were diagnosed at the time of admission. Patients with AKI were more likely to be men (61.7% vs. 42.42%, p=0.043) and older (55.68 years vs. 48.89 years, 0.018). With regards disease severity, 72% of them had a grade 1 AKI. 7 patients (9.72%) had grade 3 AKI, 4 of which needed renal replacement therapy. Overall length of stay was longer in patients with AKI (12 days vs. 7 days, p=0.003). A nonsignificant trend towards stay in critical care units was observed. 3 out of 127 patients died, all 3 had AKI. Conclusions: Amongst our studied population, AKI was associated with a longer length of stay and with a trend towards a more use of critical care services. The lack of association of AKI with mortality could be due to the low overall in-hospital mortality of COVID-19 patients (2.40%).