ABSTRACT
Background: COVID-19 poses the greatest global challenge in modern day healthcare. Chronic Kidney Disease (CKD) patients are classed as 'high risk' in terms of the morbidity and mortality associated with COVID-19. We present data from a large centre encompassing a 24-bed inpatient renal ward, 2 in-centre haemodialysis (HD) units and a large ITU. We aim to compare and contrast clinical outcomes for COVID-19 patients with renal disease. Methods: Observational analysis was performed on 61 patients (mean age 65y), all positive for COVID-19. Patients were stratified according to their renal status at the point of contracting the virus (table 1). Results: Acute Kidney Injury (AKI) (n=24;mean age 67y) - 23 of 24 patients were intubated and ventilated in ITU. 18 died. 4 remain on haemofiltration (1 patient transferred for Extracorporeal Membrane Oxygenation). Only 1 patient required no ventilatory support and survived with resolution of the AKI. 1 patient requiring invasive ventilation survived with recovery of renal function. Chronic HD (n=20;mean age 60y) - 20 prevalent adult HD patients tested positive for COVID-19. 10 recovered and remain on HD. 10 died. Kidney Transplant Recipients (KTR) (n=4;mean age 59y) - 3 were managed as outpatients and have recovered with functioning grafts. 1 died. Peritoneal Dialysis (PD) (n=2;mean age 68y) - 1 was managed as an outpatient and has made a good respiratory recovery. 1 patient died. CKD (without renal replacement therapy (RRT)) (n=11;mean age 72y) - 11 patients with pre-existing CKD (stages 3-5) contracted COVID-19. 5 made a recovery with no progression to RRT. 2 died without RRT. 2 received acute HD and subsequently died. 1 remains on acute HD and 1 has progressed to chronic HD. Conclusions: AKI patients had the poorest outcomes in terms of need for ventilatory support and mortality. 50% of chronic HD patients with COVID-19 died. Despite immunosuppressants, only 4 KTRs (total cohort of 352) contracted COVID-19. The introduction of virtual transplant clinics, minimisation of face-to-face contact and effective shielding may have influenced this. These data aim to reinforce the international collaborative against this global pandemic.