COVID-19 IN MOSCOW REGION AMONG HD PATIENTS: RESULTS OF A POPULATION CROSS-SECTIONAL STUDY

BACKGROUND AND AIMS: We aimed to analyze the outcomes of HD patients with COVID-19 hospitalized in the Moscow region, Russia, and to compare it with those in the general population. METHOD: Data were obtained retrospectively from the Moscow region COVID-19 register database, which comprises all hospitalizations with suspected or confirmed COVID-19 between February 2020 and November 2021. A total of 384 327 patients were included;1 435 of them were ESRD patients. RESULTS: Among ESRD patients there were 1386 HD patients and 49 kidney graft recipients. Thus, during the specified period, 48.5% of all prevalent HD patients of the Moscow region and only 7.8% of the graft recipients required hospitalization. Due to a few number of hospital admissions among kidney recipients they were excluded from the further analyses. We observed typical 4 waves of hospital admissions in the general population, but not in HD patients. In these patients, we noted a peak in December 2020 with a subsequent decrease in February, 2021;then the number of hospitalizations remained stable. The proportion of HD patients was approximately 0.5% of all patients with COVID-19 admitted to hospital. Almost all HD patients with COVID-19 were hospitalized regardless of disease severity. The mean age of hospitalized HD patients was significantly more than that in the general population: 68.95 ± 13.69 years versus 59.18 ± 17.11 years, P < 0.001. Of note, the mean age of HD patients in Russia is 56.3 ± 11.7 years. The proportion of men among hospitalized HD patients with COVID-19 reached 50.4% versus 43.5% in the general population. HD was associated with a significant increase in the risk of critical but stable and extremely critical (+ worsened: terminal and clinical death) condition at admission (Figure 1A): RR = 3.36 [95% confidence interval (95% CI) 3.12-3.59], P < 0.001 and RR = 4.83 (95% CI 3.93-5.92), P < 0.001, respectively. HD patients were significantly more likely to need for any kind of respiratory support (oxygen mask and mechanical ventilation (MV)) or MV alone (Figure 1B): RR = 1.72 (95% CI 1.63-1.81), P < 0.001 and RR = 4.67 (95% CI 4.18-5.21), P < 0.001, respectively. HD was associated with a significant increase in the risk of death (Figure 1C): RR = 3.48 (95% CI 3.24-3.72), P < 0.001. HD significantly increased the risk of death in patients without oxygen support and in patients with need for an oxygen mask (Figure 2A): RR = 3.56 (95% CI 2.97-4.25), P < 0.001 and RR = 2.47 (95% CI 2.18-2.78), P < 0.001, respectively. For patients requiring MV, mortality was >95% in both cohorts: RR = 0.999 (95% CI 0.955-1.01), P = 0.309. Deceased patients were older than survivors both in HD patients [73 (IQR 65-82) versus 69 (IQR 59-78) years;P < 0.001] and in the general population [72 (IQR 63- 82) versus 60 (IQR 48-69) years;P < 0.001], however, the difference between medians was significantly greater in the general population: 13 (95% CI 12-14) versus 5 (95% CI 3-6) years. Heart and lung diseases increased the risk of death. In the general population concomitant heart diseases worsened the prognosis to a greater extent compared with lung diseases: RR = 2.69 (95% CI 2.64-2.74), P < 0.001 and RR = 1.3 (95% CI 1.26-1.35), P < 0.001, respectively. In HD patients pre-existing lung diseases had a greater impact on the risk of death than heart diseases: RR = 2.02 (95% CI 1.71-2.41), P < 0.001 and RR = 3.05 (95% CI 2.73-3.41), P < 0.001, respectively. In the multivariate model, significant predictors of death in HD patients were need for MV (OR = 9.81, 95% CI 8.48-17.8;P < 0.001) and lung diseases (OR = 2.92, 95% CI 1.92-5.42;P < 0.001], but not heart diseases, age and gender. CONCLUSION: HD patients with COVID-19 have a significantly worse prognosis compared with the general population. The main risk factors for death are need for respiratory support and pre-existing lung diseases.

Renal service during the covid-19 pandemic (association of nephrologists position statement)

The editorial touches upon the problem of the possible impact of COVID-19 on CKD patients, mediated by the forced reorganization of the health care system in a whole, the redistribution of its resources in the context of the COVID-19 pandemic. Lack of regular outpatient monitoring, delayed diagnosis and therapy in patients with kidney dysfunction are factors of adverse clinical outcomes - accelerated disease progression, ESKD development and the need for KRT, life-threatening complications, reduced quality of life and survival. The data of a pooled analysis of the impact of the pandemic on specialized renal care and its availability in a number of regions of the Northwest Federal District of Russia and the Moscow Region are presented: a fall in hospital admissions, outpatient consultations and a decrease in the use of hospital beds (on average, by 37 %, 40 % and 32 %, respectively). Principles and conditions of the functioning of health systems associated in the COVID-19 pandemic have been discussed. The main approaches to maintaining the standard level of renal patients care have been formulated, aimed at preventing an unfavorable patient-oriented CKD outcomes. © 2021 Patristica et Mediaevalia. All rights reserved.