ABSTRACT
BACKGROUND AND AIMS: COVID19 worldwide crisis has shown the fragility of usually overbooked hospital care, encouraging improvements on the homecare and remote monitoring of patients. IMUP (Intelligent Manager for Ubiquitous Personal Mobile Care) is a Mobile App developed by UPM to follow up chronic kidney disease (CKD) patients affected with COVID19. METHOD: CKD patients (or their home caregivers) with access to a mobile phone were asked to introduce daily their symptoms (headache, tiredness, short of breath, cough and diarrhea) in addition to blood pressure and temperature. IMUP also allowed: (1) free asynchronous message exchange between patients and physicians, (2) provided general information and guidelines to reduce household COVID19 transmissions, (3) countdown of isolation days, and (4) notified alarms and alerts. All patients consented to a mobile phone monitor. Physicians categorized clinical situations reviewing IMUP symptoms into: (1) stable, (2) alert, and (3) presential assistance advised. RESULTS: A total of 38 patients (9 kidney transplant, 23 haemodialysis, 3 peritoneal dialysis, 3 low clearance)( 58.8% male, age 62.2±15.6 years, 17.6 % diabetics) with confirmed COVID19 infection were followed up with IMUP, 23 after hospitalization (median of 10 [4-16] days) and 15 with complete outpatient follow-up. The mean follow-up with IMUP was 8 [4,17] days. Four houndred and seven daily symptoms were introduced in IMUP, being tiredness the commonest (27%), followed by cough (21.5%) and diarrhea (20.6%). Reviewing IMUP daily symptoms, 185 clinical situations were categorized in stable and 21 alert. Five patients required presential assistance, 3 of them requiring hospital admission (1 rehospitalization). 81 messages were exchanged, delivering 17 therapeutic recommendations. IMUP countdown helped to organize isolation on the HD unit (cases and contacts), plus follow up with chest X rays and blood samples. CONCLUSION: The easy and intuitive use of mobile apps makes them widely accepted by the general population. Remote monitoring by mobile phone apps brings a new opportunity to alleviate our overbooked hospital care. Besides, remote monitoring could help to stratify and organize clinical follow up, allowing a closer communication between physicians and patients.
ABSTRACT
BACKGROUND AND AIMS: End-stage renal disease patients on haemodialysis (HD) seem more likely to develop severe COVID19 disease. Over the course of COVID disease, we observed a poor tolerance to HD sessions with a marked tendency of clinical deterioration over them. The objective is to evaluate changes on immunological system over HD session on patients affected with COVID19 compared with patients without COVID19. METHOD: Fourteen HD patients were studied including 9 confirmed COVID19 infection and 5 healthy controls. Predialysis and postdialysis blood samples were compared to study alterations on immune status. We identified cytoKines by Luminex (CCL2, CXCL10, IL1Ra, IL10, IL12p70, TNFa, IL17Ra, IL6, IL7) and adaptive lymphocyte subsets (CD4/CD8 naïve, CD4/CD8 MC, CD4/CD8 MP, CD19, CD56). Monocyte subsets (CD14+CD16-, CD14+CD16+, CD14-CD16+) were detected from peripheral blood mononuclear cells (PBMC), as well as immune activation (CD11b, HLA-DR, CD86) and migration factors (CCR2, CCR5). The supernatant of isolated CD14+ cells after 4-hour stimulation with LPS where analysed by Luminex to measure cytokines (CCL2, CXCL10, GM-CSF, IL10, IL12p70, IL17Ra, IL6, IL7, TNFa). RESULTS: Patients with COVID19 presented predialysis: (1) higher plasmatic levels of IL12p70, TNFa e IL7, (2) lymphopenia and neutrophilia, (3) higher percentage of intermediate monocytes and lower of non-classical, (4) lower membrane expression of CCR2, HLA-DR y CD86 over Cd14+ cells, and (5) higher production of CCL2, GMCSF, IL10, IL12p70 y IL17Ra by LPS stimulated monocytes compared with patients without COVID19. When analysed the fold-change between pre and postdialysis values, patients with COVID19 infection present a: (a) higher plasmatic levels of IL6, IL1Ra, CCL2 e CXCL10, (b) reductions of total lymphocites, (c) higher membrane expression of CCR2, CD33 y CD86 on CD14+ cells, and (d) higher production of TNFa, GM-CSF, IL10, IL17, IL6 e IL7 by LPS stimulated monocytes compared with patients without COVID19. No differences on lymphocite subset were found. CONCLUSION: The clinical deterioration on COVID19 infected patients over HD session could be related with monocyte activation and pro-inflammatory cytokines secretion.
ABSTRACT
BACKGROUND AND AIMS: Changes on body composition have an impact on the survival of haemodialysis (HD) patients. The aim of the study was to determine the impact of the reduction of physical activity due to COVID19 lockdown on body composition in HD patients. METHOD: Retrospective and observational study including 149 HD patients. Nutritional and Bioimpedance spectroscopy (BIS) data were recorded before and after COVID19 lockdown (mean of 148±20 days between determinations). RESULTS: Over the 49 days of COVID19 lockdown, we observed a decrease in normohydrated weight (NHW) of 1.01±3.59 kg mainly secondary to a reduction on total body water (TBW) 0.95±3.78 L (extracellular water 0.45±1.58 L and intracellular water 0.41±2.36 L). There was also a small loss on lean tissue index (LTI) of 0.28±2.42 kg/m2, with an increase of fat tissue index (FTI) 0f 0.02±2.82 kg/m2. Twenty-three patients presented COVID19 infection, of which 21 required admission (median of 10 [4-16] days). Patients who presented COVID19 were older (70.7±12.0 vs 64.9±16.6 years, NS) with higher Charlson index (7.48±2.77 vs 6.33±2.65, p = 0.07). Patients with COVID19 infection presented a greater loss on LTI (-1.18±3.15 bs-0.16±2.30 kg/m2;p = 0.22), FTI (-0.41±3.38 vs 0.06±2.74 kg/m2;p = 0.54);BMI (-1.49±2.14 vs-0.25±0.96 kg/m2;p = < 0.01) and NHW (-4.00±6.33 vs-0.62±2.90 kg;p = < 0.01) compared to patients without COVID19 infection. The length of hospitalization was associated with greater loss of BMI and NHW, resulting, therefore, in overhydration. There also had lower serum phosphorus (3.6±0.8 vs 5.2±0.8 mg/dl;p = 0.01) and serum albumin (3.5±0.4 vs 4.0±0.1 g/dl;p = 0.01). Seven patients died during hospitalization. Deceased patients were older (78.4±6.6 vs 67.4±12.4 years;p = 0.01), presented higher comorbidity (estimated by Charlson index 10.0 [8.0-11.0] vs 6.5 [4.3-8.0];p = 0.02) and were more overhydrated (3.4±3.6 vs 1.9±1.9;p = 0.34). Although not statistically different, they had lower LTI (10.4±2.1 vs 12.0±3.4 kg/m2;p = 0.18) and lower serum albumin (3.4±0.6 vs 3.9±0.4 g/dl;p = 0.08) compared to survivors. Patients who survived COVID19 infection had longer hospitalization (57% were discharged between twelfth and forty third day;mean hospitalization 14.6±11.5 days). Deceased patients died within the first 12 days of hospitalization (6.8±4.1 days). CONCLUSION: COVID19 lockdown induced a weight reduction on HD patients due to decrease in total body water. COVID19 infection increased this reduction, inducing greater loss on lean and fat tissue composition. Moreover, COVID19 impact on body composition was magnified with the length of hospitalization.