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1.
Swiss Medical Weekly ; 152(Supplement 266):11S, 2022.
Article in English | EMBASE | ID: covidwho-2207816

ABSTRACT

Background: Previous American studies suggest that dialysis patients want dialysis caregivers to discuss spirituality and mobilize appropriate spiritual resources. Whether this also applies to the Swiss dialysis population, and whether patients' spiritual experiences contribute to their coping mechanisms is unknown. The objective of this pilot study was therefore to explore the spiritual expectations of hemodialysis patients in a Swiss Dialysis Center. Methods or Case description: An experienced sociologist (SM) conducted 20 qualitative, semi-structured interviews with dialysis patients in the ambulatory chronic dialysis unit of the University Hospital of Lausanne. Among the questions asked were: Do you have any spirituality, religion, belief, or interest in broader existential issues? If so, which one(s)? Did the COVID-19 pandemic influence your spiritual practices? Would you like health professionals to take note of what you have just told me? All interviews were recorded, transcribed, and then coded and analyzed with Atlas.ti software. Results or Learning points: In total, 14/20 (70%) patients practiced some form of religion (believers), 4 were agnosts, and 2 defined themselves as atheist. The majority (75%) consider that spirituality can play a positive role to preserve hope and to manage the difficulties caused by the disease and its treatment. However, only 25% of believers would appreciate support of a spiritual nature from dialysis caregivers. The majority of those who have spiritual practices wish to keep it private and outside the hospital structure. Their relationship to spirituality has generally not been significantly impacted by their changing health status, or the COVID-19 pandemic. The most frequently mentioned needs are related to social dimensions (isolation, loneliness, need to talk, financial problems). Conclusion(s): In this pilot study, the majority of Swiss dialysis patients did not express the wish to discuss more often spiritual issues with dialysis caregivers, but they would appreciate more attention for social and socio-economic difficulties.

2.
Swiss Medical Weekly ; 152(Supplement 266):39S, 2022.
Article in English | EMBASE | ID: covidwho-2207728

ABSTRACT

Background: Dialysis quality ismeasured by Kt/V, it is one of the most important parameter for assessing hemodialysis for patients. Decreased Kt/V is associated with increased mortality and increased risk of complications, normal or increased Kt/V is associated with decreased mortality and complication rates. Guidelines have recommended Kt/V of 1.2 as the minimum dose for thrice-weekly HD. We analyzed the Kt/v, mortality and risk of complications in our hemodialysis center patients Methods or Case description: We analyzed patients from 2021-2022, within 1 year 50 patients undergoing hemodialysis 3 times a week were analyzed. Results or Learning points: The average Kt/V was 1.38. Patient mortality was minimal during this period and was related to Covid 19 infection, 3 patients died, one from sepsis and two from Covid 19 infection. 5 patients were hospitalized several times with hyperhydration and accompanying consequences, which were not related to dialysis, but with non-compliance with the regimen and increased fluid intake. Conclusion(s): In general, the patients felt satisfactory and there were no complaints. Therefore, it can be considered that Kt/V above 1.3 is satisfactory and reduces the risk of mortality and complications.

3.
Swiss Medical Weekly ; 152(Supplement 266):28S, 2022.
Article in English | EMBASE | ID: covidwho-2207627

ABSTRACT

Background: A recent Dutch study suggests that dialysis withdrawal has increased over the last years. The aims of this study were to investigate whether this is also the case in Switzerland, and to identify factors associated with withdrawal. Methods or Case description: In this retrospective study, data were retrieved from the Swiss Dialysis Registry (srrqap). Annual death rates and causes of death were analyzed between 2014-2021. We compared clinical characteristics of patients who were withdrawn for medical/other reasons or who withdrew from dialysis with those who had another cause of death and with those who stayed alive. Results or Learning points: A total of 7'246 incident patients on hemodialysis or peritoneal dialysis between 2014-2021 were included;of those, 2'325 patients died. In 2020, there was an above-average number of deaths, due to the coronavirus pandemic. Dialysis withdrawal because the patient refused further treatment represented 8.3-13.3% of all causes of death. Withdrawal by the patient did not increase throughout the study period, but withdrawal for medical/other reasons increased from 6.2 to 8.9% (see figure). Patients who died because of withdrawal from dialysis were significantly older and longer on dialysis than those with other causes of death, and had suffered less often from COVID-19. In multivariate regression analysis adjusted for age, sex, and Charlson score, testing negative for coronavirus was the only factor associated with withdrawal by the patient, whereas withdrawal for medical or other reason was also associated with higher age. Conclusion(s): Unlike the Netherlands, dialysis withdrawal is not the leading cause of death in Switzerland, and withdrawal by the patient has not increased, not even during the COVID-19 epidemic. However, the percentage of patients who was withdrawn for medical/other reasons increased during this period, for unclear reasons. The only risk factors for withdrawal were higher age and - surprisingly - testing negative for the coronavirus.

4.
Blood Purification ; 51(Supplement 2):36, 2022.
Article in English | EMBASE | ID: covidwho-2214198

ABSTRACT

Background: Lung-protective ventilation (LPV) with low tidal volumes (TV), aimed to reduce ventilator-induced lung injury, is one of the cornerstones in the treatment of acute respiratory distress syndrome (ARDS), including that secondary to Coronavirus disease 2019 (COVID-19). To allow LPV, and avoid the risk of progressive hypercapnia and respiratory acidosis, a wide range of extracorporeal CO2 removal (ECCO2R) techniques have been developed. These treatments may be performed alone or in combination with other organ support therapies. Here, we report our experience with a pregnant woman with multiorgan failure (MOF), occurring as a sequela of COVID-19, who was successfully treated with ECCO2R coupled with continuous renal replacement therapy (CRRT). Case Presentation: A 34-year-old pregnant patient at the 16th gestational week affected by COVID-19 was admitted for dyspnea, rapidly complicated by MOF. Because of concomitant hypercapnia and acute kidney injury the patient was treated with an ECCO2R membrane inserted in series after a hemofilter in a common CRRT platform. ECCO2R was provided using a polymethyl pentene, hollow fiber, gas-exchanger membrane of 1.35 m2. ECCO2R+CRRT was set in continuous venovenous hemodialysis (CVVHD) mode with blood flow of 300 mL/min and a sweep gas blood flow of 5 l/min. Systemic anticoagulation was obtained by continuous administration of unfractionated heparin (UFH), with a target activated partial thromboplastin time (aPTT) of 70-80 seconds. (In table 1, ventilatory and hemodynamic parameters collected during ECCO2R+CRRT treatment are reassumed). The combined treatment was effective in reducing hypercapnia, allowing the maintenance of LPV. Moreover, it was associated with the hemodynamic stability of both mother and fetus and it was well-tolerated. Anyway, the treatment was complicated by minor bleeding episodes mainly linked to the anticoagulation required to maintain the patency of the extracorporeal circuit. After ECCO2R+CRRT termination, the patient progressively recovered pulmonary and kidney function, so that it was possible to withdraw any support therapy. Moreover, she underwent a preterm spontaneous vaginal delivery of an alive baby. Conclusion(s): Our case supports the use of ECCO2R+CRRT as a suitable approach in complex patients, including those with severe COVID-19, being aware of the potential complications linked to this treatment.

5.
Blood Purification ; 51(Supplement 2):35, 2022.
Article in English | EMBASE | ID: covidwho-2214195

ABSTRACT

Background: Occurrence of acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) in patients with Coronavirus disease-19 (COVID-19) is associated with an elevated mortality rate. However, due to the high clinical impact, the COVID-19 has been the object of extensive studies that have potentially changed disease presentation and outcomes. In this regard, the development of vaccination has shown high effectiveness in preventing severe disease, hospitalization, and death related to COVID- 19. Thus, this study aimed at investigating whether any difference exists in clinical presentation, management, and mortality of COVID- 19 critically ill patients requiring CRRT before and after the vaccination campaigns. Method(s): We performed a retrospective study on critically ill adult COVID-19 patients with AKI undergoing CRRT in the Intensive care Unit (ICU) before (from March 2020 to March 2021- 1st Group) and after (from April 2021 to March 2022- 2nd Group) the availability of COVID-19 vaccines. Result(s): Overall, we considered 111 patients, aged 64 (62-65) years, 75.7 % males. The main comorbidities were diabetes (DM), lung diseases, cardiovascular disease, and hypertension. Among them, 88 (79%) were in 1st and 23 (21%) in the 2nd group, respectively. The 2nd group included 5 (22%) patients vaccinated against COVID-19, a percentage significantly lower than that reported for the Italian age-matched general population (i.e. 84.4%) There were no significant differences in general characteristics, such as in comorbidities, except for a higher prevalence of hypertension in the 1st group. Lab examinations at ICU admission were similar between the two groups except for procalcitonin and lactate dehydrogenase, which were higher in the 2nd group. While ventilation strategies were not different between the two groups, ECMO was used in a significantly higher number of patients in the 2nd group (30 vs 4%, p<0.001). Regarding specific drug therapy, while hydroxychloroquine was abandoned in the 2nd group, the use of heparin significantly increased, and monoclonal antibodies were introduced in the clinical practice (and prescribed in 4/23 patients of the 2nd group). CRRT was mostly provided according to CVVHD modality (about 87% in both groups) and sepsis devices were used in 45.4 and 56.5% of the 1st and the 2nd group, respectively. Looking at the outcomes, in terms of length of ICU stay and mortality, we found no significant difference between the two groups. Indeed, 58 (66%) and 15 (68%) patients died in ICU in the 1st and the 2nd group, respectively. Finally, considering the whole population at multivariate Cox regression, the length of ICU hospitalization, days on CRRT, invasive ventilation, and DM were independently related to the 90-day mortality rate. Conclusion(s): Despite the recent acquisitions and progress in COVID-19 pathogenesis and management, when compared with patients undergoing CRRT during the first phases of the pandemic, patients critically ill COVID-19 requiring CRRT after the availability of vaccines presented similar clinical characteristics and poor outcomes. This population was characterized by a low vaccination rate when compared with the general population, suggesting that this factor could be a key determinant of the clinical course of these patients. These data further reinforce the concept that in absence of established effective treatments, the most useful strategy to reduce COVID-19-related mortality is constituted by the prevention of the severe form of the disease, through the wide diffusion and universal implementation of vaccines.

6.
Blood Purification ; 51(Supplement 2):58, 2022.
Article in English | EMBASE | ID: covidwho-2214190

ABSTRACT

Background: Acute kidney injury (AKI) is frequent in critical ill patients and around 20% of patients admitted to intensive care unit (ICU) require continuous renal replacement therapy (CRRT). In our center, during the first pandemic wave, we observed severe metabolic acidosis associated with a worsening of respiratory function in our COVID-19 patients receiving continuous hemodialysis (CVVHD) and hemodiafiltration (CVVHDF). The aim of the study is to assess the association between arterial blood gas (ABG) data and haemodynamic parameters in COVID-19 patients receiving CVVHD or CVVHDF. Regional citrate anticoagulation was applied for all CRRT treatments. Our hypothesis was that hypoperfused patients could face a reduced metabolic and hepatic activity, making them unable to metabolize the citrate to bicarbonate, worsening their acidosis instead of correcting it. Method(s): This is a retrospective, observational study. It includes 10 COVID-19 patients hospitalized at the ICU of the Bufalini Hospital of Cesena (Italy) from the 11th of March to 26th of April 2020 and treated with CRRT. Overall, 28 CRRT treatments were analysed and patients were divided in two groups: 1) Hypotensive Group (MAP < 70 mmHg);2) Non Hypotensive Group (MAP> 70 mmHg). ABG and MAP data were recorded pre and post-treatment. Patients with severe or worsening metabolic acidosis (pH < 7.3) pre-CRRT were defined as "non-adjusters". Result(s): A number of 9 (50%) hypotensive patients were able to correct their acidotic status, while (70%) of normotensive patients were able to improve their pH. The number of patients and treatments is too low to calculate p-value. In 28 CRRTs performed, 16 (57%) corrected their pH. (57%), while 12 (43%) severe acidosis were refractory to the treatment. Eighteen patients (64%) presented hypotension, 10 (36%) presented with normal pressure levels (MAP>65mmHg). In hypotensive patients,mean pre-CRRT pH value was 7,31 (+/-0,07) with BE mean value-3,4 (+/-2,7);in non-hypotensive group the pre- CRRT mean pH value was 7,33 (+/-0,01) with BE mean value-2,67 (+/-4,7). Mean lactate levels in the hypotensive group were 1,26 (+/-0,6), in the non hypotensive group the mean value was 1,6 (+/-0,74). Conclusion(s): In COVID19 patients, the impairement of organ perfusion might reduce the ability of the liver to metabolise citrate, worsening metabolic acidosis. The use of CRRT with lactate-buffered fluids in some cases might not be helpful, leading to further increases in lactate levels.

8.
Clin J Am Soc Nephrol ; 2022 Oct 14.
Article in English | MEDLINE | ID: covidwho-2198191
10.
Turkish Journal of Medical Sciences ; 52(6):1762-1770, 2022.
Article in English | EMBASE | ID: covidwho-2207223

ABSTRACT

Background/aim: There is limited data on COVID-19 disease in children with kidney disease. We aimed to investigate the characteristics and prognosis of COVID-19 in pediatric nephrology patients in Turkey. Material(s) and Method(s): This was a national, multicenter, retrospective cohort study based on an online survey evaluating the data between 11th March 2020 and 11th March 2021 as an initial step of a detailed pediatric nephrology COVID-19 registry. Result(s): Two hundred and three patients (89 girls and 114 boys) were diagnosed with COVID-19. One-third of these patients (36.9%) were between 10-15 years old. Half of the patients were on kidney replacement therapy: kidney transplant (KTx) recipients (n = 56, 27.5%), patients receiving chronic hemodialysis (n = 33, 16.3%) and those on peritoneal dialysis (PD) (n = 18, 8.9%). Fifty-four (26.6%) children were asymptomatic. Eighty-two (40.3%) patients were hospitalized and 23 (28%) needed intensive care unit admission. Fifty-five percent of the patients were not treated, while the remaining was given favipiravir (20.7%), steroid (16.3%), and hydroxychloroquine (11.3%). Acute kidney injury developed in 19.5% of hospitalized patients. Five (2.4%) had MIS-C. Eighty-three percent of the patients were discharged without any apparent sequelae, while 7 (3.4%) died. One hundred and eight health care staff were infected during the study period. Conclusion(s): COVID-19 was most commonly seen in patients who underwent KTx and received HD. The combined immunosuppressive therapy and frequent exposure to the hospital setting may increase these patients' susceptibility. Staff infections before vaccination era were alarming, various precautions should be taken for infection control, particularly optimal vaccination coverage. Copyright © TUBITAK.

11.
Giornale di Clinica Nefrologica e Dialisi ; 34:80-86, 2022.
Article in Italian | EMBASE | ID: covidwho-2206066

ABSTRACT

From the analysis of the national and international literature and considering the socio-demographic changes, it is necessary to rethink the organizational models capable of giving concrete answers to the new health and welfare needs of the population. The progressive increase of the elderly population and of people with at least one chronic disease and the SARS-CoV-2 pandemic have highlighted the need for a health and social system close to the population, which increases the territorial assistance, in particular at the patient's home. Home care must become an elective place for prevention and health promotion activities. PNRR funds for proximity networks, telemedicine and innovation in the health field will enable assistance to be directed towards a new organizational and operational perspective, where the family and community nurse will play a key role. In the care of patients on home dialysis the evidence described in the literature reports the benefits of home hemodialysis treatment, in which the nurse of the family and community through his care skills, technical and psychological counselling, tele assistance and e-health can be integrated into the home care path, assisting the patient and the family unit and supporting them in the different health needs, especially in the quality of life outcome. Copyright © 2022 The Authors.

12.
Infectious Diseases: News, Opinions, Training ; 11(4):38-46, 2022.
Article in Russian | Scopus | ID: covidwho-2206016

ABSTRACT

Patients with end-stage kidney disease undergoing hemodialysis have one of the highest COVID-19 mortality rates. The use of innovative methods capable of optimizing their treatment outcomes is important for clinical practice. Aims – to investigate the efficacy and safety of neutralizing monoclonal antibodies in COVID-19 patients treated with hemodialysis. Material and methods. We conducted a retrospective controlled single-center study with 102 COVID-19 patients on maintenance hemodialysis involved (M: 67;65.7%;W: 35;34.3%), aged 57.2±15.3 years. PCR-detected SARS-CoV-2 infection was diagnosed in all patients. Neutralizing monoclonal antibodies were administered to 69 patients, who formed the study group (group 1). The control group included 33 patients (group 2). The combination of bamlanevimab and etesevimab was the most frequent therapy used (in 59 patients). Results. In the course of the disease, group 1 patients, compared to those of group 2, had statistically significantly higher blood oxygen saturation values (94.2±5.7 vs 89.8±10.7);they required less frequent oxygen support (29.0 vs 54.5%) and ICU treatment (18.8 vs 48.5%), respectively. Fatal outcomes occurred in 4 (5.8%) of 69 patients who received neutralizing antibodies and in 6 (18.2%) of 33 patients who did not receive the therapy, p<0.05. Except for one patient, all other patients in both groups developed an unfavorable outcome due to progressive lung damage. However, only 4 of 6 (2/3) patients with progressive lung damage died in group 1, whereas the similar course of the disease proved fatal in all cases in group 2. Conclusion. The use of neutralizing monoclonal antibodies in hemodialysis patients is safe and effective when the drugs are administered early, the pulmonary process progression is insignificant and dominant SARSCoV-2 variants are sensitive to them. © 2022 Tomsk Polytechnic University, Publishing House. All rights reserved.

13.
Ukrainian Journal of Nephrology and Dialysis ; - (4):43-50, 2022.
Article in Ukrainian | Scopus | ID: covidwho-2205786

ABSTRACT

Hemodialysis patients (HD) are at high risk for coronavirus infection (COVID-19) and associated adverse outcomes compared with the general population. Although vaccination against SARSCoV-2 has played an important role in stemming the spread of COVID-19 in the general population, the characterization of vaccine efficacy in dialysis patients is based primarily on humoral responses, whereas clinical data are generally not available. The aim of this study was to determine the incidence of COVID-19, clinical outcomes, and risk factors for SARS-CoV-2 infection in fully vaccinated HD patients. Methods. Of 186 HD patients treated at Link-Medital LLC Medical Center (Odesa, Ukraine) between March 2020 and March 2022, 170 patients aged 53.5 (44-63.5) years were enrolled in this prospective observational cohort study and followed up one year after completion of vaccination. Among them were 67 (39.4%) HD patients who were fully vaccinated against COVID-19 with BNT162b2 (Pfizer-BioNTech) or Moderna-mRNA-1273 mRNA vaccines and 103 (60.6%) unvaccinated HD patients. The outcomes assessed were COVID-19 morbidity and severity, hospitalization, and death associated with COVID-19. Results. During the 12-month follow-up, nearly half of 83/170 (48.8%) patients became infected with SARS-CoV-2, including 18/67 (26.7%) vaccinated patients and 65/103 (63.1%) unvaccinated patients (χ2 = 10.8;p = 0.001). The incidence rate of COVID-19 was 27 (95% CI 16, 42) in vaccinated patients at our center and 63 (95% CI 49, 80) per 100 patient-years (p = 0.001) in unvaccinated patients. Cox proportional hazards regression analysis showed that vaccinated HD patients had a statistically significant lower risk of hospitalization [HR = 0.2 (95%CI 0.1;0.4)] and need for oxygen support [HR = 0.19 (95%CI 0.09;0.38)] compared with unvaccinated patients. Kaplan-Meyer analysis of COVID-19-associated mortality demonstrated a significantly higher survival of vaccinated HD patients compared with unvaccinated (χ2 = 4.6, log-rank p = 0.03). Further multivariate logistic analysis showed that age over 65 years, obesity, low adequacy of HD and duration of more than 5 years, anemia, low levels of parathyroid hormone (PTH) and high-density lipoprotein cholesterol (HDL-C), elevated CRP, arterial hypertension, and other cardiovascular diseases (CVD) significantly increased the risk of SARS-CoV-2 infection in fully vaccinated HD patients. Conclusions. Vaccination against COVID-19 is associated with a reduction in morbidity, hospitalization rates, and mortality in HD patients. Age over 65 years, obesity, low adequacy of HD and its duration of more than 5 years, anemia, low PTH and HDL-C levels, elevated CRP, arterial hypertension, and other CVDs significantly increased the risk of SARS-CoV-2 infection in fully vaccinated HD patients. © A. Rysyev, I. Poperechnyi, D. Chernianu, V. Filonov, S. Pyankovskyi, A. Khyzhuna, 2022. All rights reserved.

14.
Cureus Journal of Medical Science ; 14(12), 2022.
Article in English | Web of Science | ID: covidwho-2203396

ABSTRACT

Introduction: Acute kidney injury (AKI) is frequently reported in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of our work is to evaluate the impact of acute dialysis use on mortality in patients with AKI during the coronavirus disease 2019 (COVID-19) pandemic.Methods: This is a retrospective study conducted in the Hassan II University Hospital of Fez, Morocco. From July 2020 to December 2021, we included all patients admitted to a COVID-19 unit with acute kidney injury defined according to Kidney Disease Improvement Global Outcomes 2012 (KDIGO 2012) criteria. Our patients were older than 18 years , SARS-CoV-2 infection was confirmed by a positive RT-PCR test or thoracic CT scan imaging. Patients with end-stage renal disease (ESRD) , pregnant women were excluded from our study. Results: The total number of patients hospitalized in the COVID-19 unit during the study period was 2560, including 206 in an intensive care setting. We included 61 patients with AKI, with an incidence in the intensive care unit (ICU) setting of 15.5%. Eighty percent of patients had respiratory distress on admission, which was the main reason for consultation. Stage 1 AKI was found in 1.6% of patients, 25.8% had stage II AKI, and 72.6% had KDIGO stage 3 AKI. The main etiology of AKI was acute tubular necrosis. Lung involvement secondary to infection was severe in 18 patients;21 had moderate involvement. In our study, twenty-one of our patients (34.4%) were hospitalized in an ICU. Thirteen of our patients were intubated (21.1%). Twenty-one (34.4%) patients were hemodynamically unstable and were put on vasoactive drugs. Twenty-three (37.7%) of our patients received at least one session of conventional acute hemodialysis with an average duration of 2.1 hours +/- 0.9 (1-3.5). The indication was overload (27%), severe metabolic acidosis (1.6%), threatening hyperkalemia (1.6%), and symptomatic hyperuremia (62%). The evolution was marked by a return to baseline renal function in two patients, partial improvement in 35 of them at discharge, and no improvement in 24 patients. We recorded a death rate of 34.4% (n=21). In a univariate analysis, we compared the demographic, clinical, paraclinical, and dialytic characteristics of the dialysis and non-dialysis groups. There was a significant difference between unstable, intubated patients and those hospitalized in the ICU in the dialysis group, with respective p-values of p=0.0001, p=0.0001, and p=0.01. We noticed there were more deaths in the dialysis group than in the non-dialysis group;this difference was statistically significant with a p-value of 0.005. In multivariate analysis, a logistic regression model was performed to test the relationship between dialysis and COVID-19 mortality while adjusting for other co-factors. The final model did not show a significant association between dialysis and mortality (p = 0.150, OR: 2.578 [0.710-9.364]). The only factor that remained independently significant was admission to the intensive care unit (p = 0.004, OR: 6.732 [1.847-24.540]).Conclusion: AKI is a frequently encountered complication in patients with COVID-19, especially those hospitalized in the ICU. In the context of the SARS-CoV-2 infection, the use of at least one dialysis session seems to represent an excess risk of mortality related to AKI.

15.
Journal of Imab ; 28(4):4735-4737, 2022.
Article in English | Web of Science | ID: covidwho-2202663

ABSTRACT

Purpose: Since its inception in early 2020, COVID-19 has quickly become a pandemic, killing more than six million people worldwide. The aim of this study is to in-vestigate the morbidity and mortality of COVID-19 in one Bulgarian hemodialysis center. Materials and methods: The study is retrospective, conducted for the period of 25th Apr 2020 - 31st Dec 2021. The mean annual number of hemodialysis patients was 184, including patients with end-stage renal disease and acute renal failure. The total number of patients with COVID-19 was 78 (42%), 49of which (63%) were males, the average age was 60 years (+/-12.1 years). Results: There was no significant difference between the mean age of patients divided by sex (p=0.069). A total of 33 people died (42%), 17 of whom (51%) were males. The average age of the deceased patients (64.24 +/-10.846) was higher than that of the survivors (58.44 +/-12.286), and the difference was significant (p=0.034). There was no sig-nificant difference in the mean age of survived and de-ceased males (p=0.74) but for females, the difference was statistically significant - the mean age of survivorswas 55.00 (+/-12.03)and of the deceased patients was 67.6 (+/-8.79) years. Conclusion: Our results confirm data from similar studies aboutthe high incidence and mortality of COVID-19 in hemodialysis patients. We confirma statistically sig-nificant increase in mortality of these patients with increas-ing age. Probably the mass vaccination of patients and staff;the use of antiviral drugs and biological therapy is the way to reduce morbidity and mortality among them.

16.
Indian Journal of Nephrology ; 32(7 Supplement 1):S125, 2022.
Article in English | EMBASE | ID: covidwho-2201598

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 is a highly transmissible and pathogenic coronavirus that emerged in late 2019. This has been posing great threats to the world in many aspects. Comprehensive understandings on SARS-CoV-2 and the interaction of the virus with hosts are fundamentally important in the fight against SARS-CoV-2. SARS-CoV-2 is a positive-sense single-stranded RNA virus. The purpose of this study is to assess the clinical profile of ESRD patients undergoing maintenance hemodialysis with COVID-19 infection. Patients with Chronic Kidney Disease on hemodialysis are at an increased risk for any infections and often have unfavorable outcomes in case of serious infections. Here we present the data regarding the outcome of maintenance hemodialysis patients who had COVID 19 infection. AIM OF THE STUDY: To study incidence of COVID 19 infection and clinical profile in Chronic Kidney Disease -Maintenance hemodialysis patients METHODS: This is single-center cross-sectional observational study conducted at Amrita Institute of Medical Science and Research Centre Kochi between March 2020 to August 2022. All patients on maintenance hemodialysis who developed COVID19 infection was included in the study. Patients who become COVID positive were managed as per institutional COVID 19 protocols. Only patients who received 2 doses of COVID 19 vaccine and crossed 14 days after second dose of vaccination were considered as vaccinated in the study population. RESULT(S): The incidence of COVID 19 infection among our maintenance hemodialysis patients was 56%. 62 out of our 110 maintenance hemodialysis patients were COVID 19 positive. Majority were males, hypertension was common among this population. 30% developed COVID-19 pneumonia. 90% of the study population were vaccinated, 75% of them were infected after 6 months of taking second dose of COVID 19 vaccine. 88% of the vaccinated patients had only mild infection. The mortality was 31%. There was no mortality in patients who received the cocktail antibody. CONCLUSION(S): The study shows that incidence of COVID 19 infection was high in our hemodialysis patients, frequent hospital visits and travel could be one of the reasons for the same. COVID 19 vaccination was effective especially during the first 6 months after the second dose of COVID 19 infection, it helps in reducing the severity of COVID 19 infection and has a good recovery rate. Cocktail antibody ( Casirivimab and imdevimab ) were effective in reducing the mortality rate in hemodialysis patients. More studies are warranted for scheduling further doses of COVID 19 vaccines in maintenance hemodialysis patients.

17.
Indian Journal of Nephrology ; 32(7 Supplement 1):S37, 2022.
Article in English | EMBASE | ID: covidwho-2201595

ABSTRACT

BACKGROUND: COVID-19 is primarily a respiratory tract infection, but it should be regarded as a systemic disease involving multiple systems including kidneys. The incidence of acute kidney injury in hospitalized patients with COVID-19 varies ranging from 10% in Indian subcontinent to 37-45% from Western studies. AIM OF THE STUDY: To study the incidence of acute kidney injury in patients hospitalized with COVID-19 infection. To study the risk factors for acute kidney injury in patients with COVID-19 infections. To study the impact of acute kidney injury on the outcomes in COVID19 infected patients. METHOD(S): All hospitalized COVID-19-infected patients diagnosed by RT-PCR and rapid antigen tests were included. Patients with structural abnormalities of the urinary tract renal transplant recipients patients on maintenance hemodialysis those with incomplete records and outpatients were excluded from the study. Variables analyzed included age, gender, comorbidities, vital signs S. Creatinine values. Urinary abnormalities mortality need for hemodialysis recovery of renal function and duration of hospital stay. RESULT(S): Out of the 400 patients in our study, 50 patients (12.5%) had acute kidney injury. Of theses 50 patients, 27 patients had acute kidney injury stage 1, seven had stage 2, and 16 had stage 3. There were 31 males and majority (41 out of 50 patients) were above 60 years of age. Diabetes mellitus was present in 45 out of 50 patients, 42 patients had systemic hypertension, 30 had coronary artery disease, and 16 had bronchial asthma. Thirty-six out of 50 patients had COVID-19 category B and 14 belonged to COVID-19 category C. Urinary abnormalities included albuminuria (42 patients), microscopic hematuria (16 patients), pyuria (21 patients) and normal in 3 patients. Most common urinary abnormality among the AKI group was proteinuria (84%), whereas in non-AKI group urine was bland in majority of cases. Hemodialysis was needed for 16 patients. Thirteen patients required vasopressor support, and 12 patients required ventilatory support. Twenty-nine patients had complete recovery, and 10 patients had partial recovery of renal functions and eleven patients expired (22% of those with AKI);the mortality in the non-AKI group was 6.5%. All those who died had AKI stage 3. CONCLUSION(S): Among COVID-19-infected patients, 12.5% had acute kidney injury with majority in AKI stage 1 (54%). Majority of the patients were males and elderly (>60 years). Most common comorbidity was diabetes mellitus, followed by systemic hypertension and coronary artery disease. Majority of patients belonged to COVID-19 category B (72%). Most common urinary abnormality was proteinuria (84%). Need for vasopressor support, duration of ICU stay, hospital stay, and mortality were more in the AKI group.

18.
Indian Journal of Nephrology ; 32(7 Supplement 1):S38, 2022.
Article in English | EMBASE | ID: covidwho-2201591

ABSTRACT

BACKGROUND: The Covid-19 infection has become a pandemic now. The rapidly changing morphology of the virus is a great challenge for accurate diagnosis management and for making effective preventive strategies. Understanding the development of neutralizing antibodies after vaccination in different subgroups of the population is important to curb the disease more so in CKD-HD group which is known for blunted immune response. As of now we have limited data regarding covid vaccinated CKD patient's protection status against SARS-COV-2 Virus. The recently published COVID-FRIAT study has presented a worrisome conclusion for CKD patients. It says that the antibody levels in patients on dialysis declining more rapidly than previously reported for the general population. AIM OF THE STUDY: AIM - This study is done to assess the development of covid neutralizing antibodies their adequacy and sustainability after vaccination in CKD-HD patients. Have analyzed the immune response according to the patient'S age, sex, comorbidities, adequacy of dialysis, and types of vaccine. METHOD(S): Material and method - Stage 5 CKD Patients who were on regular hemodialysis are selected for the study. Patients and vaccines related to various factors were recorded. Antibody level was checked by VIDAS II (9COG) kit which detects IgG specific for SARS COVID 2 Receptor Binding Domain (RBD) of the spike protein by ELFA (Enzyme-linked fluorescent assay) technique. The most patient had received either COVAXIN or COVISHIELD RESULTS: Result -The study confirms that CKD-HD patients are showing good responses after vaccination. The extraneous variables like gender, comorbidities didn't significantly affect the COVID-19 IGG antibodies formation The peak antibody level is seen around an average of 125 +- 25 days (4 months). The significant declining trend is seen around 225 +- 25 days (8 months). The robust response seen when the gap is around 100 days between 2 doses. Nonresponders were 66% in the no-vaccinated group, 23% in the single dose, and 5.88% in the double-dose group. CONCLUSION(S): Conclusion-Two dose regimen is helping in mounting better antibody response, but there is no significant effect on declining trend when compared to single vaccinated cohort. Both indigenously developed vaccines, Covaxin and Covishield are showing good and comparable efficacy.

19.
Indian Journal of Nephrology ; 32(7 Supplement 1):S132, 2022.
Article in English | EMBASE | ID: covidwho-2201588

ABSTRACT

BACKGROUND: Here we discuss a chronic kidney disease (CKD) patient with large pericardial effusion who arrested secondary to tamponade and had an unintentional pericardial decompression secondary to cardiopulmonary resuscitation (CPR) that subsequently saved his life. AIM OF THE STUDY: To bring to light management difficulties in chronic kidney disease patients undergoing maintenance hemodialysis with large pericardial effusion METHODS: 67-year-old male a case of CKD on maintenance hemodialysis (for last two years) but inadequately dialyzed over last two months after recent Covid pneumonia was detected to have large pericardial effusion on echocardiography. He was planned for intensive heparin-free dialysis in view of absence of frank clinical and echocardiographic findings of tamponade with close surveillance for pericardial effusion. 60 minutes into hemodialysis patient developed dyspnea hypotension and cardiac arrest. Return of spontaneous circulation was achieved after three cycles of cardiopulmonary resuscitation. Echocardiography (echo) guided pericardiocentesis was planned based on clinical suspicion of tamponade. But echocardiography revealed only mild pericardial effusion. Chest X-ray showed new left pleural effusion. Pleurocentesis revealed hemorrhagic fluid. Subsequently done CT thorax showed multiple rib fractures. Patient was discharged on day eleven in stable condition with repeat chest X ray and echocardiography showing no further collection. RESULT(S): Though cardiac tamponade is largely a clinical diagnosis, various other features like echocardiography aid in its diagnosis. Diagnosis of tamponade in CKD patient with pericardial effusion is difficult because of several reasons. All classical clinical features of tamponade like hypotension or elevated systemic pressures may not be manifested all the time in cases of tamponade. Our patient developed clinical signs of tamponade 60 minutes into dialysis session indicating that precipitation of tamponade was likely due to reduction in preload due to ultrafiltration (UF) during hemodialysis. Though, daily dialysis is the initial preferred treatment of choice for uremic pericardial effusions in CKD patients without clinical or echocardiographic signs of tamponade, there are case reports which support early pericardiocentesis as treatment of choice in all large pericardial effusions in CKD patients on maintenance hemodialysis (MHD). In our case of large pericardial effusion, due to absence of frank clinical/ echocardiographic evidence of tamponade, we were prompted to go for aggressive dialysis treatment plan, but had tamponade during dialysis. CPR can cause inadvertent injury to surrounding structures, ribs, abdominal organs, and vascular injury. In our case, CPR-associated injury leads to unintentional pericardial decompression probably due to rib injury or due to high force generated during CPR coupled with high pericardial pressures which overcame the tensile strength of pericardium resulting in pericardial decompression. Findings of fractured ribs on CT scan post-resuscitation in our case supports that high force and pressure were generated during CPR. CONCLUSION(S): This case report supports early pericardiocentesis as treatment of choice for large pericardial effusion in CKD patients on MHD. Also, care should be taken while dialyzing these patient as rapid UF can precipitate tamponade.

20.
Indian Journal of Nephrology ; 32(7 Supplement 1):S67, 2022.
Article in English | EMBASE | ID: covidwho-2201587

ABSTRACT

BACKGROUND: COVID-19 has been associated with high morbidity and mortality in renal transplant recipients. However, risk factors for COVID-19 disease in patients with kidney transplants remain poorly defined. The outcome following vaccination in renal transplant recipients is less reported. AIM OF THE STUDY: To assess effect of vaccination in renal transplant recipients with COVID-19 METHODS: We enrolled patients who underwent kidney transplantation at our center who tested positive for COVID-19 from the beginning of the pandemic till June 2022. Patients were screened for baseline and transplant characteristics functional parameters comorbidities immunosuppressive therapies vaccination status and treatment received. COVID-19 disease severity was assessed. Patients were followed up during the pandemic until June 2022 of those admitted or home quarantined via teleconsultation. Data was collected compiled and analyzed. RESULT(S): A total of 85 renal transplant recipients with COVID-19 infection were studied. The mean age was 42.5 years. Nine were not vaccinated, 11 had taken 1 dose of vaccination, and rest completed 2 doses of vaccination. 23 had received antibody cocktail, 65 survived, and 20 succumbed to COVID-19. A total of 48 of them had graft dysfunction, 22 had severe graft dysfunction requiring hemodialysis. Among those who expired only had received antibody cocktail, all of them had severe graft dysfunction and only 2 were not vaccinated. Among those who expired most expired in the second wave of the pandemic. CONCLUSION(S): Renal transplant recipients with COVID-19 have a high risk of mortality. Comorbidities like obesity, diabetes mellitus, asthma, and chronic pulmonary disease were associated with higher risk of developing COVID-19 disease. Effect of vaccination and outcome of COVID-19 infection in renal transplant recipients is under reported. There is risk of severe COVID-19 infection despite vaccination. Therefore, safety preventive measures to be continued. More work needed to find a definitive treatment for COVID-19 infection and much more efficacious vaccines and vaccination strategies to be designed.

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