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1.
Pan Afr Med J ; 37(Suppl 1): 51, 2020.
Article in English | MEDLINE | ID: covidwho-1143824

ABSTRACT

Patients on hemodialysis are a group at risk for infection with SARS-CoV-2 due to impaired immunity. Our knowledge of the specific characteristics of the disease in this population is limited. Our study aims to improve our understanding of diagnostic, therapeutic, and prognostic aspects of this disease. Seventy hemodialysis patients tested by RT-PCR positive for SARS-CoV-2 were hospitalized in the nephrology department from April 1 to September 30, 2020. The patients' average age was 60.3 ± 15.0 years (18 - 88 years); including 39 patients (55.7%) were male. The comorbidities found were hypertension (67.1%), diabetes (32.9%), and obesity (17.1%). Our patients' laboratory abnormalities were leukopenia (15.7%) and lymphopenia in 60% of patients. The pulmonary involvement on computed tomography was classified as moderate (74.3%) and severe in 24.3% of cases. Fifty-seven patients (78.6%) had received hydroxychloroquine and 14 patients (20%) antivirals therapy. We recorded 82.9% of cured patients and 17.1% of deaths in our series. The death occurred 8 ± 7.5 days (1 - 25 days) of hospitalization. Hemodialysis centres are high-risk places, and hemodialysis patients are considered a vulnerable population during the COVID-19 pandemic. They should be given special attention.


Subject(s)
/physiopathology , Hospitalization/statistics & numerical data , Renal Dialysis , Adolescent , Adult , Aged , Aged, 80 and over , Algeria , Antiviral Agents/administration & dosage , /mortality , Female , Humans , Hydroxychloroquine/administration & dosage , Leukopenia/epidemiology , Lymphopenia/epidemiology , Male , Middle Aged , Prognosis , Prospective Studies , Risk Factors , Vulnerable Populations , Young Adult
2.
Am J Case Rep ; 22: e928900, 2021 Jan 25.
Article in English | MEDLINE | ID: covidwho-1138931

ABSTRACT

BACKGROUND This is of the first fatal case of coronavirus disease 2019 (COVID-19) pneumonia at a National Heart Center in Indonesia following planned elective triple-vessel coronary artery bypass graft (CABG) who was considered to be at low risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection when admitted for surgery. CASE REPORT A 48-year-old man was diagnosed with coronary artery disease (CAD) in 3 vessels (3VD) with an ejection fraction (EF) of 61% and chronic kidney disease (CKD) with routine hemodialysis. The patient was scheduled for a coronary artery bypass graft (CABG) surgery. He underwent surgery after COVID-19 screening using a checklist provided by the hospital. The patient's condition worsened on the 3rd postoperative day in the ward, and he was transferred back to the Intensive Care Unit (ICU), reintubated, and tested for COVID-19 with a real time-polymerase chain reaction (PCR) test. Because of the COVID-19 pandemic, we excluded the other possible pneumonia causes (e.g., influenza). An RT-PCR test performed after surgery revealed that the patient was positive for COVID-19. COVID-19 tracing was performed for all health care providers and relatives; all results were negative except for 1 family member. The patient was treated for 4 days in the isolation ICU but died due to complications of the infection. CONCLUSIONS This report shows the importance of testing patients for SARS-CoV-2 infection before hospital admission for elective surgery and during the hospital stay, and the importance of developing rapid and accurate testing methods that can be used in countries and centers with limited health resources.


Subject(s)
/diagnosis , Coronary Artery Bypass , Elective Surgical Procedures , Fatal Outcome , Humans , Indonesia , Male , Middle Aged , Renal Dialysis , Renal Insufficiency, Chronic/therapy
3.
Medicine (Baltimore) ; 100(10): e24893, 2021 Mar 12.
Article in English | MEDLINE | ID: covidwho-1138015

ABSTRACT

ABSTRACT: Chronic renal replacement therapy by either a kidney transplant (KTX) or hemodialysis (HD) predisposes patients to an increased risk for adverse outcomes of COVID-19. However, details on this interaction remain incomplete. To provide further characterization, we undertook a retrospective observational cohort analysis of the majority of the hemodialysis and renal transplant population affected by the first regional outbreak of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) in Germany. In a region of 250,000 inhabitants we identified a total of 21 cases with SARS-CoV-2 among 100 KTX and 260 HD patients, that is, 7 KTX with COVID-19, 14 HD with COVID-19, and 3 HD with asymptomatic carrier status. As a first observation, KTX recipients exhibited trends for a higher mortality (43 vs 18%) and a higher proportion of acute respiratory distress syndrome (ARDS) (57 vs 27%) when compared to their HD counterparts. As a novel finding, development of ARDS was significantly associated with the time spent on previous renal replacement therapy (RRT), defined as the composite of dialysis time and time on the transplant (non-ARDS 4.3 vs ARDS 10.6 years, P = .016). Multivariate logistic regression analysis showed an OR of 1.7 per year of RRT. The association remained robust when analysis was confined to KTX patients (5.1 vs 13.2 years, P = .002) or when correlating the time spent on a renal transplant alone (P = .038). Similarly, longer RRT correlated with death vs survival (P = .0002). In conclusion our data suggest renal replacement vintage as a novel risk factor for COVID-19-associated ARDS and death. The findings should be validated by larger cohorts.


Subject(s)
/epidemiology , Kidney Failure, Chronic/epidemiology , Kidney Transplantation/mortality , Renal Dialysis/statistics & numerical data , Aged , Aged, 80 and over , Female , Germany/epidemiology , Humans , Kidney Failure, Chronic/therapy , Logistic Models , Male , Middle Aged , Retrospective Studies , Risk Factors
4.
Esc. Anna Nery Rev. Enferm ; 24(spe): e20200413, 20200000.
Article in Portuguese | LILACS (Americas) | ID: covidwho-1127853

ABSTRACT

Objetivo: refletir sobre os cuidados de enfermagem aos pacientes em hemodiálise no contexto da pandemia de COVID-19. Método: trata-se de um estudo reflexivo, realizado mediante análise de documentos oficiais dos órgãos de saúde, artigos científicos e outras fontes conceituadas. Está organizado nos seguintes eixos: Pandemia de COVID-19; Insuficiência Renal Crônica e o tratamento hemodialítico; e Cuidados de enfermagem aos pacientes em tratamento hemodialítico no contexto da COVID-19. Resultado: as ações de educação em saúde, educação continuada e a supervisão em enfermagem ganharam destaque no contexto da pandemia. Elas garantiram as orientações necessárias aos pacientes e familiares e à equipe de enfermagem, para prevenção e controle da COVID-19. Consequentemente, contribuíram para a proteção da saúde dos pacientes com insuficiência renal crônica, que já apresentavam sua saúde comprometida e não poderiam deixar de realizar a hemodiálise. Considerações finais e implicações para a prática: no contexto da pandemia da COVID-19, os profissionais de enfermagem precisam redobrar a atenção na assistência prestada aos pacientes em tratamento hemodialítico, além de adaptarem-se às novas orientações. Espera-se que esta reflexão contribua para que os cuidados de enfermagem sejam os mais seguros possíveis, tanto para pacientes e familiares quanto para os profissionais de enfermagem


Objective: to reflect on nursing care for hemodialysis patients in the context of the COVID-19 pandemic. Method: This is a reflective study carried out through the analysis of official documents from health agencies, scientific articles and other reputable sources, organized in the following axes: Pandemic of COVID-19; Chronic kidney failure and hemodialysis treatment and Nursing care for patients undergoing hemodialysis in the context of COVID-19. Results: Health education, continuing education and nursing supervision have gained prominence in the context of the pandemic. They have provided the necessary guidance to patients and family members and to the nursing team, for prevention and control of COVID-19. Consequently, they contributed to the health protection of patients with chronic kidney failure who already had their health compromised and could not fail to perform hemodialysis. Final considerations and implications for practice: In the context of the COVID-19 pandemic, nursing professionals need to redouble their attention in assisting patients in hemodialysis treatment, in addition to adapting to the new guidelines. It is hoped that this reflection will contribute to the safest possible nursing care for patients and families and for nursing professionals


Objetivo: Reflexionar sobre el cuidado de enfermería de los pacientes en hemodiálisis en el contexto de la pandemia COVID-19. Método: Se trata de un estudio reflexivo realizado a través del análisis de documentos oficiales de organismos de salud, artículos científicos y otras fuentes acreditadas, organizado en los siguientes ejes: Pandemia de COVID-19; Insuficiencia renal crónica y el tratamiento de hemodiálisis y Atención de enfermería a pacientes en hemodiálisis en el contexto del COVID-19. Resultados: Se pudo reflexionar que las acciones de educación en salud, educación continua y supervisión de enfermería cobraron protagonismo en el contexto de la pandemia, a fin de garantizar la orientación necesaria a los pacientes y familiares y al personal de enfermería, para la prevención y control del COVID-19. Consecuentemente contribuyeron a la protección de la salud de los pacientes con insuficiencia renal crónica que ya tienen su salud comprometida y no pueden dejar de someterse a hemodiálisis. Consideraciones finales e implicaciones para la práctica: En el contexto de la pandemia de COVID-19, los profesionales de enfermería necesitan redoblar su atención en la atención brindada a los pacientes en hemodiálisis, además de adaptarse a las nuevas pautas. Se espera que esta reflexión contribuya a que el cuidado de enfermería sea lo más seguro posible, tanto para los pacientes y familiares como para los profesionales de enfermería


Subject(s)
Humans , Pneumonia, Viral , Renal Dialysis/nursing , Coronavirus Infections/prevention & control , Betacoronavirus , Nursing Care , Coronavirus Infections/transmission , Renal Insufficiency, Chronic/nursing
5.
BMC Nephrol ; 22(1): 81, 2021 03 06.
Article in English | MEDLINE | ID: covidwho-1119416

ABSTRACT

BACKGROUND: Emory Dialysis serves an urban and predominantly African American population at its four outpatient dialysis facilities. We describe COVID-19 infection control measures implemented and clinical characteristics of patients with COVID-19 in the Emory Dialysis facilities. METHODS: Implementation of COVID-19 infection procedures commenced in February 2020. Subsequently, COVID-19 preparedness assessments were conducted at each facility. Patients with COVID-19 from March 1-May 31, 2020 were included; with a follow-up period spanning March-June 30, 2020. Percentages of patients diagnosed with COVID-19 were calculated, and characteristics of COVID-19 patients were summarized as medians or percentage. Baseline characteristics of all patients receiving care at Emory Dialysis (i.e. Emory general dialysis population) were presented as medians and percentages. RESULTS: Of 751 dialysis patients, 23 (3.1%) were diagnosed with COVID-19. The median age was 67.0 years and 13 patients (56.6%) were female. Eleven patients (47.8%) were residents of nursing homes. Nineteen patients (82.6%) required hospitalization and 6 patients (26.1%) died; the average number of days from a positive SARS-CoV-2 (COVID) test to death was 16.8 days (range 1-34). Two patients dialyzing at adjacent dialysis stations and a dialysis staff who cared for them, were diagnosed with COVID-19 in a time frame that may suggest transmission in the dialysis facility. In response, universal masking in the facility was implemented (prior to national guidelines recommending universal masking), infection control audits and re-trainings of PPE were also done to bolster infection control practices. CONCLUSION: We successfully implemented recommended COVID-19 infection control measures aimed at mitigating the spread of SARS-CoV-2. Most of the patients with COVID-19 required hospitalizations. Dialysis facilities should remain vigilant and monitor for possible transmission of COVID-19 in the facility.


Subject(s)
African Americans , Ambulatory Care Facilities/standards , Infection Control/methods , Renal Dialysis/standards , Vulnerable Populations/ethnology , Aged , /ethnology , Disease Susceptibility , Female , Georgia , Humans , Male , Middle Aged , Telemedicine , Urban Population
6.
J Med Case Rep ; 15(1): 104, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1112451

ABSTRACT

BACKGROUND: Pregnancy seems to increase the risk of thrombotic thrombocytopenic purpura (TTP) relapses and make the TTP more severe in any of the pregnancy trimesters, or even during the postpartum period. CASE PRESENTATION: This study highlights details of treating a COVID-19 pregnant patient who survived. This 21-year addicted White woman was admitted at her 29th week and delivered a stillbirth. She was transferred to another hospital after showing signs of TTP, which was caused by a viral infection. CONCLUSION: This viral infection caused fever and dyspnea, and the patient was tested positive for COVID-19 infection. A chest computed tomography scan showed diffuse multiple bilateral consolidations and interlobar septal thickening. She stayed at the Intensive Care Unit for 20 days and treated with plasmapheresis. As far as we know, this is the first report of a TTP pregnant patient with COVID-19 infection.


Subject(s)
/diagnosis , Plasmapheresis , Pregnancy Complications, Hematologic/diagnosis , Pregnancy Complications, Infectious/diagnosis , Purpura, Thrombotic Thrombocytopenic/diagnosis , Stillbirth , Acute Kidney Injury/therapy , Amphetamine-Related Disorders , Antiviral Agents/therapeutic use , Drug Combinations , Erythrocyte Transfusion , Female , Hemoglobins/metabolism , Humans , Hydroxychloroquine/therapeutic use , Intensive Care Units , L-Lactate Dehydrogenase/metabolism , Lopinavir/therapeutic use , Methamphetamine , Pregnancy , Pregnancy Complications, Hematologic/metabolism , Pregnancy Complications, Hematologic/therapy , Pregnancy Complications, Infectious/metabolism , Pregnancy Complications, Infectious/therapy , Purpura, Thrombotic Thrombocytopenic/metabolism , Purpura, Thrombotic Thrombocytopenic/therapy , Renal Dialysis , Ritonavir/therapeutic use , Tomography, X-Ray Computed , Young Adult
9.
Curr Opin Nephrol Hypertens ; 30(2): 190-197, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1109367

ABSTRACT

PURPOSE OF REVIEW: Using case vignettes, we highlight challenges in communication, prognostication, and medical decision-making that have been exacerbated by the coronavirus disease-19 (COVID-19) pandemic for patients with kidney disease. We include best practice recommendations to mitigate these issues and conclude with implications for interdisciplinary models of care in crisis settings. RECENT FINDINGS: Certain biomarkers, demographics, and medical comorbidities predict an increased risk for mortality among patients with COVID-19 and kidney disease, but concerns related to physical exposure and conservation of personal protective equipment have exacerbated existing barriers to empathic communication and value clarification for these patients. Variability in patient characteristics and outcomes has made prognostication nuanced and challenging. The pandemic has also highlighted the complexities of dialysis decision-making for older adults at risk for poor outcomes related to COVID-19. SUMMARY: The COVID-19 pandemic underscores the need for nephrologists to be competent in serious illness communication skills that include virtual and remote modalities, to be aware of prognostic tools, and to be willing to engage with interdisciplinary teams of palliative care subspecialists, intensivists, and ethicists to facilitate goal-concordant care during crisis settings.


Subject(s)
Communication , /epidemiology , Humans , Palliative Care , Pandemics , Renal Dialysis
10.
CMAJ ; 193(8): E278-E284, 2021 Feb 22.
Article in English | MEDLINE | ID: covidwho-1105842

ABSTRACT

BACKGROUND: Patients undergoing long-term dialysis may be at higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and of associated disease and mortality. We aimed to describe the incidence, risk factors and outcomes for infection in these patients in Ontario, Canada. METHODS: We used linked data sets to compare disease characteristics and mortality between patients receiving long-term dialysis in Ontario who were diagnosed SARS-CoV-2 positive and those who did not acquire SARS-CoV-2 infection, between Mar. 12 and Aug. 20, 2020. We collected data on SARS-CoV-2 infection prospectively. We evaluated risk factors for infection and death using multivariable logistic regression analyses. RESULTS: During the study period, 187 (1.5%) of 12 501 patients undergoing dialysis were diagnosed with SARS-CoV-2 infection. Of those with SARS-CoV-2 infection, 117 (62.6%) were admitted to hospital and the case fatality rate was 28.3%. Significant predictors of infection included in-centre hemodialysis versus home dialysis (odds ratio [OR] 2.54, 95% confidence interval [CI] 1.59-4.05), living in a long-term care residence (OR 7.67, 95% CI 5.30-11.11), living in the Greater Toronto Area (OR 3.27, 95% CI 2.21-4.80), Black ethnicity (OR 3.05, 95% CI 1.95-4.77), Indian subcontinent ethnicity (OR 1.70, 95% CI 1.02-2.81), other non-White ethnicities (OR 2.03, 95% CI 1.38-2.97) and lower income quintiles (OR 1.82, 95% CI 1.15-2.89). INTERPRETATION: Patients undergoing long-term dialysis are at increased risk of SARS-CoV-2 infection and death from coronavirus disease 2019. Special attention should be paid to addressing risk factors for infection, and these patients should be prioritized for vaccination.


Subject(s)
/epidemiology , Hemodialysis Units, Hospital/statistics & numerical data , Kidney Failure, Chronic/therapy , Renal Dialysis/statistics & numerical data , Adult , Disease Transmission, Infectious/prevention & control , Female , Humans , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Ontario , Risk Factors
11.
BMC Nephrol ; 22(1): 73, 2021 02 27.
Article in English | MEDLINE | ID: covidwho-1105701

ABSTRACT

BACKGROUND: Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. METHODS: This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients' medical records. A binary logistic regression analysis was performed to assess risk factors for mortality. RESULTS: A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83). CONCLUSIONS: This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.


Subject(s)
/mortality , Multimorbidity , Renal Dialysis , Age Factors , Aged , Coronary Disease/complications , Critical Care , Dementia/complications , Female , Fever/complications , Heart Failure/complications , Hospitalization , Humans , Lebanon/epidemiology , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , Stroke/complications
12.
BMJ Open ; 11(2): e043015, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1088255

ABSTRACT

OBJECTIVES: In a previously published Delphi exercise the European Pediatric Dialysis Working Group (EPDWG) reported widely variable counteractive responses to COVID-19 during the first week of statutory public curfews in 12 European countries with case loads of 4-680 infected patients per million. To better understand these wide variations, we assessed different factors affecting countermeasure implementation rates and applied the capability, opportunity, motivation model of behaviour to describe their determinants. DESIGN: We undertook this international mixed methods study of increased depth and breadth to obtain more complete data and to better understand the resulting complex evidence. SETTING: This study was conducted in 14 paediatric nephrology centres across 12 European countries during the COVID-19 pandemic. PARTICIPANTS: The 14 participants were paediatric nephrologists and EPDWG members from 12 European centres. MAIN OUTCOME MEASURES: 52 countermeasures clustered into eight response domains (access control, patient testing, personnel testing, personal protective equipment policy, patient cohorting, personnel cohorting, suspension of routine care, remote work) were categorised by implementation status, drivers (expert opinion, hospital regulations) and resource dependency. Governmental strictness and media attitude were independently assessed for each country and correlated with relevant countermeasure implementation factors. RESULTS: Implementation rates varied widely among response domains (median 49.5%, range 20%-71%) and centres (median 46%, range 31%-62%). Case loads were insufficient to explain response rate variability. Increasing case loads resulted in shifts from expert opinion-based to hospital regulation-based decisions to implement additional countermeasures despite increased resource dependency. Higher governmental strictness and positive media attitude towards countermeasure implementation were associated with higher implementation rates. CONCLUSIONS: COVID-19 countermeasure implementation by paediatric tertiary care centres did not reflect case loads but rather reflected heterogeneity of local rules and of perceived resources. These data highlight the need of ongoing reassessment of current practices, facilitating rapid change in 'institutional behavior' in response to emerging evidence of countermeasure efficacy.


Subject(s)
/prevention & control , Delivery of Health Care/organization & administration , Nephrology/organization & administration , Pandemics , Child , Europe , Humans , Infection Control , Pediatrics/organization & administration , Renal Dialysis
13.
BMC Infect Dis ; 21(1): 68, 2021 Jan 13.
Article in English | MEDLINE | ID: covidwho-1067191

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus that was first discovered in December 2019 in Wuhan, China. With the growing numbers of community spread cases worldwide, the World Health Organization (WHO) declared the COVID-19 outbreak as a pandemic on March 11, 2020. Like influenza viruses, SARS-CoV-2 is thought to be mainly transmitted by droplets and direct contact, and COVID-19 has a similar disease presentation to influenza. Here we present a case of influenza A and COVID-19 co-infection in a 60-year-old man with end-stage renal disease (ESRD) on hemodialysis. CASE PRESENTATION: A 60-year-old man with ESRD on hemodialysis presented for worsening cough, shortness of breath, and diarrhea. The patient first developed a mild fever (37.8 °C) during hemodialysis 3 days prior to presentation and has been experiencing worsening flu-like symptoms, including fever of up to 38.6 °C, non-productive cough, generalized abdominal pain, nausea, vomiting, and liquid green diarrhea. He lives alone at home with no known sick contacts and denies any recent travel or visits to healthcare facilities other than the local dialysis center. Rapid flu test was positive for influenza A. Procalcitonin was elevated at 5.21 ng/mL with a normal white blood cell (WBC) count. Computed tomography (CT) chest demonstrated multifocal areas of consolidation and extensive mediastinal and hilar adenopathy concerning for pneumonia. He was admitted to the biocontainment unit of Nebraska Medicine for concerns of possible COVID-19 and was started on oseltamivir for influenza and vancomycin/cefepime for the probable bacterial cause of his pneumonia and diarrhea. Gastrointestinal (GI) pathogen panel and Clostridioides difficile toxin assay were negative. On the second day of admission, initial nasopharyngeal swab came back positive for SARS-CoV-2 by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). The patient received supportive care and resumed bedside hemodialysis in strict isolation, and eventually fully recovered from COVID-19. CONCLUSIONS: We presented a case of co-infection of influenza and SARS-CoV-2 in a hemodialysis patient. The possibility of SARS-CoV-2 co-infection should not be overlooked even when other viruses including influenza can explain the clinical symptoms, especially in high-risk patients.


Subject(s)
/diagnosis , Influenza, Human/diagnosis , /diagnostic imaging , Coinfection/diagnosis , Coinfection/diagnostic imaging , Coinfection/virology , Hospitalization , Humans , Influenza A virus/genetics , Influenza A virus/isolation & purification , Influenza A virus/physiology , Influenza, Human/diagnostic imaging , Influenza, Human/virology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Pandemics , Renal Dialysis , /isolation & purification , Tomography, X-Ray Computed
14.
J Healthc Eng ; 2020: 8862645, 2020.
Article in English | MEDLINE | ID: covidwho-1066956

ABSTRACT

The COVID-19 pandemic has highlighted resource constraints in respiratory support. The oxygen transfer characteristics of a specific hollow fiber membrane dialyser was investigated with a view to repurposing the device as a low-cost, readily available blood oxygenator. Oxygen transfer in a low-flux hollow fiber dialyser with a polysulfone membrane was studied by passing first water and then blood through the dialyser in countercurrent to high-purity oxygen. Oxygen transfer rates of about 15% of the nominal 250 ml (STP)/min of a typical adult oxygen consumption rate were achieved for blood flow rates of 500 ml/min. Using two such dialysis devices in parallel could provide up to 30% of the nominal oxygen consumption. Specific hollow fiber dialysis devices operating with suitable pumps in a veno-venous access configuration could provide a cost-effective and readily available supplementation of respiratory support in the face of severe resource constraints.


Subject(s)
/therapy , Oxygenators , Renal Dialysis/instrumentation , Blood Physiological Phenomena , Critical Illness/therapy , Equipment Design , Equipment Reuse , Humans , Models, Biological , Oxygen/metabolism , Pandemics
16.
Semin Vasc Surg ; 34(1): 71-78, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1062789

ABSTRACT

End-stage kidney disease (ESKD) is a common and morbid disease that affects patients' quality and length of life, representing a large portion of health care expenditure in the United States. These patients commonly have associated diabetes and cardiovascular disease, with high rates of cardiovascular-related death. Management of ESKD requires renal replacement therapy via dialysis or transplantation. While transplantation provides the greatest improvement in survival and quality of life, the vast majority of patients are treated initially with hemodialysis. However, outcomes differ significantly among patient populations. Barriers in access to care have particularly affected at-risk populations, such as Black and Hispanic patients. These patients receive less pre-ESKD nephrology care, are less likely to initiate dialysis with a fistula, and wait longer for transplants-even in pediatric populations. Priorities for ESKD care moving into the future include increasing access to nephrology care in underprivileged populations, providing patient-centered care based on each patient's "life plan," and focusing on team-based approaches to ESKD care. This review explores ESKD from the perspective of epidemiology, costs, vascular access, patient-reported outcomes, racial disparities, and the impact of the COVID-19 crisis.


Subject(s)
/epidemiology , Kidney Failure, Chronic/epidemiology , Pandemics , Renal Dialysis/methods , Comorbidity/trends , Global Health , Humans , Kidney Failure, Chronic/therapy , Morbidity/trends
18.
Kidney Blood Press Res ; 46(1): 126-134, 2021.
Article in English | MEDLINE | ID: covidwho-1050416

ABSTRACT

BACKGROUND: CKD is a risk factor for severe COVID-19. However, the clinical spectrum of COVID-19 in hemodialysis patients is still poorly characterized. OBJECTIVE: To analyze the clinical spectrum of COVID-19 on hemodialysis patients. METHOD: A retrospective observational study was conducted on 66 hemodialysis patients. Nasopharyngeal swab PCR and serology for SARS-CoV-2, blood analysis, chest radiography, treatment, and outcomes were assessed. RESULTS: COVID-19 was diagnosed in 50 patients: 38 (76%) were PCR-positive and 12 (24%) were PCR-negative but developed anti-SARS-CoV-2 antibodies. By contrast, 17% of PCR-positive patients failed to develop detectable antibodies against SARS-CoV-2. Among PCR-positive patients, 5/38 (13%) were asymptomatic, while among PCR-negative patients 7/12 (58%) were asymptomatic (p = 0.005) for a total of 12/50 (24%) asymptomatic patients. No other differences were found between PCR-positive and PCR-negative patients. No differences in potential predisposing factors were found between asymptomatic and symptomatic patients except for a lower use of ACE inhibitors among asymptomatic patients. Asymptomatic patients had laboratory evidence of milder disease such as higher lymphocyte counts and oxygen saturation and lower troponin I and interleukin-6 levels than symptomatic patients. Overall mortality was 7/50 (14%) and occurred only in symptomatic PCR-positive patients in whom mortality was 7/33 (21%). CONCLUSIONS: Asymptomatic SARS-CoV-2 infection is common in hemodialysis patients, especially among patients with initial negative PCR that later seroconvert. Thus COVID-19 mortality in hemodialysis patients may be lower than previously estimated based on PCR tests alone.


Subject(s)
Asymptomatic Diseases/epidemiology , /epidemiology , Renal Dialysis/trends , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Renal Insufficiency, Chronic/blood , Retrospective Studies
19.
Clin Infect Dis ; 72(2): 265-270, 2021 01 27.
Article in English | MEDLINE | ID: covidwho-1050125

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a life-threatening respiratory condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was initially detected in China in December 2019. Currently, in Germany >140 000 cases of COVID-19 are confirmed. Here we report a nosocomial outbreak of SARS-CoV-2 infections in the pediatric dialysis unit of the University Hospital Münster (UHM). METHODS: Single-step real-time reverse-transcription polymerase chain reaction (rRT-PCR) from nasopharyngeal swabs was used to diagnose the index patient and identify infected contacts. Epidemiological links were analyzed by patient interviews and medical record reviews. In addition, each contact was assessed for exposure to the index case and monitored for clinical symptoms. Cycle threshold (Ct) values of all positive test results were compared between symptomatic and asymptomatic cases. RESULTS: Forty-eight cases were involved in this nosocomial outbreak. Nine contact cases developed laboratory-confirmed COVID-19 infections. Two SARS-CoV-2-positive cases remained clinically asymptomatic. Eleven cases reported flulike symptoms without positive results. Ct values were significantly lower in cases presenting typical COVID-19 symptoms, suggesting high viral shedding (P = .007). CONCLUSIONS: Person-to-person transmission was at the heart of a hospital outbreak of SARS-CoV-2 between healthcare workers (HCWs) and patients in the pediatric dialysis unit at UHM. Semiquantitative rRT-PCR results suggest that individuals with high viral load pose a risk to spread SARS-CoV-2 in the hospital setting. Our epidemiological observation highlights the need to develop strategies to trace and monitor SARS-CoV-2-infected HCWs to prevent COVID-19 outbreaks in the hospital setting.


Subject(s)
Cross Infection , Child , China/epidemiology , Cross Infection/epidemiology , Disease Outbreaks , Germany , Humans , Renal Dialysis
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