Impacto de la segunda ola de infección de covid-19 en pacientes de hemodiálisis extremadura (España)

ABSTRACT

BACKGROUND AND AIMS: Hemodialysis patients are high-risk patients for severe forms of SARS-Cov 2. Extremadura has two provinces Badajoz(B) and Caceres(C) with one million of people. The incidence was small in the first part of the pandemic (2,6%) compared with the national incidence, and it was higher in C than in B (5,6% vs 1,1%) The aim of this study was to estimate the incidence of COVID-19 disease in the population of Extremadura's hemodialysis patients and to study the clinical evolution, treatment and mortality in patients with confirmed infection with Polymerase chain reaction(PCR) during the second wave. METHOD: Multicenter, retrospective, observational study of hemodialysis patients with COVID-19 disease between August and December of 2020. There were 683 hemodialysis patients in this period distributed in 5 hospital units and 7 out of hospital Units. RESULTS: Incidence 6,8% (46 infected of SARS-Cov 2), with almost one patient in each center (the highest with 16,1%) and higher incidence in B than in C (8,1% vs 4,1%). Males (58,7%), media age, (69,3±11,9) and median renal replacement therapy time 29 months (RIC 47,4). The most frequent CKD was diabetic nephropathy (16%), but 35% of the patients have diabetes, 86% hypertension and 56% cardiovascular illness. Treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers 40% and with vitamin D 62,8%. There were 42% patients who had contacted with positive people of hemodialysis unit and 37% with positive people outside. 67% have symptoms the most frequent cough and fever (46%). Hospitalized patients 41,6%, all of them with bilateral pneumonia. All had lymphocytopenia and high acute phase reactants D-dimer 1195 ng/ml (RIC 1545), Ferritin 950,12ng/ml (RIC 533,6) IL-6 30,11pg/ml (RIC 41,13) C-reactive protein 28 mg/l (RIC 62,10) Procalcitonin 0,42 ng/ml (RIC 0,44), all increased in the hospitalized period without significant differences. Median hospitalized time was 10 days (RIC 11). Nine patients died (19,5%), 3 of them in intensive unit care with 15 days median. Most of them needed antibiotic therapy, steroids and anticoagulation, 5 convalescent plasma and 5 tocilizumab. We stopped isolated room dialysis when they had negative PCR (56%) or IgG positive (54%), median insulation 17 days (RIC 7). We haven't found differences in hospitalized vs no hospitalized patients in age, gender, renal replacement therapy time, etiology, DM, hypertension or cardiovascular illness and treatment, nor in relation with mortality. CONCLUSION: We have observed an increase in the incidence of infection in this period compared with the first period of the pandemic, parallel to the increases in the incidence of the general population in Extremadura (more in B than in C). The mortality is high but similar to other publications. We have to do screening due to the possibility of asymptomatic patients that could have contributed to expand the infection. The high number of hospitalized patients and the need of isolated rooms dialysis for infections patients is a challenge for the organization of hemodialysis units but having positive serologic reduce the isolation time.