Renal Outcomes in Hospitalized Patients Receiving Hemodialysis After Infection With Acute COVID-19

ABSTRACT

Background: Kidney injury in acute COVID-19 infection has been associated with decreased survival and prolonged duration of hospitalization irrespective of patient population or severity of illness. Outcomes among hospitalized patients with COVID-19 and kidney injury in terms of recovery of renal function are insufficiently assessed. A good understanding of the same is vital to plan post-discharge renal care, and to estimate the potential burden that COVID-19 confers on the nephrology community. Method(s) In a cohort study, we included patients who received hemodialysis (HD) during hospital stay after infection with COVID-19 at our center following kidney injury during the second wave of the pandemic in New Delhi between June and December, 2021. Participants were excluded if they received dialysis following previously existing chronic renal failure. Participants were followed-up telephonically for a period of six months to assess renal function and need for HD. Recovery of renal function was considered early if serum creatinine improved by 33% of peak value during hospital stay, or late if a 33% reduction in follow-up evaluation was noted over the discharge serum creatinine. Result(s) A total of 62 patients (34 (54.8%) men and 28 (45.2%) women) with a mean age of 51.2 years (+16.3), and mean urea of 181 mg/dl (+95.7) and mean creatinine of 6.9 mg/dl (+3.5) at presentation were included in the cohort. Of these, 31 (50%) had presented with mild, 11 (17.7%) with moderate and 20 (32.3%) with severe disease. Ten (16.1%) succumbed to illness during hospital stay and another 12 (19.3%) patients died during the follow up period. 34 (54.8%) patients were discharged from hospital on HD, and 18 (29%) were not advised HD at discharge. While 30 (75%) of the survivors had indicated early renal recovery at discharge, none had recovered renal function at the end of follow up period. A median decline of 48% and 44% at follow up was noted from the peak and presentation values of creatinine recorded during hospital stay. Conclusion(s) Patients undergoing hemodialysis after hospitalization with acute COVID-19 infection had poor short-term outcome and survivors continued to have renal impairment after six months. It is important to recognize recovery rates and patterns to offer early comprehensive renal care.