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Clinical Profile and Outcomes of Covid-19 in Renal Transplant Recipients - a Single Centre Experience
Kidney International Reports ; 8(3 Supplement):S438-S439, 2023.
Article in English | EMBASE | ID: covidwho-2249505
ABSTRACT

Introduction:

The COVID-19 infection amongst the renal transplant recipients (RTR) has a varied presentation and severity of illness. The overall mortality amongst RTR was found to be 11.6%- 27% compared to the mortality rate of 2-3% amongst the COVID-19 infected general population. The incidence of acute kidney injury(AKI) in RTR was also found to be higher compared to general population with Covid 19 (27.5% versus 13.3%). We assessed the clinical outcomes of COVID 19 infection among RTR and its impact on the graft function along with predictors of poor clinical outcomes. Method(s) Ours is a single centre observational cohort study of 83 RTR with Covid 19 infection with a follow up period of 6 months. The data pertaining to demographics, renal transplantation, maintenance immunosuppression, baseline allograft function prior to Covid 19 infection and comorbidities was recorded in both hospitalised and outpatient RTR. Lab investigations including renal function tests and inflammatory markers were noted. Renal allograft function was assessed by estimated glomerular filtration rate(eGFR) using CKD-EPI equation prior to admission, hospital stay and 6 months follow up. The need for oxygenation, invasive ventilation;presence of hypotension, acute kidney injury(AKI),acute respiratory distress syndrome(ARDS) and need for renal replacement therapy(RRT) was noted. Modification of immunosuppressant medications with respect to dose reductions and withdrawal was recorded. The primary endpoint was mortality and presence of acute kidney injury during Covid 19 infection. Result(s) The mean age was 47.67+/-13.7 years and 75.91 % were males. Around 81.9%(68/83) RTR were hospitalised & 18.9%(15/83)were managed as outpatients. Out of 83 patients,43 (51.8%), 23(27.7%),17(20.5%) had mild, moderate and severe COVID 19 illness respectively. The mortality rate amongst COVID 19 infected RTR was 19.3%(16/83). Out of 83 RTR,17 required inotropic support owing to hypotension. The baseline eGFR(ml/min) prior to Covid 19 infection was 66.3 +/- 30.66. The eGFR(ml/min) during Covid 19 was 44.27 +/- 31.53.Acute kidney injury(AKI) was seen in 72.3%(60/83) of RTR.19.28%(16/83) required RRT.The percentage change in eGFR from baseline during COVID-19 was found to be statistically significant(p=0.003)and correlated with mortality(p=0.003).At 6 months of follow up,55/83 RTR had stable allograft function with mean eGFR(ml/min) of 51.74 +/- 29.92 and 8/83 patients(9.6%) patients were on maintenance haemodialysis. In contrast to the survivors, the non survivors had a higher mean age(67+/-13 vs 57+/-12 years), number of years of hypertension(15+/-9 vs 8.5 +/-7 years),body mass index(27.05+/-4.7 vs 23.11+/- 7.8), percentage change in eGFR from baseline(114.1 +/-81.7% vs 58.8 +/-61.4%), serum Interleukin levels (120.7 vs 10 pg/ml) and D dimer(145 vs 21.3 mcg/ml) levels (p<0.05).Other risk factors which correlated significantly with outcome of mortality and reduced renal recovery include presence of hypoxia at presentation and ARDS(87.5 Vs 28.1%),presence of hypotension requiring inotropes(81.3% vs 6%) and AKI and the need for RRT(56.7% vs 10.4%). [Formula presented] [Formula presented] Conclusion(s) The mortality rate amongst the RTR with COVID 19 infection was found to be 19.3%.AKI was found in 72% of patients during the illness and about 9.6% developed graft loss by 6 months. RTR needs a close supervision and follow up as they are prone to acute kidney injury and may develop allograft failure. No conflict of interestCopyright © 2023
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Prognostic study Language: English Journal: Kidney International Reports Year: 2023 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Prognostic study Language: English Journal: Kidney International Reports Year: 2023 Document Type: Article