Hemoglobin Levels in Peruvian Patients with Chronic Kidney Disease at Different Altitudes.

Hurtado-Aréstegui, Abdías, Karina Rosales-Mendoza, Yanissa Venegas-Justiniano, José Gonzales-Polar, Rina Barreto-Jara, and Alaciel Melissa Palacios-Guillén. Hemoglobin levels in Peruvian patients with chronic kidney disease at different altitudes. High Alt Med Biol. 24:209-213, 2023. Background: Decreased hemoglobin is a manifestation of chronic kidney disease (CKD), and people who reside at high altitude adapt to hypoxia by increasing their hemoglobin. The study's objective was to determine the influence of altitude and the associated factors on the hemoglobin levels of patients with CKD who were not on dialysis (ND). Methods: This exploratory and cross-sectional study was carried out in three Peruvian cities, located at different altitudes: (1) "sea level" (161 m), (2) "moderate altitude" (2,335 m), and "high altitude" (3,399 m). The study included female and male individuals between 20 and 90 years old, with CKD stage 3a, through stage 5. Results: Of the 256 volunteers evaluated, 92 lived at sea level, 82 at moderate altitude, and 82 at high altitude. The three groups were similar in age, number of volunteers in each CKD stage, systolic blood pressure, and diastolic blood pressure. Hemoglobin levels were statistically different according to gender (p = 0.024), CKD stage, and altitude (p < 0.001). High-altitude dwellers had higher hemoglobin by 2.5 g/dl (95% confidence interval: 1.8-3.1, p < 0.001) than those living at lower altitudes (adjusted for gender, age, nutritional status, and smoking habit). For all CKD stages, the high-altitude population had higher hemoglobin levels than population at moderate altitude and at sea level. Conclusion: Subjects living at high altitude with CKD stages 3 to 5 who are yet ND have higher hemoglobin levels than those who live at moderate altitude and at sea level.

Factors related to mortality in patients with stage 5 chronic kidney disease on dialysis with COVID-19: An exploratory case series analysis.

Introduction: Different studies describe the clinical profile and factors that could explain the evolution and outcome of patients with chronic kidney disease and COVID-19. This study aims to evaluate the factors related to the mortality of patients with stage-5 chronic kidney disease on chronic dialysis hospitalized for COVID-19 at the Hospital Nacional Arzobispo Loayza from April to December 2020. Methods: Retrospective case series and exploratory analysis were performed. Patients with stage-5 chronic kidney disease on dialysis, older than 18 years, and hospitalized for COVID-19 disease were included. Hospital medical records were the primary data source. Results: A total of 105 medical records were reviewed. 57 were male (54.3%), with a mean age of 58.6 years (standard deviation: 14.3). Eighty-four patients survived (80%), and 21 died (20%). The main cause of hospital admission, present in 80 patients (76.2%), was respiratory failure; the mean hospital stay was of 11.8 days (SD: 7.8). In the bivariate analysis: patients with moderate to severe COVID-19, overweight and obesity, increased levels of leukocytes, D-dimer, ferritin, C-reactive protein, lactate dehydrogenase, as well as, decreased levels of lymphocytes, bicarbonate and arterial oxygen pressure/inspired oxygen fraction were related to mortality risk. In multivariate analysis, only severe COVID-19 disease (OR 1.48; 95% CI 2.24 to 7.77), C-reactive protein > 10 mg/dL (OR: 9.72; 95% CI: 1.41 to 18.58), and arterial oxygen pressure/inspired oxygen fraction ≤ 150 millimeters of mercury (OR: 10.23; 95% CI: 5.87 to 36.06) were factors associated with poor survival. Conclusions: In patients with stage-5 chronic kidney disease hospitalized for COVID-19, severe COVID-19 disease, C-protein reactive levels > 10 milligrams per deciliter, arterial oxygen pressure / inspired oxygen fraction ≤ 150 millimeters of mercury and severe COVID-19 disease were the main factors related to mortality.

Introducción: Diferentes estudios describen el perfil clínico y los factores que podrían explicar la evolución y el resultado de los pacientes con enfermedad renal crónica y COVID-19. El objetivo de este estudio fue evaluar los factores relacionados con la mortalidad de los pacientes con enfermedad renal crónica estadio-5 en diálisis crónica hospitalizados por COVID-19 en el Hospital Nacional Arzobispo Loayza de abril a diciembre de 2020. Métodos: Serie de casos retrospectiva y análisis exploratorio. Se incluyeron pacientes con enfermedad renal crónica estadio 5 en diálisis, mayores de 18 años, hospitalizados por COVID-19. La fuente primaria de datos fueron las historias clínicas. Resultados: Se revisaron 105 historias clínicas. 57 (54,3%) eran varones, con una edad media de 58,6 años (desviación estándar: 14,3). Sobrevivieron 84 (80%) pacientes y fallecieron 21 (20%). La principal causa de ingreso hospitalario fue la insuficiencia respiratoria en 80 (76,2%). La estancia hospitalaria fue de 11,8 días (desviación estándar: 7,8). En el análisis bivariante: los pacientes con COVID-19 moderada a grave, sobrepeso y obesidad, aumento de los niveles de leucocitos, dímero D, ferritina, proteína c reactiva, lactato deshidrogenasa, así como, disminución de los niveles de linfocitos, bicarbonato y presión arterial de oxígeno/fracción inspirada de oxígeno se relacionaron con el riesgo de mortalidad. En el análisis multivariante, sólo la enfermedad grave por COVID-19 (odds ratio: 1,48; intervalo de confianza del 95%: 2,24 a 7,77), la proteína C reactiva > 10 mg/dL (odds ratio: 9,72; intervalo de confianza del 95%: 1,41 a 18,58) y una presión arterial de oxígeno/fracción de oxígeno inspirado ≤ 150 milímetros de mercurio (odds ratio: 10,23; intervalo de confianza del 95%: 5,87 a 36,06) fueron factores asociados a una mala supervivencia. Conclusiones: En los pacientes con enfermedad renal crónica en estadio-5 hospitalizados por COVID-19, la enfermedad grave por COVID-19, los niveles de proteína C reactiva > 10 miligramos por decilitro, la presión arterial de oxígeno/fracción inspirada de oxígeno ≤ 150 milímetros de mercurio y la enfermedad grave por COVID-19 fueron los principales factores relacionados con la mortalidad.

Factors related to mortality in patients with stage 5 chronic kidney disease on dialysis with COVID-19: An exploratory case series analysis / Factores relacionados con mortalidad de pacientes con enfermedad renal crónica en estadio 5 en diálisis con COVID-19: Análisis exploratorio de una serie de casos

Introduction Different studies describe the clinical profile and factors that could explain the evolution and outcome of patients with chronic kidney disease and COVID-19. This study aims to evaluate the factors related to the mortality of patients with stage-5 chronic kidney disease on chronic dialysis hospitalized for COVID-19 at the Hospital Nacional Arzobispo Loayza from April to December 2020. Methods Retrospective case series and exploratory analysis were performed. Patients with stage-5 chronic kidney disease on dialysis, older than 18 years, and hospitalized for COVID-19 disease were included. Hospital medical records were the primary data source. Results A total of 105 medical records were reviewed. 57 were male (54.3%), with a mean age of 58.6 years (standard deviation: 14.3). Eighty-four patients survived (80%), and 21 died (20%). The main cause of hospital admission, present in 80 patients (76.2%), was respiratory failure; the mean hospital stay was of 11.8 days (SD: 7.8). In the bivariate analysis: patients with moderate to severe COVID-19, overweight and obesity, increased levels of leukocytes, D-dimer, ferritin, C-reactive protein, lactate dehydrogenase, as well as, decreased levels of lymphocytes, bicarbonate and arterial oxygen pressure/inspired oxygen fraction were related to mortality risk. In multivariate analysis, only severe COVID-19 disease (OR 1.48; 95% CI 2.24 to 7.77), C-reactive protein > 10 mg/dL (OR: 9.72; 95% CI: 1.41 to 18.58), and arterial oxygen pressure/inspired oxygen fraction ≤ 150 millimeters of mercury (OR: 10.23; 95% CI: 5.87 to 36.06) were factors associated with poor survival. Conclusions In patients with stage-5 chronic kidney disease hospitalized for COVID-19, severe COVID-19 disease, C-protein reactive levels > 10 milligrams per deciliter, arterial oxygen pressure / inspired oxygen fraction ≤ 150 millimeters of mercury and severe COVID-19 disease were the main factors related to mortality.

Introducción Diferentes estudios describen el perfil clínico y los factores que podrían explicar la evolución y el resultado de los pacientes con enfermedad renal crónica y COVID-19. El objetivo de este estudio fue evaluar los factores relacionados con la mortalidad de los pacientes con enfermedad renal crónica estadio-5 en diálisis crónica hospitalizados por COVID-19 en el Hospital Nacional Arzobispo Loayza de abril a diciembre de 2020. Métodos Serie de casos retrospectiva y análisis exploratorio. Se incluyeron pacientes con enfermedad renal crónica estadio 5 en diálisis, mayores de 18 años, hospitalizados por COVID-19. La fuente primaria de datos fueron las historias clínicas. Resultados Se revisaron 105 historias clínicas. 57 (54,3%) eran varones, con una edad media de 58,6 años (desviación estándar: 14,3). Sobrevivieron 84 (80%) pacientes y fallecieron 21 (20%). La principal causa de ingreso hospitalario fue la insuficiencia respiratoria en 80 (76,2%). La estancia hospitalaria fue de 11,8 días (desviación estándar: 7,8). En el análisis bivariante: los pacientes con COVID-19 moderada a grave, sobrepeso y obesidad, aumento de los niveles de leucocitos, dímero D, ferritina, proteína c reactiva, lactato deshidrogenasa, así como, disminución de los niveles de linfocitos, bicarbonato y presión arterial de oxígeno/fracción inspirada de oxígeno se relacionaron con el riesgo de mortalidad. En el análisis multivariante, sólo la enfermedad grave por COVID-19 (odds ratio: 1,48; intervalo de confianza del 95%: 2,24 a 7,77), la proteína C reactiva > 10 mg/dL (odds ratio: 9,72; intervalo de confianza del 95%: 1,41 a 18,58) y una presión arterial de oxígeno/fracción de oxígeno inspirado ≤ 150 milímetros de mercurio (odds ratio: 10,23; intervalo de confianza del 95%: 5,87 a 36,06) fueron factores asociados a una mala supervivencia. Conclusiones En los pacientes con enfermedad renal crónica en estadio-5 hospitalizados por COVID-19, la enfermedad grave por COVID-19, los niveles de proteína C reactiva > 10 miligramos por decilitro, la presión arterial de oxígeno/fracción inspirada de oxígeno ≤ 150 milímetros de mercurio y la enfermedad grave por COVID-19 fueron los principales factores relacionados con la mortalidad.