Introduction
With the spread of the novel coronavirus (COVID-19) throughout the world since December 2019, patients with End-Stage Kidney Disease (ESKD), due to their extensive comorbid conditions, were considered one of the most vulnerable populations. In this study, we evaluated 240 patients on maintenance hemodialysis (MHD), of which 44 had been diagnosed with COVID-19.
Methods
Study Design: Retrospective two-centers cohort study
Setting and participants: From March 2nd, 2020 to September 21st, 2020, a total of 240 patients received MHD at Beheshti and Vali-Asr Hospitals affiliated to Abadan University of Medical Sciences of which 44 were diagnosed with COVID-19. (Based on Reverse transcriptase-polymerase chain reaction (RT-PCR) test results or chest CT scan findings). Demographic, clinical, laboratory, and radiologic findings of these 44 patients were collected.
Results
COVID-19 was diagnosed in 44 patients (18.33 %) and 8 patients had died (18.1%). RT-PCR test was carried out for 39 patients of which 15 (40.54%) tested positive. Among the 44 patients with COVID-19 infection, 26 were men (59.09%) and 18 were women (40.9%) and the mean age was 54.5±16.00 years. Patients with diabetes mellitus (either as an underlying cause or as a comorbidity) accounted for 61.36% of cases. Other common comorbidities were hypertension (52.27%) and cardiovascular disease (25%). Fever (36.36 %), shortness of breath (34.09 %), cough (25%), and fatigue (13.63%) were the most common symptoms and 18.18 % of the patients were asymptomatic. We detected high levels of inflammatory markers such as C-reactive protein (CRP), in 80% of patients. Chest CT scan was obtained for all suspected patients and showed ground glass opacity, consolidation, and pleural effusion in 54.83%, 48.38%, and 29.03% of cases, respectively. However, 9.67 % of patients had no pathologic finding on their Chest CT scan. Peripheral and central pulmonary involvement were found in 70.96 % and 19.35 % of patients. The mean single pool KT/V (SpKT/V) was calculated 1.10±0.39. Eventually, 20 patients were admitted to the hospital ( 45% ) and the average length of stay at hospital was 3.91± 4.63 days. Of our patients, 80% underwent hemodialysis three times a week.
Conclusions
Based on our results, COVID-19 pandemic is a significant concern for in-center hemodialysis patients. These patients are particularly susceptible because of their comorbidities. Moreover, limitations in physical distancing, public exposures and pre-existing lung involvement in these patients may complicate their management and affect the overall outcome. Less availability of RT-PCR testing across the nation in low middle-income countries (LMIC) like Iran, is another downside that has to be considered.
No conflict of interest