Introduction
SARS-CoV-2 infection is challenging healthcare systems around the world. Hemodialysis (HD) patients are at increased risk for COVID-19 and its transmission due to difficulty maintaining physical distancing. There is a lack of evidence regarding the epidemiology of COVID-19 in maintenance HD patients. In this study, we describe our experience of covid 19 infection in our dialysis unit.
Methods
It is a retrospective, observational, single-center study including all positifs patients managed at our COVID-19 hemodialysis unit in nephrology departement of Sousse from October 1st to November 23th, 2020 as confirmed by real-time polymerase chain reaction.
We collected the clinical characteristics, laboratory investigation , treatement and evolutionary profile of COVID-19 hemodialysis patient.
Results
A total of 20 hemodialysis patients were enrolled in the study with a mean age of 56+/-12 years. there were 15 males and 5 females. The common comorbidities were hypertension and diabetes present respectively in 47.1% and 35.3% of cases. The diabetic nephropathy was the most frequent cause of end stage renal disease (ESRD). The mean time on dialysis therapy was of 83 months (8–288 months).
The most common symptom was fever (68.4%), followed by dry cough (57.9%) and dyspnea (42,1%). Three patients were asymptomatic. All COVID-19–infected patients had lymphopenia; lympocyte level was less than 500/mm3 in 4 patients. Hyperleukocytosis was noted in only one patient. Mean hemoglobin level was 8.9+/-2g/dL . Thrombopenia was found in 4 patients. Eleven patients had elevated CRP; hepatic cytolysis has been noted in 6 patients. rhabdomyolysis has occurred in 2 cases.
At disease diagnosis, 7 of the 20 (35%) patients were managed on an out patient basis, whereas the remaining 13 (65%) required hospitalization because of hypoxia. Eight patients required intensive care unit (ICU) care.Choices regarding management strategy were made based on disease severity.79% received double antibiotherapy and 60% curative anticoagulation. Dexamethasone was administered to 7 of 2 0 patients. All patients recieved vitaminotherapy. Ten patients required high oxygen flow CPAP – VNI, only one patient was intubated.
Six patients were discharged, and 7 patients died during hospitalisation, all due to respiratory failure.
Conclusions
The current outbreak of SARS-CoV-2 r epresents a special risk for l patients with chronic kidney disease. Its severity is highly variable in hemodialysis patients.
It is essential to have an adequate training of all professional in the hemodialysis unit on the prevention and identification measures of COVID-19 .
No conflict of interest