Introduction
Although SARS CoV-2 infection primarily causes respiratory illness with variable clinical presentation; other organs are also damaged by the virus, kidney being one of the major site of complication. Haemodialysis patients are a major risk group to contract the infection and often associated with high morbidity and mortality. In this study we describe the clinical characteristics and outcomes of SARS CoV-2 illness in chronic kidney disease patients on maintenance haemodialysis.
Methods
All patients of Chronic kidney disease on maintenance haemodialysis admitted with SARS-CoV-2 illness over a period of 14 months from 1STApril 2020 to 30thJune 2021 were included in this study. SARS-CoV-2 illness was documented with HRCT chest and RT-PCR test. The demography, basic disease, clinical manifestation, laboratory data, treatment modalities and outcomes were retrospectively analysed.
Results
A total number of 50 patients on maintenance haemodialysis were admitted with SARS-CoV-2 illness of which 36 (72%) were males and 14 (28%) were females in the age group of 18-80 years.
The basic disease causing End Stage Kidney Disease was Diabetic Nephropathy in 24 patients (48%),IgA Nephropathy in 6 patients (12%), Hypertensive Nephrosclerosis in 1 patient (2%),Chronic Interstitial Nephritis in 7 patients (14%),ADPKD in 2 patients (4%),Lupus Nephritis in 1 patient (2%),Focal Segmental Glomerulosclerosis in 1 patient (2%), Chronic Glomerulonephritis in 6 patients (12%) and Membranous Nephropathy in 2 patient (4%).
The most common presenting symptoms were fever (74%), dyspnea (60%), cough (24%), lose motions (12%), loss of smell (16%), hematuria (8%), fatigue (10%) and malena (2%).
HRCT Chest revealed a CORADS score of 5 (28%), 4 (20%), 3 (28%), 2 (18%), 1 (6%). 20 (40%) patients were admitted in ICU and 30 (60%) in wards.14 patients (28%) required face mask, 13 patients (26%) required mechanical ventilation, 6 patients (12%) required NIV, 6 patients (12%) required HFO and 11 patients (22%) did not require any mode of ventilation.
43 patients (86%) underwent haemodialysis via arteriovenous fistula, 2 patients (4%) via arteriovenous grafts and 5 patients (10%) via permacath. 8 patients (16%) underwent continuous renal replacement therapy, 11 patients (22%) underwent sustained low-efficiency dialysis and 31 patients (62%) underwent conventional haemodialysis.
47 patients (94%) were treated with steroids and 27 patients (54%) were treated with remdesevir for a mean period of 3 days. Mortality was seen in 17 patients (34%). The average duration of hospital stay in those who recovered was 8 days. The most common cause of death was septic shock.
Conclusions
The prevalence of SARS-CoV-2 infection in our haemodialysis patients was less as compared to the general population. Fever, dyspnea, cough and lose motions were the most common presenting symptoms. Mortality was significant in those requiring ICU admission and mechanical ventilation.
No conflict of interest