tetano
Editor, Senior Moderator
Med J Armed Forces India
. 2022 Feb 10.
doi: 10.1016/j.mjafi.2021.12.004. Online ahead of print.
Chronic Kidney Disease and COVID-19: Outcomes of hospitalised adults from a tertiary care centre in North India
Onkar Singh Bhinder[SUP] 1 [/SUP], Swarnim Swarnim[SUP] 2 [/SUP], Mukta Mantan[SUP] 3 [/SUP], Aashima Dabas[SUP] 4 [/SUP], Ravinder Singh Ahlawat[SUP] 5 [/SUP]
Affiliations
Abstract
Background: Coronavirus disease 2019 (COVID-19) is a novel disease caused by the SARS-CoV-2 virus and has emerged as a deadly pandemic affecting countries all over the world. Here we share our experience of managing adults with chronic kidney disease (CKD) and concomitant COVID-19 infection jointly managed by pediatric and adult nephrology teams.
Methods: This retrospective study was done on patient admissions (>18 years) between 20[SUP]th[/SUP] June- 30[SUP]th[/SUP] October 2020 with previously diagnosed CKD and hospitalised with COVID-19 infection. The demographic details, underlying comorbidities, clinical presentation, medications, laboratory, radiological profile and outcomes were studied.
Results: A total of 213 adults (62% males) with CKD were admitted during this period with a median (IQR) age of 52 (42, 60) years; 75 (35.2%) had associated diabetes mellitus, 83.1% hypertension, 5.2% hypothyroidism and 7% coronary artery disease. 165 (77.5%) were on maintenance haemodialysis (MHD), and 72.8% had arteriovenous fistula as vascular access at presentation. Most (84.5%) patients were symptomatic for COVID-19, and about 2/3 diarrhoea had moderate to severe disease. Oxygen therapy was needed in 62.9%, and medications used were hydroxychloroquine in 84.5%, azithromycin in 21.6%, ivermectin in 82.6%, steroids in 63.8% and Low molecular weight heparin in 59.2%. A further comparison of patients with CKD5D and CKDND revealed similar parameters except for a higher incidence of diarrhoea, acute kidney injury (AKI) and a shorter period to RTPCR negativity (12.5 vs 15 days; P = 0.038) in CKDND. The overall mortality was 24.4%, with similar mortality rates in both groups (P = 0.709) and 20.7% needed ICU transfer.
Conclusions: Adults with CKD especially on haemodialysis, are prone to more severe COVID-19 infection and take a longer time for viral clearance (>2 weeks); the mortality too is higher in these patients.
Keywords: CKD; COVID-19; Diabetes; Haemodialysis; Oxygen therapy.
. 2022 Feb 10.
doi: 10.1016/j.mjafi.2021.12.004. Online ahead of print.
Chronic Kidney Disease and COVID-19: Outcomes of hospitalised adults from a tertiary care centre in North India
Onkar Singh Bhinder[SUP] 1 [/SUP], Swarnim Swarnim[SUP] 2 [/SUP], Mukta Mantan[SUP] 3 [/SUP], Aashima Dabas[SUP] 4 [/SUP], Ravinder Singh Ahlawat[SUP] 5 [/SUP]
Affiliations
- PMID: 35169379
- PMCID: PMC8830751
- DOI: 10.1016/j.mjafi.2021.12.004
Abstract
Background: Coronavirus disease 2019 (COVID-19) is a novel disease caused by the SARS-CoV-2 virus and has emerged as a deadly pandemic affecting countries all over the world. Here we share our experience of managing adults with chronic kidney disease (CKD) and concomitant COVID-19 infection jointly managed by pediatric and adult nephrology teams.
Methods: This retrospective study was done on patient admissions (>18 years) between 20[SUP]th[/SUP] June- 30[SUP]th[/SUP] October 2020 with previously diagnosed CKD and hospitalised with COVID-19 infection. The demographic details, underlying comorbidities, clinical presentation, medications, laboratory, radiological profile and outcomes were studied.
Results: A total of 213 adults (62% males) with CKD were admitted during this period with a median (IQR) age of 52 (42, 60) years; 75 (35.2%) had associated diabetes mellitus, 83.1% hypertension, 5.2% hypothyroidism and 7% coronary artery disease. 165 (77.5%) were on maintenance haemodialysis (MHD), and 72.8% had arteriovenous fistula as vascular access at presentation. Most (84.5%) patients were symptomatic for COVID-19, and about 2/3 diarrhoea had moderate to severe disease. Oxygen therapy was needed in 62.9%, and medications used were hydroxychloroquine in 84.5%, azithromycin in 21.6%, ivermectin in 82.6%, steroids in 63.8% and Low molecular weight heparin in 59.2%. A further comparison of patients with CKD5D and CKDND revealed similar parameters except for a higher incidence of diarrhoea, acute kidney injury (AKI) and a shorter period to RTPCR negativity (12.5 vs 15 days; P = 0.038) in CKDND. The overall mortality was 24.4%, with similar mortality rates in both groups (P = 0.709) and 20.7% needed ICU transfer.
Conclusions: Adults with CKD especially on haemodialysis, are prone to more severe COVID-19 infection and take a longer time for viral clearance (>2 weeks); the mortality too is higher in these patients.
Keywords: CKD; COVID-19; Diabetes; Haemodialysis; Oxygen therapy.