Clinical Presentation and Outcome of Covid-19 Infection in Patients Undergoing Maintenance Hemodialysis

Covid-19 infection in hemodialysis

Abstract

Background: WHO declared Covid-19 a pandemic disease; although 80% of patients with CoV-2 infection have no or mild symptoms, the remaining 20% of patients develop complications. In patients undergoing dialysis, mortality could be higher than that in the general population. This study was conducted to assess the frequency, clinical presentation, and outcome of COVID-19 infection in patients of end-stage renal disease (ESRD) on maintenance hemodialysis.

Methodology: This Cross-sectional study was conducted at Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi, from April to September 2020. This study included 130 patients of either gender of End-Stage Renal Disease on maintenance hemodialysis for at least 3 months. Two Samples for COVID-19 PCR were taken through nasal swab. Blood samples were collected for hemoglobin level, total and differential leucocyte count, platelet count, intact Parathyroid hormone, vitamin D level, Urea, Creatinine, ferritin, transferrin saturation, procalcitonin, D-Dimer, C-reactive proteins, and lactate dehydrogenase.  Radiological assessment was done by X-ray Chest. Urea reduction ratio and single pool Kt/V was used for assessment of adequacy of hemodialysis.

Results: Out of 130 patients on hemodialysis, COVID-19 was detected in 52 patients, of which males were 69.2% and females were 30.8%. The most common presentation was shortness of breath (28.8%), followed by cough (19.2%). Home isolation was advised to 38.5% while noninvasive ventilation was given to 34.6%. Mechanically ventilated patients were 26.9%. There were 63.5% patients who recovered and were discharged from the hospital or home-isolated, while 19 patients died (36.5%).

Conclusion: COVID-19 pandemic has high chances of infection with increased mortality in people with chronic diseases, especially those having ESRD on hemodialysis. This spreading of infection can be hampered with standard measures of disinfection in centers, social distancing in patients, and the use of a face mask.

Keywords: Covid-19, Cough, Hemodialysis, Home isolation, Ventilation