Result For Hemodialysis Patients
As a result of the decision taken by the provincial health authority, patients who were diagnosed with laboratory-confirmed Covid -19 hemodialysis in 5 dialysis centers in the city center between 11 March and 11 March 2021 were included in the study. We included 72 patients, 36 (%50) were female and 36 (%50) were male. The median age was 57.5 (43-65) years. The mean dialysis treatment period of the patients was 39 months (10-94.5). All of the patients had positive RT-PCR. All the patients had thorax computerized tomography (CT). Pulmonary findings were not observed in two patients on thorax CT. The most common abnormalities as thorax CT findings in 87.9% of the patients were ground-glass appearance and irregular opacities. Lesions often affected the bilateral lungs in 83.3% of the patients. No statistical significance was found between the groups in terms of frequency of ground glass appearance and bilateral lung involvement.
The most common presenting symptom overall was dyspnea (36.1%) followed by fever (31.9%), cough (19.4%), and fatigue/malaise (19.4%). Patient less commonly reported sore throat (2.8%).
The most common primary causes of ESKD in these patients were hypertensive kidney disease (47.2%) and diabetic nephropathy (43.1%) and followed by polycystic kidney disease (5.6%), focal segmental glomerulosclerosis (2.8%), vesicoureteral reflux (2.8%) and in one patient; nephrolithiasis (1.4%).
Coexisting comorbidities were hypertension (75%), diabetes mellitus (%43.1), coronary artery disease (%29.2), two patients had asthma, 1 patient had a previous CVA and 1 patient had a history of malignancy.
Almost all of our patients were receiving hemodialysis treatment 3 times a week before being diagnosed with COVID-19. Most patients (72.2%) dialyzed via arteriovenous fistula or non-tunneled hemodialysis catheter (12.5%) / tunneled dialysis catheters (15.3%).
The white blood cell, lymphocyte, hemoglobin, platelet counts as well as CRP, procalcitonin, d-dimer, ferritin, ALT, LDH, creatinine kinase tests were reviewed in all of our patients who were treated both in outpatient and hospitalized patients. A comparison of blood tests of alive and deceased patients is available in Table 1 with their averages.
The rate of patients taking hydroxychloroquine was 27.8%, and the rate of those who took favipiravir was 83.3%. In 48 patients, anti-biotherapy was started for secondary infection or prophylaxis (66.7%). Also, dexamethasone was administered in 20 (27.8%) patients.
Of our 72 patients, 48 (66.6%) who needed oxygen therapy or had low oxygen saturation and moderate or poor general condition were hospitalized. Sixteen (26.3%) of 48 patients were admitted to the intensive care unit. Ten (13.9%) of the patients hospitalized in the intensive care unit were intubated and connected to a mechanical ventilation device. Nasal oxygen support was sufficient for the patients hospitalized in the clinic. The median length of stay of the inpatients was found to be 9.5 (5-13), and the median length of stay in the intensive care unit was 4.5 (1.25-10.75). Fıfteen of our patients (20.8%) died.
All patients were divided into two groups according to the presence and absence of in-hospital mortality. The groups were compared according to demographic, clinical, laboratory findings, and COVID-19 treatments.
Between the two groups, increased age, female gender, AVF as the access route to dialysis, dyspnea as an admission symptom, increased d-dimer and decreased albumin, ferritin was found to be statistically significant in presence of in-hospital mortality group. (Table 1)
There was no significant relationship between the two groups in terms of comorbid disease, White blood cell, lymphocyte, platelet, procalcitonin, CRP, ALT, CK, values. (Table 1)
To identify the independent predictors of in-hospital mortality, multivariable logistic regression analyses with a stepwise backward model were performed using the variables in the univariate analyses including age, female gender, diabetes mellitus, ferritin, d-dimer, albumin, CRP, procalcitonin, dyspnea. Age (OR:1.12, 95% confidence interval [CI]: 1.03-1.21, p=0.004), and dyspnea (OR: 9.7 95% CI 1.80-52.2, p=0.008) were found to be associated with in-hospital mortality. (Table 2)