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)