Hospitalizations, which affect quality of life, differ little between elderly and younger patients on HD. Therefore, hospitalizations do not constitute an argument for restricting access to HD to elderly patients.

Hospitalization rate is high in patients on chronic hemodialysis (HD). We investigated whether initiation of HD changes the rate and length of hospitalization. We analyzed hospitalizations in HD patients in one hospital over 15 years. We compared annual rate and length of hospitalizations, both presented as mean (95% confidence interval [CI]) between the pre-HD and HD period. Three hundred ninety-two patients, 98% men, 59% diabetic, and 66.3 ± 11.2 years old at the onset of HD, had 1016 hospitalizations in the pre-HD period (60.0 ± 42.9 months) and 1627 hospitalizations in the HD period (32.5 ± 25.9 months). Higher values were found in the HD than the pre-HD period for rate, (pre-HD 0.557 [95% CI 0.473-0.611], HD 2.198 [95% CI 1.997-2.399] admissions/[patient-year], P<0.001) and length (pre-HD 4.63 [95% CI 3.71-5.55], HD 28.07 [95% CI 23.55-32.59] days/patient-year], P<0.001) of hospitalizations for all causes, cardiac disease, infections, vascular access, peripheral vascular disease, metabolic disturbances, gastrointestinal diseases, and miscellaneous conditions, mainly respiratory illness and malignancy. Similar differences were found when we compared the year before and the year after the start of HD. Diabetics had higher all cause rate and length of hospitalizations than non-diabetics in the pre-HD and HD periods. The rate and length of hospitalizations was higher in the HD than the pre-HD period for both HD-specific conditions and conditions encountered in both HD and general populations. Study of factors specific to HD that may affect these conditions should constitute the first step toward improving the morbidity of patients on HD.

While anemia is common in patients on chronic hemodialysis (HD), spontaneous erythrocytosis is rare and can be caused by either the same conditions causing erythrocytosis in the general population or any condition specific to chronic renal failure. We present a patient illustrating this latter circumstance. A 53-year-old man with diabetic nephropathy, with no known disease causing hypoxemia started HD in April 2001. Blood hemoglobin (Hgb) level was 13.7 +/- 2.8 g/dL while his kidney function was normal (1993-1996) and after 1997, with the development of chronic kidney disease, decreased progressively to a low of 10.2 g/dL in March 2001 when erythropoietin (EPO) injections were started. Erythropoietin requirements progressively decreased because of rising Hgb. Erythropoietin was discontinued in mid-2005. Blood hemoglobin continued to rise, however, to a high value of 17.6 g/dL in February 2006. At the same time, endogenous blood EPO level was 3.6 mIU/mL, a value consistent with primary polycythemia. White blood cell and platelet counts were normal. Several small renal cysts, including 1 complex cyst, were detected by ultrasonography and computer tomography in April 2006. He refused surgical treatment. He was treated with small phlebotomies (not returning the blood in the dialyzer at the end of dialysis) and monitoring of Hgb, which decreased toward the desired range. Repeated computer tomographic scans showed a slow increase in the size of the complex cyst and several other cysts. In late 2007 Hgb started rising again, and in February 2008, while the Hgb level was 16.4 g/dL, the endogenous serum EPO level was 726 mIU/mL (upper normal limit 31.5 mIU/mL). Intermittent phlebotomies were reinstituted. He subsequently developed multiple vascular catastrophes and expired from ischemic bowel disease in September 2008. Acquired cystic disease of the kidneys should be considered in HD patients who develop spontaneous erythrocytosis. The risks of acquired cystic disease include, in addition to the development of malignancy, vascular events from elevated Hgb.

Background: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel strain of coronavirus, which is the cause of the current coronavirus disease 2019 (COVID-19) pandemic, ravaging many countries of the world. The objective of this study is to assess the symptomatology and case management outcome of hospitalized COVID-19 patients in Ondo State, Southwestern Nigeria.Methodology: This was a longitudinal study carried out on randomly selected patients with COVID-19, confirmed by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR), admitted to the Infectious Disease Hospital, Akure, from March to July 2020. Clinical and outcome data obtained from the patients were analysed using the Statistical Package for the Social Sciences (SPSS) version 24.0 software, and variables were compared using the Chi square (χ²) test and Odds ratio (OR).Results: A total of 215 hospitalized COVID-19 patients were randomly recruited, with 103 males and 112 females (M:F ratio of 1:1.1), and mean age of 37.24 ± 16.83 years. The most common symptoms were shortness of breath (22.8%), cough (18.6%), fatigue (17.2%), runny nose (16.7%), fever (16.3%), and sneezing (14.0%). Mortality rate among the patients was 4.7% (10/215). Statistical analysis showed that fever [χ² = 8.75, OR 2.17 (95% CI: 0.29-16.63), p=0.003] and sneezing [χ²=11.35, OR 2.75 (95% CI: 0.34-18.27), p=0.001] were clinical presentations with significant impact on the final outcome of the patients.Conclusion: This study showed that the most common symptoms in hospitalized COVID-19 patients were shortness of breath, cough, running nose, fever and sneezing, which underscores the importance of monitoring of patients for these symptoms. Keywords: COVID-19; symptoms; management; hospitalized; outcome; Nigeria   French Title: Symptômes cliniques et résultats chez les patients hospitalisés COVID-19 dans l'État d'Ondo, dans le sud-ouest du Nigéria Contexte: Le coronavirus-2 du syndrome respiratoire aigu sévère (SRAS-CoV-2) est une nouvelle souche de coronavirus, qui est à l'origine de la pandémie actuelle de coronavirus 2019 (COVID-19), ravageant de nombreux pays du monde. L'objectif de cette étude est d'évaluer les résultats de la symptomatologie et de la prise en charge des cas de patients hospitalisés COVID-19 dans l'État d'Ondo, dans le sud-ouest du Nigéria. Méthodologie: Il s'agissait d'une étude longitudinale réalisée sur des patients sélectionnés au hasard atteints de COVID-19, confirmée par réaction en chaîne par transcriptase-polymérase inverse en temps réel (rRT-PCR), admis à l'hôpital des maladies infectieuses d'Akure de mars à juillet 2020. Les données cliniques et les résultats obtenus des patients ont été analysés à l'aide du logiciel Statistical Package for the Social Sciences (SPSS) version 24.0, et les variables ont été comparées à l'aide du test du Chi carré (χ²) et du rapport de cotes (OR). Résultats: Un total de 215 patients hospitalisés COVID-19 ont été recrutés au hasard, avec 103 hommes et 112 femmes (rapport H: F de 1: 1,1), et un âge moyen de 37,24±16,83 ans. Les symptômes les plus courants étaient l'essoufflement (22,8%), la toux (18,6%), la fatigue (17,2%), l'écoulement nasal (16,7%), la fièvre (16,3%) et les éternuements (14,0%). Le taux de mortalité parmi les patients était de 4,7% (10/215). L'analyse statistique a montré que la fièvre [χ²=8,75, OR 2,17 (IC à 95%: 0,29 à 16,63), p=0,003] et les éternuements [χ²=11,35, OR 2,75 (IC à 95%: 0,34 à 18,27), p=0,001] étaient présentations cliniques avec un impact significatif sur le résultat final des patients. Conclusion: Cette étude a montré que les symptômes les plus courants chez les patients hospitalisés sous COVID-19 étaient l'essoufflement, la toux, le nez qui coule, la fièvre et les éternuements, ce qui souligne l'importance de la surveillance des patients pour ces symptômes. Mots clés: COVID-19; symptômes; la gestion; hospitalisé; résultat; Nigeria