Clinical features and outcome of maintenance hemodialysis patients with COVID-19 from a tertiary nephrology care center in Romania

Ștefan, Gabriel; Mehedinti, Ana Maria; Andreiana, Iuliana; Zugravu, Adrian; Cinca, Simona; Busuioc, Ruxandra; I, Miler; Sica, Simona; Petrescu, L.; Dimitriu, Ioana; Moldovanu, E.; Crasnaru, Diana Elena; Gugonea, Georgeta; Georgescu, Valentin; Strâmbu, Victor; Căpuşă, Cristina

doi:10.1080/0886022x.2020.1853571

Cited by 34 publications

(39 citation statements)

References 34 publications

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“…Age of confirmed COVID-19 patients on HD was largely heterogeneous since principally tends to reflect national policy of access to dialysis treatment. Median and mean age of this large cohort of patients ranged between 48 and 79.5 years [ 11 , 15 , 17 , 21 , 23 , 61 , 82 , 94 , 108 – 122 ] and 54.1–76 years, [ 6 , 19 , 25 , 31 , 32 , 69 , 93 , 123 – 135 ] respectively. The percentage of male was 37.5%-100% of the examined population [ 11 , 13 , 15 , 17 , 19 , 21 , 23 , 25 , 31 , 32 , 69 , 82 , 94 , 108 – 131 , 133 – 138 ].…”

Section: Resultsmentioning

confidence: 99%

“…In research articles reporting clinical manifestation and outcome of COVID-19 patients (78[54.4%]) the diagnosis of SARS-CoV-2 infection relied principally on RT-PCR (52[63.4%]) [ 11 – 20 , 32 , 61 , 62 , 69 , 93 , 94 , 100 , 108 – 111 , 113 , 115 – 124 , 126 , 129 , 132 , 134 , 135 , 138 – 151 ], serology (4[6.3%]) [ 18 , 20 , 22 – 24 , 86 , 99 ], RT-PCR and serological assay (5[6.6%])[ 29 – 31 , 85 , 127 , 152 ] or a combination of diagnostic tests including clinical evaluation [ 6 , 13 , 19 , 21 , 112 , 114 , 125 , 128 , 130 , 131 , 133 , 136 , 137 , 153 , 154 ].…”

Section: Resultsmentioning

confidence: 99%

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The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

et al. 2021

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Background Patients undergoing in-centre haemodialysis (HD) are particularly exposed to the dire consequences of COVID-19. The present systematic scoping review aims to identify the extent, range, and nature of articles related to COVID-19 and maintenance HD: it reports specifically the prevalence of the COVID-19 pandemic in the HD population, implementation of strategies for the prevention, mitigation and containment of the COVID-19 pandemic in HD centres, demographic and clinical characteristics, and outcomes of the pediatric and adult HD patients. Methods A multi-step systematic search of the literature in Pubmed, Scopus, Ovid Medline, Embase and Web of Science, published between December 1, 2019, and January 30, 2021 was performed. Two authors separately screened the titles and abstracts of the documents and ruled out irrelevant articles. A report of the papers that met inclusion criteria was performed; then, a descriptive analysis of the characteristics of the included articles and a narrative synthesis of the results were performed. Results The review process ended with the inclusion of 145 articles. Most of them were based on single-centre experiences, which spontaneously developed best practices. Most studies were conducted in high-income countries (69.7%) and a part of them (9.6%) were not in English. Prevalence of COVID-19 among dialysis patients accounted for 0%-37.6%. Preventive measures were reported in 54% of the included articles, with particular emphasis on education, triage, hygiene, and containment measures. Patients experienced a heterogeneous spectrum of symptoms that led 35%-88.2% of them to hospital admission. Median and mean hospital length of stay ranged from 8 to 28.5 and 16.2 to 22 days, respectively. Admission to intensive care units varied widely across studies (from 2.6% to 70.5%) and was associated with high mortality (42.8%-100%). Overall, prognosis was poor in 0%-47% of the hospitalized patients. Conclusions This systematic scoping review provides an overview of the current knowledge on the impact of COVID-19 on the frail world of HD patients. Furthermore, it may help to implement the existing strategies of COVID-19 prevention and provide a list of unmet needs (safe transport, testing, shelter). Finally, it may be a stimulus for performing systematic reviews and meta-analyses which will form the basis for evidence-based guidelines.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

et al. 2021

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“… 6 , 7 , 15 , 16 In contrast, Stefan and Mehedinti from Romania reported a mortality rate of 19% in their hemodialysis population. 17 Similarly, a multi-center study from Turkey showed a mortality rate of 16.2%. 18 We found a mortality rate of 25.6% in our study, which is in-between the aforementioned studies.…”

Section: Discussionmentioning

confidence: 96%

Clinical Course and Outcome of ESRD Patients on Maintenance Hemodialysis Infected with COVID-19: A Single-Center Study

Kazmi¹,

Alam²,

Salman³

et al. 2021

IJNRD

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Background In an ESRD subset of patients, COVID-19 infection is associated with increased disease burden and higher mortality rates. Methods We conducted a retrospective single-center cohort study in which 43 ESRD patients had a diagnosis of COVID-19. Association of risk factors with mortality was assessed by chi-square test and logistic regression analysis. Data were collected on a structured performa which included variables like age, gender, comorbid conditions, drug history, clinical presentation, hemodynamic status and laboratory parameters. Outcome variables were recovery and death. All patients received standard treatment for COVID-19 according to hospital protocols, along with hemodialysis and continuous renal replacement therapy (CRRT) when needed. Results Those most affected were found to be male, 25 (58.1%), while the number of females affected was 18 (41.9%). The most frequent comorbid condition was hypertension (HTN), seen in 35 (81.4%) patients; however, thromboembolic complications were very few in these patients. The mortality rate in our study was 25.6%, and the population most susceptible to poor outcomes in the ESRD subgroup was elderly people (45.5%), while younger patients recovered the most from COVID-19 (53.1%). Hypoalbuminemia, leukocytosis, lymphopenia and raised LDH were also found to be associated with death in ESRD patients suffering from COVID-19 (81.8, 72.7, 100 and 100%, respectively). In multivariate logistic regression analysis, we found that the odds ratio of dying from COVID-19 was 19.5 times higher in patients aged >65 years as compared to patients aged 18–50 years (p=0.039). Similarly, patients with a high TLC were 24.1 times more likely to die than patients with a normal TLC (p=0.008). Conclusion In our center, the mortality rate of ESRD patients affected with COVID-19 disease was 25.6%, and older age, leukocytosis, lymphopenia, hypoalbuminemia and high LDH were significantly associated with mortality.

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“…In Romania, one study evaluating the outcome of hemodialysis patients reported that 60% received hydroxychloroquine, 22% received the lopinavir/ritonavir combination, 11% received tocilizumab, and 24% received systemic glucocorticoids, while only 54% received anticoagulation [64]. Even if azithromycin use was not recommended by the August 2020 protocol update of the Romanian Ministry of Health due to cardiovascular risk when administrated in parallel to hydroxychloroquine and the risk of antibiotherapy resistance in Romania, the use of hydroxychloroquine in COVID-19 was not contraindicated when no other alternative was available [40]; this was highly debated on Romanian physician forums.…”

Section: Treatment Of Sars-cov-2 Infectionmentioning

confidence: 99%

Perceptions of Romanian Physicians on Lockdowns for COVID-19 Prevention

Dima

Balaban

Jurcuţ³

et al. 2021

Healthcare

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) was declared a pandemic in March 2020, triggering important changes for the entire society and healthcare systems, as well as significant lockdown measures aimed to limit the disease spread. We herein intended to catch the dynamic of Romanian physicians’ perceptions of COVID-19 impact. For this purpose, after a literature review, a 30-item questionnaire was designed. The questionnaire was twice distributed online, about 1 month apart, during which partial relaxation measures were decreed in Romania. The questionnaire was voluntarily filled in by Romanian physicians who were willing to participate in the study. A total of 214 physicians answered the questionnaire upon its first release, and 199 respondents were registered upon its second release, most of whom (94.9%) were involved in clinical work, with one-third working in units dedicated to COVID-19 patients. In parallel with the relaxation of lockdown measures, along with increased confidence in the efficiency of protective measures (46.7% vs. 31.3%), separation from household members decreased from 36.9% to 22.1%. Nevertheless, the feeling of rejection felt by doctors remained similar (22.4% vs. 24.6%). Furthermore, answers regarding the clinical picture, diagnostic approach, and treatment options are discussed. Most of therapeutic options considered for SARS-CoV-2 treatment (e.g., lopinavir/ritonavir, oseltamivir, hydroxychloroquine, azithromycin, tocilizumab, and convalescent plasma) failed to confirm significant efficiency. On the contrary, vaccines for widescale use are already available despite the initial skepticism. In the beginning of the pandemic, 25.2% (18.2% vs. 32.2%) considered that there will not be an effective COVID-19 vaccine, while 41.6% (43.0% vs. 40.2%) thought that a vaccine would be available after at least 12 months. In conclusion, initially, following only a 1 month period, Romanian physicians’ intention to consider treatments such as hydroxychloroquine or lopinavir/ritonavir for COVID-19 decreased significantly. Moreover, confidence in the efficiency of available protective measures increased, and the rates of separation from household members decreased.

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Clinical features and outcome of maintenance hemodialysis patients with COVID-19 from a tertiary nephrology care center in Romania

Cited by 34 publications

References 34 publications

The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

Clinical Course and Outcome of ESRD Patients on Maintenance Hemodialysis Infected with COVID-19: A Single-Center Study

Perceptions of Romanian Physicians on Lockdowns for COVID-19 Prevention

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