MO304: Severe Sars-COV-2 Infection in Patients with Chronic Kidney Disease and Lung Disease. Outcomes and Referral for Palliative Care in a Tertiary Center in SÃo Paulo, Brazil

Abstract

BACKGROUND AND AIMS Coronavirus disease 2019 (COVID-19) is mainly an infectious disease of the respiratory system transmitted through air droplets, and pulmonary symptoms constitute the main presentations of this disease [1]. The first cases of the disease were identified in Wuhan, China, which occurred in early December 2019. Initially, it was called pneumonia of unknown origin, severe acute (SARS-CoV-2) [2]. In addition to being a target of the virus, the kidney also seems to have a substantial influence on the outcomes of the disease [3]. Underlying kidney disease is an emerging risk factor for more severe coronavirus disease 2019 (COVID-19) illness [4]. Identifying patients who require a palliative care approach is challenging for family physicians, even though several identification tools have been developed for this purpose. The Supportive and Palliative Care Indicators Tool (SPICT™) aims at facilitating this identification [5]. The aim of this study is to compare the outcomes presented between patients with nephropathy and lung disease in the first wave of COVID-19 assisted by a reference center in Brazil. METHOD This study is a data analysis from patients assisted by a reference center in São Paulo, Brazil, which includes 2013 patients from March to July of 2020. This period consists on the first wave of COVID-19 infection in this country. In addition, a literature review was conducted, papers were selected searching PubMed/Medline, SciELO and LILACS databases using the terms (COVID-19) AND (nephropathy) AND (pneumopathy) AND (outcomes) in January 2022. There were no language or publication date restrictions. Also, we used the (SPICT™ to classify the patients for treatment with palliative care. RESULTS Among 2013 patients included in our study, 223 had nephropathy, 127 males and 96 females. As for pulmonary disease, there were 155 patients, 93 males and 62 females. Furthermore, among pneumopathy patients, 65% were >60 years old, and, among renal patients, 47% approximately were >60 years old. In addition, the mean age of the renal patients’ group was lower than the group of patients with lung disease. The outcomes in the nephropathy group consisted in 109 discharges and 114 deaths. In the group of pulmonary patients, 90 were discharged and 59 died; the other patients were transferred to specialized services. Renal patients presented worse outcomes than pulmonary patients, even though COVID-19 mainly affects the lung, our patients had substantial impact of its infection. Despite the fact that SPICTTM identified 41 renal patients eligible for palliative care, only 31 were referred to this service at the hospital where the study was conducted. When compared with the total population of this study, the renal patient's group was the third with the highest number of hospitalizations due to COVID-19. CONCLUSION Renal patients had a worse prognosis when compared with patients with lung disease and the total population. The outcomes could have been different if all renal patients had been referred and treated with palliative care.