SARS-CoV-2 assessment in an outpatient dialysis facility of a single center in Brazil

Abstract

Background The reported incidence and fatality rates of SARS-CoV-2 infection in patients receiving maintenance dialysis are higher than those of the general population. Objective This study sought to characterize the clinical characteristics and outcomes following COVID-19 infection in this population in a single center in Brazil. Methods Out of 497 dialysis patients evaluated between March 1 st , 2020 and February 1 st , 2021, those presenting symptoms or history of close contact with COVID-19 patients were tested. Disease severity was categorized as mild, moderate, or severe. Results Out of the 497 patients, 8.8% tested positive for COVID-19. These patients were predominantly male (59%), mean age 57.5±17. Hospitalization was required for 45.4% of patients and 15.9% received mechanical ventilation. Symptoms such as fever, cough, dyspnea and asthenia were more frequent in the severe group. Neutrophil to lymphocyte ratio, C- reactive protein, glutamic oxalacetic transaminase and lactic dehydrogenase were significantly higher in the severe group, while hemoglobin and lymphocyte counts were significantly lower. Chest CT>50% of ground glass lesions was the risk factor associated with severe disease and need for hospitalization. The incidence of a thromboembolic event was of 22.7% in this population. The incidence, mortality, and case fatality rates were 954.4/10,000 patients, 151.8/10,000 patients, and 15.9%, respectively. Conclusions The incidence, mortality and case fatality rates in our cohort were significantly higher than those reported for the general population. To institute appropriate control measures and early vaccination in dialysis facilities is imperative to prevent the spread of COVID-19 infection.

Clinical outcomes of COVID-19 in patients undergoing chronic hemodialysis and peritoneal dialysis

“…Other studies also found a higher COVID-19 fatality rate in the PD group than in the HD group (33% vs. 29.6% 22 and 45.6% vs. 34.5% 23 ), corroborating our previous study that showed that the PD group had a higher rate of severe COVID-19 than the HD group. 8 In contrast, Weinhandl et al reported that the PD group had a much lower risk of hospitalization than the HD group 27 . Hsu et al did not find significant differences in the morbidity and mortality rates between the HD and PD groups with COVID-19 2 .…”

“…24 Moreover, telehealth has played a pivotal role in the current pandemic and should be implemented whenever possible; however, the quality of evidence is controversial. [25][26] Studies evaluating the impact of COVID-19 on PD and HD patients have conflicting results 2,8,22,23,27 . Our study found higher hospitalization, oxygen therapy need, mechanical ventilation, mortality, and fatality rates (52.9% vs. 19.4%; p = 0.005) in the PD group than in the HD group.…”

“…Accumulating evidence shows that patients on chronic dialysis are among the most vulnerable to COVID-19 1,2 , with multiple studies reporting fatality rates above 20% 3,4,5 . Although infection rates among dialysis patients tend to follow local patterns, the incidence of COVID-19 is higher in this population than in the general population, probably due to increased testing, symptoms screening, need for medical care, and sharing of public transportation for routine travel to the dialysis facility [6][7][8] . In most countries, dialysis is mostly delivered as incenter hemodialysis (HD), but the minority of home dialysis patients, either HD or peritoneal dialysis (PD), have comparable outcomes 2,9 .…”

Anosmia como manifestación inicial de COVID-19 en pacientes de hemodiálisis

“…En la literatura existen muy pocos trabajos que evalúen especí camente las alteraciones del gusto u olfacción por COVID-19 en la población en diálisis. El trabajo de Polacchini et al en Brasil reportó una prevalencia alta (47,7 %) de alteración del gusto o la olfacción en 44 pacientes que presentaron COVID-19, esta prevalencia fue similar en los casos leves, moderados y severos [7], sin embargo, no se menciona si las alteraciones precedieron, fueron concomitantes o posteriores a la aparición de los síntomas clásicos o si fue el único síntoma de COVID-19. Feehan et al realizaron un trabajo de prevalencia para indagar sobre la importancia de la anosmia o la ageusia en casos asintomáticos y sintomáticos de COVID-19; encontraron en su población un 4,8 % de pacientes con anosmia o ageusia, la cual aumentó a 29,9 % en los pacientes con rmados de COVID-19; la prevalencia del factor (síntoma presente en casos positivos divididos por el total de reportes) fue del 40,6 % [8].…”

“…Como una unidad renal es un sitio potencial de mayor prevalencia de COVID-19, con las implicaciones que tienen, como una alta tasa de hospitalización y muerte como la reportada por Polacchini et al [7] en Brasil, estos mismos argumentos nos motivaron a la realización del presente estudio; sin embargo, solo encontramos un número bajo de pacientes con COVID-19 y alteraciones de la olfacción que pudo explicarse por estar en ese momento en Colombia en una etapa posprimera ola de COVID-19. A pesar de lo anterior, nuestros resultados aportan datos importantes en la población en diálisis no reportados previamente.…”