Introduction Different studies describe the clinical profile and factors that could explain the evolution and outcome of patients with chronic kidney disease and COVID-19. This study aims to evaluate the factors related to the mortality of patients with stage-5 chronic kidney disease on chronic dialysis hospitalized for COVID-19 at the Hospital Nacional Arzobispo Loayza from April to December 2020. Methods Retrospective case series and exploratory analysis were performed. Patients with stage-5 chronic kidney disease on dialysis, older than 18 years, and hospitalized for COVID-19 disease were included. Hospital medical records were the primary data source. Results A total of 105 medical records were reviewed. 57 were male (54.3%), with a mean age of 58.6 years (standard deviation: 14.3). Eighty-four patients survived (80%), and 21 died (20%). The main cause of hospital admission, present in 80 patients (76.2%), was respiratory failure; the mean hospital stay was of 11.8 days (SD: 7.8). In the bivariate analysis: patients with moderate to severe COVID-19, overweight and obesity, increased levels of leukocytes, D-dimer, ferritin, C-reactive protein, lactate dehydrogenase, as well as, decreased levels of lymphocytes, bicarbonate and arterial oxygen pressure/inspired oxygen fraction were related to mortality risk. In multivariate analysis, only severe COVID-19 disease (OR 1.48; 95% CI 2.24 to 7.77), C-reactive protein > 10 mg/dL (OR: 9.72; 95% CI: 1.41 to 18.58), and arterial oxygen pressure/inspired oxygen fraction ≤ 150 millimeters of mercury (OR: 10.23; 95% CI: 5.87 to 36.06) were factors associated with poor survival. Conclusions In patients with stage-5 chronic kidney disease hospitalized for COVID-19, severe COVID-19 disease, C-protein reactive levels > 10 milligrams per deciliter, arterial oxygen pressure / inspired oxygen fraction ≤ 150 millimeters of mercury and severe COVID-19 disease were the main factors related to mortality.
Objetivo: Describir las características y permanencia de los catéteres venosos centrales temporales (CVCT) para en hemodiálisis en el servicio de Nefrología de un hospital público en el periodo del 2015 al 2019. Métodos: Estudio analítico longitudinal de cohorte retrospectiva. Se incluyeron 2156 registros de procedimientos de colocación de CVCT para hemodiálisis en pacientes con enfermedad renal crónica estadio 5 (ERC-5), se registró la condición final de los catéteres durante el periodo de seguimiento. Se excluyeron los pacientes que se perdieron en el seguimiento. Resultados: Se evaluaron 2156 procedimientos en 1650 pacientes. La localización del catéter fue: Yugular 1019 (51,9 %), Subclavia 198 (9,2 %), Femoral 129(5,9%). Las principales causas de retiro fueron por: disfunción de catéter 730 (33,9 %) e infección 410 (19,1 %). En el curso de 5 años se observaron variaciones en la proporción pacientes que inician hemodiálisis con Fístulas Arteriovenosa (FAV) de 9,6 % a 17,1 % (p=0,042) y en la colocación de Catéteres Venoso Central (CVC) tunelizados al año de inicio de 8 % a 23,03 % (p<0.001). La mediana del tiempo de permanencia de un CVCT disminuyó de 81 días a 58 días. Los factores relacionados al retiro de CVCT disfuncional fueron: edad mayor de 60 años [HR: 5.31 (IC 95 %: 1,8 – 9,74), p<0.001] y etiología diabética [HR: 6,82 (IC95 %: 1,3 – 18,2), p=0,021]. Conclusión: El CVCT, es el acceso vascular más frecuente para inicio de hemodiálisis crónica, y tiene una prolongada permanencia. Los factores asociados al retiro de catéter disfuncional son la edad avanzada (> 60 años) y la etiología diabética. En el periodo de estudio las variaciones en la proporción de pacientes que inician terapia de hemodiálisis crónica con FAV son muy bajas.
Introduction: Chronic kidney disease (CKD) in Covid 19 is relevant, however, there are few descriptions and fewer in Peru. Our goal was to describe the epidemiological profile and the factors related to mortality and survival of patients with stage 5 (CKD) on chronic dialysis hospitalized for Covid-19 in a public hospital. Methods: Retrospective case series. Patients with stage 5 CKD, older than 18 years, hospitalized for Covid-19 infection were included. The primary data source was medical records. The clinical and epidemiological profile of the study sample and the factors related to mortality and survival are described. Results: 105 medical records of patients with CKD 5 were evaluated. 57 (54,29%) were male, with a mean age of 58,59 +/- 14,3 years. 84 (80%) patients survived and 21 (20%) died. The main cause of admission to hospitalization was respiratory failure in (80) 76,2%. The hospital stay was 11,76 +/- 7,8 days. In the bivariate analysis: the increase in leukocytes, D dimer, ferritin, CRP, LDH and the decrease in lymphocytes, pH, bicarbonate and PaO2/FiO2 were related to mortality. In the multivariate analysis, only CRP> 10 mg/dl [HR: 10.72 (95% CI 1,4-81,58)] and a PaO2/FiO2 ≤ 150 mmHg [HR: 44,40 (95% CI 5,86-336,06)] they were factors related to poor survival. Conclusions: CRP levels> 10mg/dl and PaO2/FiO2 ≤ 150 mmHg are the main factors related to mortality and poor survival in patients with stage 5 CKD hospitalized for Covid-19. Keywords: Renal Insufficiency, renal dialysis, Coronavirus infections, Covid- 19, survival. (MeSH)
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