Kidney care in low- and middle-income countries

Qarni, Bilal; Osman, Mohamed A.; Levin, Adeera; Feehally, John; Harris, David; Jindal, Kailash; Olanrewaju, Timothy Olusegun; Samimi, Arian; Olah, Michelle E.; Braam, Branko; Sakajiki, Aminu Muhammad; Lunney, Meaghan; Wiebe, Natasha; Ye, Feng; Jha, Vivekanand; Okpechi, Ikechi G.; Courtney, Mark; Klarenbach, Scott; Johnson, David W.; Bello, Aminu K.

doi:10.5414/cnp92s104

Cited by 30 publications

(26 citation statements)

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“…The ability to identify high COVID suspicion with an inexpensive, widely available, point-of-care test, has important practical implications, particularly for early hemodialysis isolation to avoid spread of SARS-CoV-2 throughout a center. This low cost triage tool is of particular interest in the coming months, especially for low-income countries with limited access to RT-PCR and chest CT scans (12,13). Receiver operating characteristic (ROC) curve of eosinophil count showing speci city and sensitivity for COVID-19 diagnosis AUC, area under the ROC curve…”

Section: Resultsmentioning

confidence: 99%

Triage of Patients Suspected of COVID-19 in Chronic Hemodialysis: Eosinophil Count Differentiates Low and High Suspicion of COVID-19

Vial

Gully

Bobot

et al. 2020

Preprint

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Background: Daily management to shield chronic dialysis patients from SARS-CoV-2 contamination makes patient care cumbersome. There are no screening methods to date and a molecular biology platform is essential to perform RT-PCR for SARS-CoV-2; however, accessibility remains poor. Our goal was to assess whether the tools routinely used to monitor our hemodialysis patients could represent reliable and quickly accessible diagnostic indicators to improve the management of our hemodialysis patients in this pandemic environment.Methods: In this prospective observational diagnostic study, we recruited patients from La Conception hospital. Patients were eligible for inclusion if suspected of SARS-CoV-2 infection when arriving at our center for a dialysis session between March 12th and April 24th 2020. They were included if both RT-PCR result for SARS-CoV-2 and cell blood count on the day that infection was suspected were available. We calculated the area under the curve (AUC) of the receiver operating characteristic curve.Results: 37 patients were included in the final analysis, of which 16 (43.2%) were COVID-19 positive. For the day of suspected COVID-19, total leukocytes were significantly lower in the COVID-19 positive group (4.1 vs 7.4 G/L, p=0.0072) and were characterized by lower neutrophils (2.7 vs 5.1 G/L, p=0.021) and eosinophils (0.01 vs 0.15 G/L, p=0.0003). Eosinophil count below 0.045 G/L identified SARS-CoV-2 infection with AUC of 0.9 [95% CI 0.81-1] (p<0.0001), sensitivity of 82%, specificity of 86%, a positive predictive value of 82%, a negative predictive value of 86% and a likelihood ratio of 6.04.Conclusions :Eosinophil count enables rapid routine screening of chronic hemodialysis patients suspected of being COVID-19 within a range of low or high probability.

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Section: Resultsmentioning

confidence: 99%

Triage of Patients Suspected of COVID-19 in Chronic Hemodialysis: Eosinophil Count Differentiates Low and High Suspicion of COVID-19

Vial

Gully

Bobot

et al. 2020

Preprint

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“…Uma baixa densidade de nefrologistas é preocupante, uma vez que são essenciais para liderar equipes multidisciplinares na prevenção e tratamento de doenças renais. A falta desses profissionais pode resultar em consequências adversas para as práticas e o desenvolvimento de políticas públicas voltadas principalmente aos grupos de risco com patologias renais 15,16 .…”

Section: Discussionunclassified

[Id 55160] Desafios No Cuidado Da Doença Renal Crônica Nas Unidades De Atenção Primária À Saúde Em Município Cearense

Nóbrega¹,

Nóbrega²,

Alves³

et al. 2021

RBCS

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Objetivo: O estudo analisou o cuidado à saúde de diabéticos e hipertensos quanto à prevenção, o diagnóstico e o tratamento de doença renal crônica (DRC) acompanhados em Unidades de Atenção Primária à Saúde (APS) no Município de Tauá, Ceará. Metodologia: Tratou-se de estudo de caso descritivo com abordagem qualitativa, no qual participaram 27 informantes, incluindo os profissionais de saúde de Unidades de APS; os pacientes com DRC em terapia renal substitutiva com diagnóstico de diabetes mellitus (DM) e/ou hipertensão arterial sistêmica (HAS) e os profissionais ligados à gestão da assistência à saúde local. Os dados foram obtidos pela realização de entrevistas individuais e analisados por análise temática. Resultados: Verificou-se lacunas na assistência aos pacientes diabéticos e hipertensos envolvendo tanto a APS quanto a atenção especializada, no que diz respeito à carência de medicamentos, exames e consultas especializadas; inexistência de contrarreferência e nefrologista para o acompanhamento dos casos. No âmbito da APS, observou-se um vínculo fragilizado e uma baixa adesão ao tratamento multiprofissional entre os pacientes com DM e/ou HAS, incluindo aqueles com DRC; as ações educativas não abordaram diretamente a prevenção de doenças renais e os profissionais de saúde necessitam de educação continuada sobre o manejo da DRC. Conclusão: O estudo revelou falhas no cuidado com os diabéticos e os hipertensos, sobressaindo-se o acesso insuficiente a medicamentos, exames e consultas especializadas; bem como o vínculo fragilizado e a baixa adesão destes pacientes ao tratamento multiprofissional no componente primário. Faz-se necessária a implantação de uma linha de cuidado para assistir aos usuários diabéticos e hipertensos com ou sem DRC no município em questão.

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Section: Discussionmentioning

confidence: 99%

Triage of Patients Suspected of COVID-19 in Chronic Hemodialysis: Eosinophil Count Differentiates Low and High Suspicion of COVID-19

Vial

Gully

Bobot

et al. 2020

JCM

View full text Add to dashboard Cite

Background: Daily management to shield chronic dialysis patients from SARS-CoV-2 contamination makes patient care cumbersome. There are no screening methods to date and a molecular biology platform is essential to perform RT-PCR for SARS-CoV-2; however, accessibility remains poor. Our goal was to assess whether the tools routinely used to monitor our hemodialysis patients could represent reliable and quickly accessible diagnostic indicators to improve the management of our hemodialysis patients in this pandemic environment. Methods: In this prospective observational diagnostic study, we recruited patients from La Conception hospital. Patients were eligible for inclusion if suspected of SARS-CoV-2 infection when arriving at our center for a dialysis session between March 12th and April 24th 2020. They were included if both RT-PCR result for SARS-CoV-2 and cell blood count on the day that infection was suspected were available. We calculated the area under the curve (AUC) of the receiver operating characteristic curve. Results: 37 patients were included in the final analysis, of which 16 (43.2%) were COVID-19 positive. For the day of suspected COVID-19, total leukocytes were significantly lower in the COVID-19 positive group (4.1 vs. 7.4 G/L, p = 0.0072) and were characterized by lower neutrophils (2.7 vs. 5.1 G/L, p = 0.021) and eosinophils (0.01 vs. 0.15 G/L, p = 0.0003). Eosinophil count below 0.045 G/L identified SARS-CoV-2 infection with AUC of 0.9 [95% CI 0.81—1] (p < 0.0001), sensitivity of 82%, specificity of 86%, a positive predictive value of 82%, a negative predictive value of 86% and a likelihood ratio of 6.04. Conclusions: Eosinophil count enables rapid routine screening of symptomatic chronic hemodialysis patients suspected of being COVID-19 within a range of low or high probability.

show abstract

Kidney care in low- and middle-income countries

Cited by 30 publications

References 0 publications

Triage of Patients Suspected of COVID-19 in Chronic Hemodialysis: Eosinophil Count Differentiates Low and High Suspicion of COVID-19

Triage of Patients Suspected of COVID-19 in Chronic Hemodialysis: Eosinophil Count Differentiates Low and High Suspicion of COVID-19

[Id 55160] Desafios No Cuidado Da Doença Renal Crônica Nas Unidades De Atenção Primária À Saúde Em Município Cearense

Triage of Patients Suspected of COVID-19 in Chronic Hemodialysis: Eosinophil Count Differentiates Low and High Suspicion of COVID-19

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