SARS-CoV-2 infection in hemodialysis patients: Preliminary data from a Portuguese hospital center

Tavares, Joana; Dias, Bruno; Oliveira, João Manuel de; Sala, Inês; Silva, Filipa; Castro, A.; Freitas, Cristina; Fonseca, Tomás; Pimentel, João Vitor Cândido; Cabrita, António; Castro, Rui

doi:10.32932/pjnh.2020.10.083

Cited by 4 publications

(5 citation statements)

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“…The selection process is illustrated in Figure 1 . The 22 included studies 16 – 37 were from 17 countries, with a total of 13,191 patients. Meta-analysis of epidemiological, clinical, and radiological data from COVID-19 patients undergoing MHD are summarized in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

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Mortality and risk factors for COVID-19 in hemodialysis patients: A systematic review and meta-analysis

Guan²,

Zhou

et al. 2022

Science Progress

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Introduction: The present study systematically reviewed the clinical features and risk factors in patients undergoing maintenance hemodialysis (MHD) who also acquired coronavirus disease 2019 (COVID-19). More specifically, clinical manifestations, prognosis, and risk factors for death among this population were explored. Method: A literature search using the PubMed, Web of Science, and Embase databases, for articles involving patients with laboratory-confirmed COVID-19 and undergoing MHD published between January 1, 2020, and March 13, 2022, was performed. Random-effects meta-analyses were performed to calculate the weighted mean prevalence and corresponding 95% confidence interval (CI) or weighted means and 95% CI. Heterogeneity among studies was assessed using I2 statistics. Results: Twenty-two studies including 13,191 patients with COVID-19 undergoing MHD were selected. The most common symptoms included fever (53% [95% CI 41%–65%]) and cough (54% [95% CI 48%-60%]); however, 17% (95% CI 11%–22%) of the cases were asymptomatic. In subgroup analysis, the proportion of male patients (65% [95% CI 58%–71%]), and patients with coronary artery disease (30% [95% CI 17%–44%) and chronic obstructive pulmonary disease (9% [95% CI 4%–15%]) was greater in the non-survivor group compared with the survivor group. Furthermore, patients undergoing MHD, who were also positive for COVID-19, exhibited a high mortality rate (24% [95% CI 19%–28%]). Conclusions: MHD patients with COVID-19 may initially present as asymptomatic or with mild symptoms; nevertheless, in this study, these patients exhibited a higher risk for death compared with COVID-19 patients not undergoing MHD. Moreover, male sex and underlying cardiovascular and respiratory diseases increased the mortality risk.

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Section: Resultsmentioning

confidence: 99%

“…Thirteen studies 16 – 17 , 21 – 23 , 25 , 27 – 33 , 35 reported data regarding treatment(s). Almost all patients underwent symptomatic treatment.…”

Section: Resultsmentioning

confidence: 99%

Mortality and risk factors for COVID-19 in hemodialysis patients: A systematic review and meta-analysis

Guan²,

Zhou

et al. 2022

Science Progress

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“…The most important is the study population, which included all stages of CKD, not only end-stage kidney disease as in most published series. Furthermore, to the best of our knowledge, this is the largest study of COVID-19 in CKD patients in Portugal 39,40 .…”

Section: Discussionmentioning

confidence: 92%

Presentation and outcomes of chronic kidney disease patients with COVID-19

et al. 2022

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Introduction: COVID-19 is currently a global health issue and an important cause of mortality. Chronic kidney disease (CKD) is one of the risk factors for infection, morbidity and mortality by SARS-CoV-2. In our study, we aimed to evaluate the clinical presentation and outcomes of CKD patients with COVID-19, as well as identify predictors of mortality. Methods: This was a retrospective study of CKD patients admitted in a tertiary-care Portuguese hospital between March and August of 2020. Variables were submitted to univariate and multivariate analysis to determine factors predictive of in-hospital mortality. Results: 130 CKD patients were analyzed (median age 73.9 years, male 60.0%). Hypertension (81.5%), cardiovascular disease (36.2%), and diabetes (54.6%) were frequent conditions. Cough, dyspnea, fever and respiratory failure were also common. Almost 60% had anemia, 50% hypoalbuminemia, 13.8% hyperlactacidemia and 17% acidemia. Mean serum ferritin was 1531 µg/L, mean CRP 8.3 mg/dL and mean LDH 336.9 U/L. Most patients were treated with lopinavir/ritonavir, hydroxychloroquine or corticosteroids and only 2 with remdesivir. Eighty percent had acute kidney injury and 16.2% required intensive care unit admission. The 34 patients who died were older and more likely to have heart failure. They had higher neutrophils/lymphocytes ratio, ferritin, lactate, and LDH levels. Multivariate analysis identified an association between older age [OR 1.1 (CI 1.01-1.24), p=0.027], higher ferritin [OR 1.0 (CI 1.00-1.00), p=0.009] and higher LDH levels [OR 1.0 (CI 1.00-1.01), p=0.014] and mortality. Conclusion: In our cohort of CKD patients with COVID-19, older age, higher ferritin, and higher LDH levels were independent risk factors for mortality.

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“…Asymptomatic spread in the HD unit is another challenge [1]. As a consequence of a relatively suppressed immune system, the proportion of asymptomatic infection in MHD populations may be higher than average [26,27].…”

Section: Covid-19 Challenges For Dialysis Centresmentioning

confidence: 99%

Modelling COVID-19 transmission in a hemodialysis centre using simulation generated contacts matrices

et al. 2021

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The COVID-19 pandemic has been particularly threatening to patients with end-stage kidney disease (ESKD) on intermittent hemodialysis and their care providers. Hemodialysis patients who receive life-sustaining medical therapy in healthcare settings, face unique challenges as they need to be at a dialysis unit three or more times a week, where they are confined to specific settings and tended to by dialysis nurses and staff with physical interaction and in close proximity. Despite the importance and critical situation of the dialysis units, modelling studies of the SARS-CoV-2 spread in these settings are very limited. In this paper, we have used a combination of discrete event and agent-based simulation models, to study the operations of a typical large dialysis unit and generate contact matrices to examine outbreak scenarios. We present the details of the contact matrix generation process and demonstrate how the simulation calculates a micro-scale contact matrix comprising the number and duration of contacts at a micro-scale time step. We have used the contacts matrix in an agent-based model to predict disease transmission under different scenarios. The results show that micro-simulation can be used to estimate contact matrices, which can be used effectively for disease modelling in dialysis and similar settings.

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SARS-CoV-2 infection in hemodialysis patients: Preliminary data from a Portuguese hospital center

Cited by 4 publications

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Mortality and risk factors for COVID-19 in hemodialysis patients: A systematic review and meta-analysis

Mortality and risk factors for COVID-19 in hemodialysis patients: A systematic review and meta-analysis

Presentation and outcomes of chronic kidney disease patients with COVID-19

Modelling COVID-19 transmission in a hemodialysis centre using simulation generated contacts matrices

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