key: cord-0771331-q00ymfcl
authors: HAZARA, A.; Lamplugh, A.; Kassianides, X.; Bhandari, S.
title: POS-524 MORTALITY AMONG NEW HAEMODIALYSIS PATIENTS IN THE FIRST SIX MONTHS OF COVID-19 PANDEMIC
date: 2021-04-30
journal: Kidney International Reports
DOI: 10.1016/j.ekir.2021.03.552
sha: 6268d011620e345c7b80b21b4695ce2f573ff9e7
doc_id: 771331
cord_uid: q00ymfcl

nan

Introduction: With the spread of the novel coronavirus (COVID-19) throughout the world since December 2019, patients with End-Stage Kidney Disease (ESKD), due to their extensive comorbid conditions, were considered one of the most vulnerable populations. In this study, we evaluated 240 patients on maintenance hemodialysis (MHD), of which 44 had been diagnosed with COVID-19. Methods: Study Design: Retrospective two-centers cohort study Setting and participants: From March 2nd, 2020 to September 21st, 2020, a total of 240 patients received MHD at Beheshti and Vali-Asr Hospitals affiliated to Abadan University of Medical Sciences of which 44 were diagnosed with COVID-19. (Based on Reverse transcriptasepolymerase chain reaction (RT-PCR) test results or chest CT scan findings). Demographic, clinical, laboratory, and radiologic findings of these 44 patients were collected. Results: COVID-19 was diagnosed in 44 patients (18.33 %) and 8 patients had died (18.1%). RT-PCR test was carried out for 39 patients of which 15 (40.54%) tested positive. Among the 44 patients with COVID-19 infection, 26 were men (59.09%) and 18 were women (40.9%) and the mean age was 54.5AE16.00 years. Patients with diabetes mellitus (either as an underlying cause or as a comorbidity) accounted for 61.36% of cases. Other common comorbidities were hypertension (52.27%) and cardiovascular disease (25%). Fever (36.36 %), shortness of breath (34.09 %), cough (25%), and fatigue (13.63%) were the most common symptoms and 18.18 % of the patients were asymptomatic. We detected high levels of inflammatory markers such as C-reactive protein (CRP), in 80% of patients. Chest CT scan was obtained for all suspected patients and showed ground glass opacity, consolidation, and pleural effusion in 54.83%, 48.38%, and 29.03% of cases, respectively. However, 9.67 % of patients had no pathologic finding on their Chest CT scan. Peripheral and central pulmonary involvement were found in 70.96 % and 19.35 % of patients. The mean single pool KT/V (SpKT/V) was calculated 1.10AE0.39. Eventually, 20 patients were admitted to the hospital ( 45% ) and the average length of stay at hospital was 3.91AE 4.63 days. Of our patients, 80% underwent hemodialysis three times a week. Conclusions: Based on our results, COVID-19 pandemic is a significant concern for in-center hemodialysis patients. These patients are particularly susceptible because of their comorbidities. Moreover, limitations in physical distancing, public exposures and pre-existing lung involvement in these patients may complicate their management and affect the overall outcome. Less availability of RT-PCR testing across the nation in low middle-income countries (LMIC) like Iran, is another downside that has to be considered. pandemic has had an unprecedented impact on clinical services. During this public health emergency, hospitals across the globe have been forced to prioritise the care of the most acutely unwell patients whilst protecting the rest of patient population from coming into contact with the SARS-CoV-2 virus, which is responsible for COVID-19. 1 This has resulted in disruption to routine care of patients with chronic kidney disease (CKD) who often have very unpredictable disease course particularly in its advanced stages. 2 We have estimated excess mortality risk in new haemodialysis (HD) patients in the first six months of this pandemic in United Kingdom (April to September 2020) in patients who were known to renal services for greater than three months prior to their first dialysis session. Methods: We obtained a list of all HD starters at our hospital since 2010. Follow-up data was available up to September 2020. Patients known to the renal services for less than 90 days prior to their first dialysis were excluded. Date of death, basic demographic data and vascular access type was obtained for patients who died during this period. Deaths recorded during the first six months of the pandemic (i.e. between April and September 2020) are compared to the average number of deaths during the same months (April -September) in five consecutive years prior to the pandemic between 2014 to 2019 (the 'expected number of deaths').

Results: There were 18 deaths in HD patients in the first six months of the UK COVID-19 pandemic. The expected number of deaths was 10 for this period. The mean duration of nephrology input prior to first dialysis was 3.3 and 4.2 years in patients who died in the pre-COVID (April to September of years 2015 to 2019) and post-COVID (April to September 2020) years respectively suggesting that they were wellknown to renal services. The majority of excess deaths were recorded in the months of April, May and September (when the lockdown measures were most stringent) (figure 1). Excess mortality affected both genders but was significantly higher in women compared to men (figure 2). Conclusions: In new HD starters, deaths were 1.8 times higher than expected during the first six months of the COVID-19 pandemic. The impact of COVID-19 pandemic is only just becoming obvious in this patient population who already have high early mortality rates 3 . Multicentre studies involving both incident and prevalent HD patients are needed to confirm these findings.

Introduction: Hemodialysis (HD) patients are vulnerable to have recurrent hospital admissions. The reported prevalence of readmissions rates in hemodialysis patients ranged from 11.8% to 90% and was highest in first month after HD initiation. It has been associated with higher morbidity and increase cost on health care systems. Risk factors for worse prognosis were older age, male gender, comorbid conditions and critical care admission. Data addressing such an issue in the Middle East is very limited. We aim to study causes and outcomes of recurrent admissions among HD patients in a tertiary hospital in UAE. Methods: A one year retrospective chart review study (January 2018-2019) was conducted at Tawam hospital and hemodialysis unit with capacity of 400 patients after ethical approval. Adult HD patients (age > 18 years) started on HD for more than a year and required hospitalizations were included. Day case procedures, emergency department visits and elective surgeries were excluded. Demographic, clinical and laboratory data were collected and analyzed using descriptive analysis. Results: A total of 350 HD patients required hospital admissions with mean age of 58 years and male to female ratio of 2:1. The comorbid conditions in our cohort were diabetes mellitus (85%), hypertension (80%), ischemic heart disease (60%), stroke (37%) and peripheral vascular disease (20%). The mean duration of hemodialysis was 6 years. Majority of HD patients (85%) had arteriovenous fistula or graft as primary vascular access. Total numbers of admissions for HD patients during the study period were 425 admissions. Major causes of hospital admissions were: infection (23%), acute pulmonary edema / hyperkalemia (20%), vascular access dysfunction (16%), and cardiovascular events (8%). Other causes were fractures, blood transfusion for anemia and pregnancy. Dialysis catheter related infection accounted for 5% of cases. While other focus of infections were acute respiratory infections followed by urinary tract infections and bacteremia. The average annual admission rate per patient was ranging from 1 to 2. Critical care admissions were found in 20 % of HD patients with mean duration of 12 days and mortality rate was 8%. Conclusions: the risk of hospitalization among HD patients were relatively high and associated with increased morbidity and mortality. In our cohort, infections, pulmonary edema, vascular access dysfunction and cardiovascular events, were the major causes of hospitalization. Addressing preventable causes of recurrent admissions is a fundamental step in patients care.

No (2) assess change in PROs and (3) describe outcomes such as hospitalization and mortality rates during the transition period and first year of ICHD. Methods: We enrolled 43 sites in Beijing, Guangzhou, and Shanghai metropolitan areas (14, 15, and 14 sites respectively) in DOPPS China 7, using stratified random sampling by clinic characteristics. We plan to include >650 incident ICHD patients (median accrual/ facility/year is 16) at these sites with longitudinal follow-up to characterize clinical course and optimally capture the complete patient experience. Eligible patients, $18 years old, will be approached sequentially for enrolment within one month of starting ICHD. Where available, clinical data will be collected retrospectively for up to 6 months prior to and during ICHD initiation. Clinical data will be submitted monthly via secure, web-based software. In parallel, we will deploy an electronic patient questionnaire (ePQ) into which patients report information directly via mobile device over the first year of enrollment. The ePQ encompasses a short version administered monthly and a longer version quarterly. Instruments were chosen based on previous validation in dialysis patients to minimize patient burden and content overlap (Table) .

Results: To date, the DOPPS 7 China study has enrolled 184 incident patients. With approximately 1 year of follow-up, less than 10% have died or left ICHD. Twenty-eight have been hospitalized, mostly for HD access-related reasons. Initial results from the enriched selection of incident ICHD patients with clinical and PRO data are anticipated in 2021. Conclusions: We expect this innovative study to contribute meaningful new insights on the interplay among complications of kidney failure, treatment, clinical conditions, and the patient experience during the incident dialysis period in China. Conflict of Interest: Eric Wittbrodt, Farhad Khan, James Sloand, Juan Jose Garcia Sanchez, Katarina Hedman, and Glen James are AstraZeneca employees and shareholders. Global support for the ongoing DOPPS Programs is provided without restriction on publications by a variety of funders. For details see https://www.dopps.org/AboutUs/Support.aspx

Hazara AM, Bhandari S. Can incremental haemodialysis reduce early mortality rates in patients starting maintenance haemodialysis?

Early Mortality Rates After Commencement of Maintenance Hemodialysis: A Systematic Review and Meta-Analysis

Guangzhou, China; 4 Arbor Research Collaborative for Health, Dialysis Outcomes and Practice Patterns Study Program Area