Outcomes of COVID-19 infection in patients with chronic kidney disease on maintenance hemodialysis at a COVID hospital in India

  1. Ram Singh
  2. Sudarsan Krishnasamy
  3. Jitendra Kr Meena
  4. Prashant Sirohiya
  5. Balbir Kumar
  6. Brajesh kumar Ratre
  7. Saurabh Vig
  8. Anuja Pandit
  9. Hari Sagiraju
  10. Raghav Gupta
  11. Sushma Bhatnagar

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Abstract

Background

Patients with chronic kidney disease (CKD) on hemodialysis are highly vulnerable to COVID-19 infection with a mortality rate higher than the rest of the population. There are several clinical and laboratory parameters that can predict the course and the outcomes in this group of population.

Methods

We retrospectively collected the baseline demographic, clinical, in-hospital, and laboratory data of the patients with CKD on maintenance hemodialysis who were admitted to our COVID-19 hospital during the first and the second wave.

Results

We obtained data for 35 patients from the first and 5 patients from the second wave. The analysis of the data for 35 patients from the first wave revealed shortness of breath (62.9%), and fever (54.3%) being the most common presenting symptoms, and the majority of the patients (57.2 %) presented with moderate to severe disease at admission with 57 % had bilateral lung infiltrates, and required oxygen support (65.7%) at admission. The comparison of clinical and laboratory markers between survivors (27 patients, 77.1%) and non-survivors (8 patients, 22.9%) revealed an older age, severe disease at presentation, invasive mechanical ventilation, baseline severe lymphocytopenia, high serum glutamic oxaloacetic transaminase, blood urea, and inflammatory markers like Interleukin-6 and procalcitonin, fibrinogen and low albumin in non survivors.

Conclusions

The older age, severe disease at presentation, the requirement of invasive mechanical ventilation, raised baseline Interleukin-6, procalcitonin, serum glutamic oxaloacetic transaminase, blood urea and a low albumin level could be valuable predictors of poor outcomes.

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  1. ScreenIT

    SciScore for 10.1101/2022.01.07.22268915: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The study protocol was approved by the Institute Ethics Committee of AIIMS, New Delhi.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: Data retrieved were cross-checked verified and entered MS Excel software version 16.0
    MS Excel
    suggested: None
    Statistical analysis was performed using SPSS Version 24 (SPSS Inc, Chicago IL, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are several limitations in our study, the first one being the small sample size, so the findings of the study cannot be extrapolated to the whole population of CKD patients on maintenance dialysis. Although our observations are in coherence with the findings of similar studies conducted elsewhere in the world, and a few prognostic factors are universal in this group of patients. The second limitation being the inherent information and selection bias during retrospective data retrieval. The third limitation is a very small number of CKD patients who underwent dialysis in the second wave of the COVID-19. We couldn’t compare the clinical characteristics and outcomes between the first and second wave and couldn’t come to any conclusion in this aspect. In the current literature, there are mostly retrospective studies on this group of patients so, there is a need for future similar prospective studies with an adequate sample size for better interpretation of the prognostic parameters and their association with clinical outcomes. The observation from our study led to the conclusion that the CKD patients on maintenance hemodialysis are the group of patients that are more susceptible to severe disease following infection with coronavirus due to the presence of multiple co-morbidities, frailty, and older age. The older age, severe disease at presentation, the requirement of oxygen and respiratory support, baseline elevated inflammatory markers especially IL-6, PCT, raised fibrino...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2022.01.07.22268915v1 on medRxiv