Abstract
Background and AimsIt is known that mortality from COVID-19 among patients with kidney disease is significantly higher than in general population. The worst prognosis is seen for patients receiving renal replacement therapy (RRT). At the same time, many patients undergo an urgency start of hemodialysis (HD) while suffering from COVID-19. The aim of the study was to determine the significance of the RRT urgency for the prognosis in patients with COVID-19.MethodA retrospective analysis of case histories for 253 patients who received RRT at the infectious ward of St. Petersburg State Healthcare Institution City Hospital No. 15 from May to December 2020 was performed. All patients had a diagnosis of COVID-19, confirmed by PCR and/or clinical symptoms. Urgency RRT was performed in case of detection of indications, both in acute kidney injury (AKI), and in the diagnosis of end-stage chronic kidney disease (esCKD). Kaplan-Meier curves and multivariate Cox regression were used to perform cohort analyzes of survival and relative risk of death. For the calculations, the applied statistical software package SPSS 21.0, SPSS Ink (USA) was used.ResultsOf the 253 treated patients, 197 were patients with chronic outpatient HD, in 56 HD therapy was started urgently: 45 for AKI, 11 for esCKD. Totally 83 patients died. The overall mortality rate was 33%, while in outpatient HD group it was 18% and in the urgent HD start group - 84%. After adjusting for gender and age the fact of the urgency of starting RRT was an independent risk factor that increased the probability of death by 2.5 times (95% Cl 1.6÷3.9) compared to outpatients HD (Log Rank: P<0.001, Fig. 1). The patients age over 60 was also a factor significantly worsening the prognosis (Log Rank: P <0.001).MO839 Figure 1: Risk of death from all causes among patients with renal disease and COVID-19, depending on the urgency of initiation of hemodialysis therapyConclusionAmong patients with COVID-19 and kidney disease the urgency of RRT initiating is a factor that significantly worsens the prognosis, especially among patients of the older age group.
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