POS-028 RENAL INVOLVEMENT AND OUTCOMES IN PATIENTS WITH COVID DURING THIRD WAVE IN INDIA

Abstract

SARS-CoV-2, a respiratory virus, can involve the kidneys and cause acute kidney injury (AKI) by both direct and indirect mechanisms. Patients with renal dysfunction form a special group with special needs. Chronic kidney disease (CKD) is a state of impaired innate and adaptive immunity, co-existing with chronic inflammation; their clinical manifestations can be mild, while progress rapidly giving physicians shorter window period to intervene. Many CKD patients are on immunosuppressive medications for glomerulonephritis or as transplant recipients. Kidney being the excretory organ for most drugs and its metabolites, acute or chronic renal dysfunction calls for dose modification. It is important to look for nephrotoxicity of medications especially in those with CKD. Trials involving new medications exclude patients with renal dysfunction, hence experience with such medications arrives late. This was a prospective study intended to analyze the renal involvement and outcomes in patients who were infected by COVID infection during the third wave. This study was conducted in India, across multiple hospitals. All adult patients who were seen by Nephrologist either as outpatient or as an inpatient between 12-01-2022 and 18-02-2022 were included. Data was collected in a repository in a software developed by Bloom Value Corporation, extracted to excel sheet and analyzed. 159 patients, 67.9% males, aged 59.5 ± 14.98 years, who were diagnosed to have COVID infection during third wave in India studied [figure - 1]. 45 (47.87%) out of 94, who were admitted did not need any oxygen supplementation; 9 (24.3%) of those admitted in ICU / HDU needed ventilatory support. Steroids was prescribed or dosage escalated in 36.48%; Remdesivir was used in 34.59%. Other than 54 patients, who were on maintenance hemodialysis, 23 (14.47%) needed dialysis.Previous COVID infection was noted in 12.58%; 86.79% were vaccinated with at least 1 dose. 18 (11.32%) were renal transplant recipients, 54 (33.96%) were hemodialysis patients; 30 (18.87%) were on immunosuppressive medications. Presenting complaints were fever 99 (62.26%) cough 81 (50.94%), breathlessness 43 (27.04%) diarrhea 5 (3.14%) and vomiting 15 (9.43%). 65 (40.88%) were treated as Outpatient, 57 (35.85%) in wards while 30 (18.87%) needed either ICU or HDU admission [figure - 2]. 16 new patients became dialysis dependent, they had CKD, with a mean eGFR of 14.52 ml/min. 6 (3.77%) patients died, all had been vaccinated against COVID with 2 doses of vaccine; needed ICU care; 2 were ventilated. Among those who died, 3 had CKD, one each were patient on dialysis, transplant and AKI. 4 (66.7%) had needed dialysis.View Large Image Figure ViewerDownload Hi-res image Download (PPT) None of those with normal renal functions developed AKI [figure - 3]. Renal involvement in the form of AKI or acute worsening of renal functions was seen among COVID patients. Vaccination did not prevent infection. Mortality was higher among CKD patients.