POS-537 COVID-19 IN PATIENTS ON MAINTENANCE HEMODIALYSIS - A SINGLE CENTER EXPERIENCE

Abstract

The current coronavirus disease (COVID-19) pandemic has caused high morbidity and mortality in chronic kidney disease stage 5 (CKD-5) patients on maintenance hemodialysis (MHD). The unique problems faced by the hemodialysis (HD) units are frequent hospital visits by patients for MHD, waiting area for dependent population due to difficulty in maintaining social distancing. Here, we present our experience on the impact of COVID-19 pandemic on patients at our maintenance HD unit in South India. It is a retrospective study done over a period of seven months from April 2020 to October 2020 at a tertiary care institute in Hyderabad, India. We included 110 MHD patients and 45 HD staff in the study. We followed Initial screening of all the subjects with non-contrast computerised tomography (CT) chest followed by confirmation using real-time reverse transcription-polymerase chain reaction (rRT-PCR) for diagnosing COVID-19 infection. All the positive patients were dialysed in a separate isolation unit with separate HD machines and staff. Our unit strictly followed all the precautions and preventive measures for patients and staff according to the Government of India, Ministry of Health and Family Welfare Guidelines for dialysis in COVID-19 patients. Before each MHD session, patients were screened for symptoms telephonically before physical presence at the unit, and no attendants or maximum of one attendant was allowed. In the COVID-19 isolation MHD unit, strict protocols were followed. In the non-COVID-19 MHD unit, few cost-effective measures were followed, as shown in figure 1. 53 out of 110 (48%) MHD patients are tested positive for COVID-19 infection during the study period. The mean age of infected patients was 56.8 years, and 48 (90.5%) of them were males. The comorbidities and vascular access of the MHD patients did not affect the infectivity rate at our unit. The clinical presentation of most of the infected patients was asymptomatic (29, 54.7%) followed by fever (21, 39.6%). The recovery rate from infection is 81% (43 out of 53). Mortality was seen in 6 (11%) infected patients and 4 (7%) lost follow-up by shifting to other MHD units due to travel constraints during the lockdown period. The baseline and clinical characteristics of the patients are given in table 1 and 2.In a study by Ibernon et al from Spain, the incidence rate of COVID-19 in their HD unit was 9.5% to 19.9% and the death rate of 25 to 30.5%. (2) In the study by Corbett et al from the United Kingdom, the COVID-19 incidence rate at their HD unit was 19.2%. (3) In our study, the incidence of COVID-19 infection was quite high (48%), but the mortality rate was low (11%). 6 out of 45 (13%) staff members are tested positive for COVID-19. All of them recovered without any complications. The low infectivity rate among our staff members was probably due to strict and cost-effective protocols followed for prevention in the COVID isolation and non-isolation MHD units. The incidence of COVID-19 infection was 48% in our MHD unit. The mean age of the infected subjects was 56.8 years and most of them were males. Comorbidities and vascular access did not affect the infectivity rate at our patients. Most of the infected patients are asymptomatic. The positivity rate in our dialysis staff is 13% which is quite low probably due to the strict and cost-effective preventive measures at our MHD unit.