POS-623 COVID19 IN MAINTAINENCE HEMODIALYSIS PATIENTS - CLINICAL MANIFESTATIONS AND OUTCOMES

Abstract

The unprecedented pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2, began in December 2019 in China and rapidly spread globally. ESRD patients on maintenance haemodialysis (MHD) are vulnerable to COVID19 due to various comorbidites like Diabetes Mellitus, Hypertension, Cardiovascular disease. There is limited experience about the clinical profile of hemodialysis patients with COVID19 infection.We describe our experience of 35 MHD patients who developed COVID19 at a tertiary care hospital in Kolkata, India. We also compared the clinical and laboratory parameters of critical and non-critical patients. This is a single center, observational, retrospective study, recording the demographic data, exposure history, clinical features, laboratory and radiological findings, treatment and outcome data for all patients with laboratory-confirmed COVID-19 (RT-PCR test) between15 March to 15 Sept, 2020. RT-PCR was repeated every 5 days and a patient was considered as negative for COVID-19 if RT-PCR was negative two times 24 hours apart. Patients were divided into critical (ICU admissions) and non-critical (domiciliary/ward admissions) groups. Out of 394 patients on MHD, 35(8.88%) were found to be COVID-19 positive during these 6 months. 27 (77.1%) patients were symptomatic and hospitalised; 17(48.6%) in wards and 10 (22.9%) in ICU. Rest 8 patients with mild or no symptoms received domiciliary treatment. Common underlying comorbidities were hypertension (88.6%), DM-2 (48.6%), obesity (14.3%). There was no statistical difference in the comorbidities between both groups The table shows clinical symptoms and radiological parameters. 8 (22.9%) patients were asymptomatic and detected on routine screening. Generalized fatigue and fever were the commonest symptoms. Cough, dyspnoea & pneumonia were found to be significantly higher in patients admitted to ICUs. Reason for hospitalization in 70.37 % patients was a lower respiratory tract infection . 51.85 % of the admitted patients developed pneumonia. HRCT chest showed ground glass opacities in 77.1% and consolidation in 42.9%. 50% of the patients in ICU required mechanical ventilation due to hypoxic respiratory failure. 30% required NIV support and 20 % required high flow nasal oxygen. Four patients died due to COVID pneumonia and ARDS. Median time from admission to death was 12 days. Mortality was 11.42% . 24 patients recovered and became COVID-19 negative. Mean time to virus negativity was 16.4 days. Median duration of hospitalization was 14 days (range 4 to 25 days). Laboratory parameters like CRP, LDH, D-Dimer, Serum ferritin levels in the ICU group were higher with significantly lower absolute lymphocyte count. Oxygen saturation levels were lower in the ICU group (Mean-91.8% vs 98% in the Non-ICU group) at the time of admission. Patients receiving MHD are susceptible to COVID19 and hemodialysis centers are high risk areas for cross infection during the pandemic. Increasing preventive efforts, instituting triage and screening, isolating patients of COVID19, contact tracing, and dialysing them in isolated centers would be help in prevention and disease contention.