POS-950 COVID-19 IN END STAGE KIDNEY DISEASE WITH RENAL REPLACEMENT THERAPIES: OUR EXPERIENCE IN PENANG

Abstract

COVID-19 infection in End Stage Kidney Disease (ESKD) patients is associated with increased disease burden and higher mortality rates. The aim of this study is to describe the clinical characteristics and outcomes in this group of patients. A particular focus has also been placed to gauge the effectiveness of vaccination in preventing severe disease and death in ESKD patients with COVID-19 infection. A retrospective observational study whereby we reviewed the electronic database of all dialysis-dependent patients who were admitted to four hospitals (Penang General Hospital, Seberang Jaya Hospital, Bukit Mertajam Hospital and Kepala Batas Hospital) in Penang, Malaysia for COVID-19 infection, from 1stMarch 2020 till 31stAugust 2021. There was a total of 153 admissions. 60 patients were admitted to Penang General Hospital, and the remaining 93 were admitted to the other three hospitals. 96 (63%) patients were male and 57 (37%) were female, with mean age of 59.5 ± 12.5 years. Five patients were on Continuous Ambulatory Peritoneal Dialysis (CAPD) while the others were on regular hemodialysis. 139 (90.8%) patients had hypertension, 123 (80.3%) had diabetes mellitus, and 41 (26.8%) had cardiovascular disease. At presentation, most patients had mild disease and did not require oxygen supplementation. 31 (20.3%) were asymptomatic (Category 1), 65 (42.5%) had symptoms without pneumonia (Category 2) and 21 (13.7%) had pneumonia but did not require oxygen support (Category 3). A smaller but significant proportion required oxygen supplementation at presentation. 30 (19.6%) needed oxygen therapy (Category 4). 6 (3.9%) were critically ill, requiring high flow nasal cannula or invasive ventilation (Category 5). Subsequently, during admission, their disease progressed. The number of Category 3 patients doubled to 45 (29.4%) and a larger proportion of patients had required oxygen supplementation, with 51 (33.3%) patients deteriorating to Category 4. There was a total of 31 deaths (20.3%). During this study, Malaysia’s National COVID-19 Immunization Programme was administering vaccines which required two doses (Sinovac, AstraZeneca and Pfizer-BioNTech vaccines). Most (85 patients, 55.6%) had not been vaccinated. 11 (7.2%) had received 1 dose, and 57 (37.2%) had completed 2 doses. Patients who had been vaccinated fared better than their unvaccinated counterparts. 47.1% of unvaccinated patients required oxygen therapy (Category 4-5) at some point of their disease as opposed to only 25% of patients who had received at least one dose of vaccine (p value = 0.005). Among the mortalities, most (64.5%) had not been vaccinated. ESKD is an important risk factor contributing to COVID-19 mortality. The mortality rate in ESKD patients with COVID-19 disease is high (20.3%) and most (64.5%) were not vaccinated. Patients who were unvaccinated had more severe disease.