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Abstract/Summary
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INTRODUCTION: In COVID-19, one of the concerns is that patients with immunosuppression become infected. Hemodialysis patients are a group of these patients. Therefore, in this study, we investigate the manifestations, risk factors and prognosis of COVID-19 in Patients on hemodialysis
METHODS: This cross-sectional study was performed on ESRD patients on chronic hemodialysis from March 2 to May 21, 2020 in one of the specific dialysis center for COVID-19 patients in our city.
Inclusion criteria were age > 18 years old, ESRD on chronic hemodialysis (more than 1 month), positive COVID-19 PCR or positive Lung CT scan for COVID-19. We evaluated all patients that were referred for hemodialysis to this center. We studied the records and contacted the patients. The number of them was 135 patients. Among them 23 patients had unknown diagnosis and 24 patients diagnosed acute kidney injuries that were excluded from the study.
Of the 70 patients that included, 56 were hospitalized and 14 were outpatient. We evaluated symptoms at presentation, clinical findings and outcome in the patients and compared it in subgroup analysis. We used SPSS 22 (Chi-square, independent T-test or Mann-Whitney U) for analysis.
RESULTS: The median age of the patients was 62±16 years, 70% were female. The most common comorbidities were hypertension (62%), diabetes mellitus (54%) and cardiovascular disease (27%). The average of hemodialysis duration was 5±3 months. The most common COVID-19 symptoms in the patients were fever (64%), dyspnea (55%) and cough (47%).
Of 56 hospitalized patients, 20(28%) were in severe group. The delay between the onset of symptom and diagnosis, the time of admission to death and the time of admission to discharge was 6±9, 8±8.08, 10±7 days. The total mortality rate was 28%. In sever group, the mortality rate was significantly higher than non-sever group (84% vs. 5.7%, p=0.001).
The most common findings in chest computed tomography (CT) were bilateral ground glass opacification less than 50% (59%) and pleural effusion (10%) that was not related with severity.
CONCLUSIONS: In patient undergoing chronic hemodialysis, increase in white blood cell count, phosphorous and ALT level are risk factors for severity of COVID-19 and death. In comparison with general population the prevalence of COVID-19 in hemodialysis patients is higher in women. Also, the mortality rate is higher in hemodialysis patients.
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