Outbreak and impact of coronavirus disease ۲۰۱۹ (COVID-۱۹) on dialysis patients; Al Khezam dialysis center experience, Kuwait

Introduction: Coronavirus disease ۲۰۱۹ (COVID-۱۹) is an outbreak due to SARS-CoV-۲, declared by the World Health Organization (WHO) as a global pandemic in March ۲۰۲۰. Patients with underlying diseases, such as those with end-stage kidney disease (ESKD) on dialysis, are at greater risk.Objectives: The aim of our study to assess the outbreak and impact of COVID-۱۹ on dialysis patients.Patients and Methods: Our study prospectively assessed and followed ۴۴۲ patients with ESKD undergoing dialysis [۳۹۰ patients on maintenance hemodialysis (HD) and ۵۲ patients on peritoneal dialysis (PD)] for outbreak and impact of COVID-۱۹ on these patients during the period from April ۲۲, ۲۰۲۰ until March ۲۳, ۲۰۲۱ in Al Khezam dialysis center, Kuwait. Age, gender, nationality, original kidney disease, history of hypertension (HTN), diabetes mellitus (DM), ischemic heart disease (IHD), congestive heart failure (CHF), bronchial asthma (BA), chronic obstructive pulmonary disease (COPD), history of pulmonary embolism (PE) and source of infection were analyzed. Symptoms as fever, fatigue, cough, loss of smell and taste and chest pain were recorded, the need for ICU admission, mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO), medications were recorded. The need to shift to continuous renal replacement therapy (CRRT) and outcomes (complications and mortality) were analyzed.Results: Our study reported that ۱۰۲ out of ۴۴۲ (۲۳%) dialysis patients [۹۷ out of ۳۹۰ (۲۴.۸%) HD patients and ۵ out of ۵۲ (۹.۶%) PD patients] got infected with COVID-۱۹ and reinfection reported in ۴ out of ۹۷ (۴%) COVID-۱۹ HD patients. Around ۲۷% of COVID-۱۹ HD patients had fever, ۱۹% had fatigue, ۸% had cough, ۴% had loss of smell, ۴% had loss of taste, ۴% had chest pain and ۴۰% of COVID-۱۹ PD patients had fever. Fifteen out of ۹۷ (۱۵ %) COVID-۱۹ HD patients needed ICU admission, ۱۲ out of ۹۷ (۱۲ %) COVID-۱۹ HD patients needed MV. A ۳۳ out of ۹۷ (۳۴%) COVID-۱۹ HD patients and ۴ out of ۵ (۸۰%) COVID-۱۹ PD patients needed to switch to CRRT. Mortality was ۱۷ (۱۵ HD and ۲ PD) out of ۱۰۲ (۱۶.۶ %) COVID-۱۹ dialysis patients and common causes of death were sepsis, myocardial infarction (MI), heart failure and PE.Conclusion: Outbreak and mortality of COVID-۱۹ infection is high in ESKD patients undergoing dialysis compared with general populations. Strict protocol for prevention of COVID-۱۹ should be undertaken in dialysis centers and encourage of home dialysis and highly protective COVID-۱۹ vaccination priority for dialysis patients.

Keywords:

COVID-۱۹ , Hemodialysis , Peritoneal dialysis