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Clinical Characteristics and Short-Term Outcomes of Chronic Dialysis Patients Admitted for COVID-19 in Metro Manila, Philippines

Authors Tomacruz ID, So PN, Pasilan RM, Camenforte JK, Duavit MI

Received 20 October 2020

Accepted for publication 12 January 2021

Published 17 February 2021 Volume 2021:14 Pages 41—51


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Pravin Singhal

Isabelle Dominique Tomacruz, Paolo Nikolai So, Renz Michael Pasilan, Jameel Kristine Camenforte, Maria Isabel Duavit

Division of Nephrology, Department of Medicine, Philippine General Hospital, Manila, Metro Manila, Philippines

Correspondence: Isabelle Dominique Tomacruz
Division of Nephrology, Department of Medicine, Philippine General Hospital, Taft Avenue, Manila, Metro Manila, 1000, Philippines

Aim: Data published on COVID-19 in the Filipino population, particularly those with end stage kidney disease (ESKD) are still lacking.
Methods: We performed a retrospective, observational study of 68 ESKD patients admitted with COVID-19 infection at a tertiary hospital in Metro Manila, Philippines from April 1, 2020 to July 31, 2020. We compared the clinical features, baseline laboratory data, treatment strategies and short-term outcomes between those who survived and those who died. We also determined the risk factors associated with mortality from COVID-19.
Results: Mean age was 54.5 years old, 66% were male. All patients admitted were on maintenance hemodialysis (HD). The most common presenting symptoms were dyspnea (57%), fever (47%) and cough (38%). There was an equal number of patients on high flow nasal cannula (17.7%) and invasive mechanical ventilation (17.7%). ICU admission was required in 17.7% of the cohort. In-hospital death occurred in 25% of the patients. Admission PaO2/FiO2 (PF) ratios (162 ± 134 versus 356 ± 181; p=0.0009) were lower, and procalcitonin (6.07 ± 10.5ng/mL versus 0.73 ± 3.61 ng/mL; p=0.02), lactate dehydrogenase (396 ± 274U/L versus 282 ± 148 U/L; p=0.03), and white blood cell counts (10 ± 7.3 x 109/L versus 6.3 ± 4.2 x 109/L; p= 0.0039) were significantly higher among those who died compared to those who survived. After adjusting for confounders, only low PF ratio (HR 1.01 for every unit decrease, 95% CI 1– 1.01) and need for ventilation (HR 6.45, 95% CI 1.16– 35.97) conferred a significant risk for in-hospital mortality.
Conclusion: Short-term, in-hospital mortality is high among patients on chronic hemodialysis admitted for COVID-19 infection. They present similarly with the general population. Low PF ratio on admission and need for ventilation are independent risk factors for in-hospital mortality.

Keywords: coronavirus, COVID-19, hemodialysis, dialysis, kidney failure

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