Abstract
Background and Aims
The Coronavirus Disease 2019 (COVID-19) pandemic has greatly impacted the world health system, affecting almost 20 million people with a high fatality rate, mainly patients with comorbidities including patients with chronic kidney disease (CKD) in all its stages and renal replacement therapy. The aim of the present study was to evaluate the biochemical characteristics of the patients who urgent-start hemodialysis during the pandemic and additionally to evaluate their survival.
Method
Patients urgent-start hemodialysis were taken during the months of August to November 2020, the admission laboratory data was recorded, including the test to determine SarsCov-2, and Kaplan-Meier survival analysis was applied taking in it counts variables such as sex, professional who placed the vascular access, COVID-19 test result and evaluation by nephrology in the pre-dialysis clinic.
Results
92 patients were including in the analysis, 65% male, the nephrologist placed the vascular access in 54% of the patients, 71% had a negative result in the COVID-19 test and 55% had no evaluation in the pre-dialysis clinic. Among the biochemical results was found BUN 95.3mg/dl (SD 38.1), sCr 10.3mg/dl (SD 6.3), Na 130.6mg/dl (SD 7.5), K 5mmol/L (SD 1.1), Ca 7.8mg/dl (SD 1), P 6.5mg/dl (SD 3.3), uric acid 8.3mg/dl (SD 10) and PTH 279pg/ml (SD 267). As prognostic markers of infection by COVID-19, the following results were found WC 12.3k/UL (SD 9.3), hemoglobin 9.35g/dl (SD 2.5), hematocrit 28.7% (SD 9.4), platelets 291mcL (SD 137), sedimentation 75mm/hr. (SD 37), CRP 81.8mg/L (SD 113.8), interleukin-6 232-6pg/ml (SD 838.8), ferritin 1074.3mg/ml (SD 825.3), D dimer 4.3mcg/dl (SD 11.2), lactate dehydrogenase 322U/L (SD 255) and procalcitonin 6.5ng/ml (SD 16.8). When evaluating survival with the Kaplan-Meier analysis, no statistically significant difference was found when analyzing the variable presence of COVID-19 infection (Figure 2 - p: 0.89), sex (Figure 3 - p: 0.54), professional who placed vascular access (Figure 4 - p: 0.1), and the pre-dialysis evaluation (Figure 5 - p: 0.33), having a survival in general of 77% at 3 months (Figure 1).
Conclusion
The present study found a 77% survival rate in patients with urgent-start hemodialysis. There are no other documented data in Guatemala, which is why it provides guidelines for future studies in the country. Among the variables taken, no one was found that would determine a better survival, including SarsCov-2 infection. It will be necessary to carry out more studies with greater follow-up, more patients and more centers to carry out a better analysis.
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