The second wave of COVID-19 disease in haemodialysis patients: An experience of a dialysis center from Pakistan.

OBJECTIVE: To evaluate the characteristics and outcomes of second wave of coronavirus disease-2019 in haemodialysis patients. METHODS: The retrospective, observational cohort study was conducted at The Kidney Center Post-Graduate-Training-Institute, Karachi, Pakistan and comprised data of patients regardless of gender who contracted coronavirus disease-2019 during the second wave from November 3, 2020, till February 12, 2021. Epidemiological, clinical, laboratory, and radiological characteristics and outcomes of the patients were reviewed. Data was analysed using SPSS 21. RESULTS: Of 437 patients on haemodialysis, 46(10.5%) contracted coronavirus disease-2019; 29(63%) males and 17(37%) females. The overall median age was 61.5±13.02 years. Most patients developed mild disease 27(%). The most common symptom was fever 29(63%), and 6(13.1%) patients had patchy bilateral opacity on chest radiograph. Major complications were lymphocytopenia 29(63%), pneumonia 15(32.6%), thrombocytopenia 8(17.4%), and septic shock 5(10.9%). Overall, 15(32.6%) patients required hospitalisation, and 8(17.4%) required mechanical ventilation. There were 13(28.3%) deaths. Patients aged >60 years had 6.8 times more severe disease (p=0.023) and chances of death among them were 5.8 times higher (p=0.036) than in those aged <60 years. CONCLUSIONS: There was a high susceptibility of haemodialysis patients during the second wave of coronavirus disease compared to the general population. The most important determinants of death were advanced age, lower oxygen saturation and thrombocytopenia at presentation.

A Comparative Study of the First and Second Waves of COVID-19 in Hemodialysis Patients From Pakistan.

INTRODUCTION: This study aims to compare the characteristics and outcomes of the first and second waves of coronavirus disease 2019 (COVID-19) in hemodialysis (HD) patients. METHOD: We compared the epidemiological, clinical, laboratory, and radiological characteristics and outcomes of a cohort of HD patients who contracted COVID-19 in our HD center during the first wave from May 2020 to September 2020 and the second wave from November 2020 to February 2021. RESULTS: A total of 50 (11.8%) of 423 patients during the first wave and 46 (10.5%) of 437 patients during the second wave contracted COVID-19. The median age was 59.5 ± 9.99 years (first wave) and 60.3 ± 13.02 years (second wave). Most patients developed the mild disease. Patients requiring hospitalization (22% vs. 32.6%) and mechanical ventilation (10% vs. 17.4%) were more in the second wave. The most common symptom was fever (82% and 63%) in both waves. Patchy bilateral opacity was the most common radiological finding. Major complications including lymphocytopenia (36% and 63%), pneumonia (28% and 32.6%), thrombocytopenia (30% and 17.4%), and septic shock (6% and 10.9%) were shared. Ten (20%) patients died in the first wave and 13 (28.3%) in the second wave. Patients aged > 60 years had more severe disease and died more than patients aged < 60 years in both waves. CONCLUSION: There is a high susceptibility and mortality of HD patients in both the first and second waves of COVID-19 as compared to the general population. Disease symptoms, radiological findings, and laboratory tests were similar in both waves. Patients developing critical disease and requiring hospitalization and mechanical ventilation were more in the second wave.

Clinical Characteristics and Outcomes of Coronavirus Disease 2019 Infection of In-center Hemodialysis Patients: An Experience of a Dialysis Center from Pakistan.

Much has now been learned about the coronavirus disease 2019 (COVID-19) in the general population, but data for hemodialysis (HD) patients are limited. This is the first study of COVID-19 disease in patients undergoing maintenance HD in Pakistan. We studied the epidemiological, clinical, laboratory, radiological characteristics, and outcomes of a cohort of HD patients that contracted COVID-19 in our HD center from the first confirmed case on May 12, 2020, until September 9, 2020. Out of the total 423 patients being dialyzed in our center, 87 were suspected and 50 (11.8%) were confirmed for COVID-19. Male:Female ratio was nearly equal. The median age was 59.5 ± 9.99 years. Most patients developed mild disease. The most common symptoms were fever (82%). Ten (20%) had patchy bilateral opacity (ground-glass opacity) on the chest radiograph. Major complications were lymphocytopenia (36%), thrombocytopenia (30%), pneumonia (28%), and septic shock (6%). Eleven (22%) patients were hospitalized. Five required mechanical ventilation. Ten (20%) patients died. The relative risk of death with COVID-19 in HD patient was 1.46 with 95% confidence interval 1.15-1.84, (P = 0.003). The patients aged ≥60 years had 4.3 times more severe disease (P = 0.044) and died 3.3 times (P = 0.164) more than patients aged <60 years. HD patients have a high susceptibility to COVID-19 compared to the general population with an increased mortality rate and prolonged recovery time. Patients with age >60 years, female gender, diabetics, and those presented with more severe symptoms and laboratory parameters, had a higher fatal outcome.