Respiratory Manifestations and Outcome of COVID-19 Positive Patients with CKD

Introduction: The prevalence of CKD (stage 1 to 5) among Indian population is 17.2%1. Among CKD patients; who appear most at risk for COVID-19 are those with a kidney transplant, due to immunosuppression, and those who undergo in-center hemodialysis treatments thrice weekly, due to inability to self-isolate. Patients with kidney disease also have other comorbidities, including hypertension, diabetes mellitus, and cardiovascular disease, that are risk factors for poor outcomes in COVID-192. Aim: The study aimed to evaluate the presentation and outcome of COVID-19 in patients with CKD on MHD. Methods: Retrospective descriptive study included consecutive 50 patients who are known cases of CKD on MHD with confirmed diagnosis of COVID-19 who presented to Victoria Hospital from September 1. Data including demographic information, symptoms, laboratory examination (Hemoglobin, Total WBC count, NL ratio, C-reactive protein, serum Lactate dehydrogenase, D-dimer and serum Ferritin), initial chest Xray involvement, oxygen requirement during admission and clinical outcome (recovery and discharge/death) were obtained. These parameters were compared among both outcome groups. Results: The mean age ? SD of patients was 52.08?13.38 years. 74% were males. Of the total 50 patients; 37 (74%) recovered and 13 (26%) patients died. Most common co morbidity was hypertension (100%) followed by Type 2 diabetes mellitus (25%) and IHD (16%) respectively. 30% (n=15) patients were asymptomatic on admission and all recovered. The most common symptom on admission was cough (46%), followed by dyspnea (42%). The mean haemoglobin count is 9.10?1.66gm/dl and mean total WBC count is 8466?4490.78 cells/cu.mm. The mean NLR (26.01?25.94vs6.59?8.03), LDH (611.23?193.18U/L vs 382.14?151.84) and CRP (142.77?136.53mg/L vs 40.65?37.96mg/L) was higher in the population who died and was statistically significant. Conclusion: One third of the CKD patients on MHD were asymptomatic on presentation and it was associated with positive outcome. Patients who required NIV support initially on admission were at more risk of death. High NLR, elevated serum LDH levels, and raised serum CRP levels were associated with increased risk of mortality; hence these patients require more close monitoring.