Análise dos internamentos hospitalares de pacientes dialíticos durante a pandemia de COVID-19

Abstract

INTRODUCTION: Chronic Kidney Disease (CKD) is identified as a risk factor for severe cases of COVID-19 infection and is associated with worse clinical outcomes and higher mortality. METHOD: Observational, descriptive, retrospective study. Analyzed medical records of chronic dialysis patients hospitalized in respiratory isolation at a nephrology reference hospital in southern Brazil, between May 1, 2020 and April 30, 2022. We analyzed gender, age, comorbidities, dialysis modality, hospitalization environment, need for mechanical ventilation, outcomes and length of stay. Related symptoms on admission, how many patients confirmed COVID-19 and what differential diagnoses if COVID-19 was ruled out. RESULTS: 91 hospitalized patients (57.1% male), average 58±17 years old. The average length of stay was 7 days. Hypertension and diabetes were the most common comorbidities (87.9% and 35.1% respectively). 89% of patients were undergoing hemodialysis (49.3% by AVF, 45.7% by tunneled catheter). Of the 10 patients on peritoneal dialysis, 40% required conversion to hemodialysis due to ultrafiltration failure. Among the symptoms on admission, 70.3% had dyspnea, 42.8% had cough and 33% had fever. COVID-19 infection was confirmed in 47.2% of patients (60.4% required ICU) and 37.2% died. Among those with COVID-19 ruled out, pulmonary congestion due to hypervolemia was the main differential diagnosis. DISCUSSION: CKD-5D confers a worse prognosis for COVID-19 infection and has a high prevalence in patients admitted to the ICU and in those requiring mechanical ventilation. CKD-5D is also associated with high in-hospital mortality, corroborating the data found in this study. CONCLUSIONS: The study described the disease caused by COVID-19 in dialysis patients and hypervolemia with pulmonary congestion was an important differential diagnosis.