학술논문
Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis
Document Type
article
Author
Mitra, Sandip; Jayanti, Anuradha; Vart, Priya; Coca, Armando; Gallieni, Maurizio; Øvrehus, Marius Altern; Midtvedt, Karsten; Abd ElHafeez, Samar; Gandolfini, Iliaria; Büttner, Stefan; Franssen, Casper FM; Hemmelder, Marc H; van der Net, Jeroen B; Essig, Marie; du Buf-Vereijken, Peggy WG; van Ginneken, Betty; Vogt, Nanda Maas Liffert; van Jaarsveld, Brigit C; Jager, Kitty J; Bemelman, Frederike J; Klingenberg-Salahova, Farah; Heenan-Vos, Frederiek; Vervloet, Marc G; Nurmohamed, Azam; Abramowicz, Daniel; Maoujoud, Sabine Verhofstede Omar; Malfait, Thomas; Fialova, Jana; Melilli, Edoardo; Favà, Alexandre; Cruzado, Josep M; Perez, Nuria Montero; Lips, Joy; Krepel, Harmen; Adilovic, Harun; Hengst, Maaike; Rydzewski, rzej; Gellert, Ryszard; Oliveira, João; Alferes, Daniela G; Zakharova, Elena V; Ambuehl, Patrice Max; Walker, rea; Winzeler, Rebecca; Lepeytre, Fanny; Rabaté, Clémentine; Rostoker, Guy; Marques, Sofia; Azasevac, Tijana; Katicic, Dajana; Dam, Marc ten; Krüger, Thilo; Brzosko, Szymon; Zanen, Adriaan L; Logtenberg, Susan JJ; Fricke, Lutz; Slebe, Jeroen JP; Kemlin, Delphine; van de Wetering, Jacqueline; Reinders, Marlies EJ; Eiselt, Jaromir; Kielberger, Lukas; El-Wakil, Hala S; Verhoeven, Martine AM; Canal, Cristina; Facundo, Carme; Ramos, Ana M; Debska-Slizien, Alicja; Veldhuizen, Nicoline MH; Tigka, Eirini; Konsta, Maria Anna Polyzou; Panagoutsos, Stylianos; Mallamaci, Francesca; Postorino, Adele; Cambareri, Francesco; Covic, Adrian; Matceac, Irina; Nistor, Ionut; Cordos, Monica; Groeneveld, JHM; van Buren, Jolanda Jousma Marjolijn; Pereira, Fritz Diekmann Tiago Assis; Santos, Augusto Cesar S; Arias-Cabrales, Carlos; Crespo, Marta; Llinàs-Mallol, Laura; Buxeda, Anna; Tàrrega, Carla Burballa; Redondo-Pachon, Dolores; Jimenez, Maria Dolores Arenas; Hofstra, Julia M; Franco, Antonio; Arroyo, David; Rodríguez-Ferrero, Maria Luisa; Manzanos, Sagrario Balda; Haridian Sosa Barrios, R; Ávila, Gonçalo; Laranjinha, Ivo; Mateus, Catarina; Lemahieu, Wim
Source
Nephrology Dialysis Transplantation. 36(12)
Subject
Language
Abstract
BackgroundPatients on kidney replacement therapy (KRT) are at very high risk of coronavirus disease 2019 (COVID-19). The triage pathway for KRT patients presenting to hospitals with varying severity of COVID-19 illness remains ill-defined. We studied the clinical characteristics of patients at initial and subsequent hospital presentations and the impact on patient outcomes.MethodsThe European Renal Association COVID-19 Database (ERACODA) was analysed for clinical and laboratory features of 1423 KRT patients with COVID-19 either hospitalized or non-hospitalized at initial triage and those re-presenting a second time. Predictors of outcomes (hospitalization, 28-day mortality) were then determined for all those not hospitalized at initial triage.ResultsAmong 1423 KRT patients with COVID-19 [haemodialysis (HD), n = 1017; transplant, n = 406), 25% (n = 355) were not hospitalized at first presentation due to mild illness (30% HD, 13% transplant). Of the non-hospitalized patients, only 10% (n = 36) re-presented a second time, with a 5-day median interval between the two presentations (interquartile range 2-7 days). Patients who re-presented had worsening respiratory symptoms, a decrease in oxygen saturation (97% versus 90%) and an increase in C-reactive protein (26 versus 73 mg/L) and were older (72 vs 63 years) compared with those who did not return a second time. The 28-day mortality between early admission (at first presentation) and deferred admission (at second presentation) was not significantly different (29% versus 25%; P = 0.6). Older age, prior smoking history, higher clinical frailty score and self-reported shortness of breath at first presentation were identified as risk predictors of mortality when re-presenting after discharge at initial triage.ConclusionsThis study provides evidence that KRT patients with COVID-19 and mild illness can be managed effectively with supported outpatient care and with vigilance of respiratory symptoms, especially in those with risk factors for poor outcomes. Our findings support a risk-stratified clinical approach to admissions and discharges of KRT patients presenting with COVID-19 to aid clinical triage and optimize resource utilization during the ongoing pandemic.