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Clinical triage of patients on kidney replacement therapy presenting with COVID-19: An ERACODA registry analysis
- Source :
- Nephrology, Dialysis, Transplantation, 36(12), 2308-2320. Oxford University Press, ERACODA Collaborators 2021, ' Clinical triage of patients on kidney replacement therapy presenting with COVID-19 : An ERACODA registry analysis ', Nephrology, Dialysis, Transplantation, vol. 36, no. 12, pp. 2308-2320 . https://doi.org/10.1093/ndt/gfab196, https://doi.org/10.1093/ndt/gfab196, NEPHROLOGY DIALYSIS TRANSPLANTATION, r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau, instname, Nephrology Dialysis Transplantation, Nephrology, Dialysis, Transplantation, Vol. 36, no.12, p. 2308-2320 (2021), Nephrology, Dialysis, Transplantation, 36, 2308-2320, Nephrology Dialysis Transplantation, 36(12), 2308-2320. Oxford University Press, Nephrology, Dialysis, Transplantation, 36, 12, pp. 2308-2320
- Publication Year :
- 2021
-
Abstract
- Background Patients 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. Methods The 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. Results Among 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. Conclusions This 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.
- Subjects :
- kidney
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19)
medicine.medical_treatment
Pulmonary insufficiency
infectious diseases
Kidney
Second presentation
Interquartile range
Internal medicine
medicine
Humans
Registries
Mortality
AcademicSubjects/MED00340
Dialysis
Aged
Transplantation
second presentation
business.industry
SARS-CoV-2
COVID-19
medicine.disease
mortality
Triage
Hospitalization
Renal Replacement Therapy
Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11]
Nephrology
Oxygen Saturation
dialysis
Original Article
Hemodialysis
Renal disorders Radboud Institute for Health Sciences [Radboudumc 11]
Presentation (obstetrics)
business
transplantation
Subjects
Details
- Language :
- English
- ISSN :
- 09310509
- Database :
- OpenAIRE
- Journal :
- Nephrology, Dialysis, Transplantation, 36(12), 2308-2320. Oxford University Press, ERACODA Collaborators 2021, ' Clinical triage of patients on kidney replacement therapy presenting with COVID-19 : An ERACODA registry analysis ', Nephrology, Dialysis, Transplantation, vol. 36, no. 12, pp. 2308-2320 . https://doi.org/10.1093/ndt/gfab196, https://doi.org/10.1093/ndt/gfab196, NEPHROLOGY DIALYSIS TRANSPLANTATION, r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau, instname, Nephrology Dialysis Transplantation, Nephrology, Dialysis, Transplantation, Vol. 36, no.12, p. 2308-2320 (2021), Nephrology, Dialysis, Transplantation, 36, 2308-2320, Nephrology Dialysis Transplantation, 36(12), 2308-2320. Oxford University Press, Nephrology, Dialysis, Transplantation, 36, 12, pp. 2308-2320
- Accession number :
- edsair.doi.dedup.....327d034fbf707930388f45de637b58f1