Soniya Yaqub, Amna Hamid, Zarghoona Naeem, Safia Awan.
Clinical Presentation and Outcomes of Covid-19 in Maintenance Hemodialysis patients in Pakistan: a single-Center Study.
Pak J Kidney Dis Jan ;5(1):12-21.

OBJECTIVE: The objective of the present study was to review clinical presentation and short-term outcomes of COVID-19 in patients on maintenance hemodialysis (MHD). STUDY DESIGN: Retrospective observational study place AND DURATION OF STUDY: The study was conducted at three coordinated outpatient hemodialysis units at Aga Khan University Hospital from 1st May 2020 to 31st July, 2020.METHODOLOGY: Data on baseline characteristics, clinical features, laboratory and radiographic findings, treatment and short come outcomes were analyzed for 15patients on MHD diagnosed with COVID-19during the study period. All characteristics were also compared between surviving and deceased subjects. RESULTS: Out of 108 MHD patients, 17were diagnosed with COVID-19 through polymerase chain reaction (PCR)and 15 of them were included in the study. Mean age of subjects was 62.8 years; 53.3% were females. Comorbidities were hypertension (100%), diabetes mellitus (86.7%) and cardiovascular disease (33.3%). Median HD vintage was 15 months (IQR 8-14). Forty percent of the patients were asymptomatic. Frequent symptoms observed were shortness of breath (40%), cough (26.7%) and fever (20%). Lymphopenia was not seen in our study and 40% had no radiographic finding. Acute respiratory distress syndrome, myocardial injury, hepatic dysfunction and thrombotic event were observed complications. Compared to survivors, deceased patients were significantly older (p=0.01) and had higher inflammatory markers. Forty percent were hospitalized and 83.3% required ventilation (invasive or noninvasive). By the end of follow up; 40% patients died. CONCLUSION: Patients on MHD are susceptible to severe COVID-19 and higher mortality. Asymptomatic presentation demands high clinical suspicion for prompt diagnosis. Following trend of inflammatory markers may help clinician in identification of severe cases and appropriate management.

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