Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis

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 ini...

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Autores: Mitra, S, Jayanti, A, Vart, P, Coca, A, Gallieni, M, Ovrehus, MA, Midtvedt, K, Abd ElHafeez, S, Gandolfini, I, Buttner, S, Franssen, CFM, Hemmelder, MH, Canal C., Facundo C., ERACODA Collaborators
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p8049
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=8049
https://hdl.handle.net/2434/854562
Access Level:acceso abierto
Palabra clave:COVID-19
dialysis
kidney
mortality
second presentation
transplantation
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spelling Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysisMitra, SJayanti, AVart, PCoca, AGallieni, MOvrehus, MAMidtvedt, KAbd ElHafeez, SGandolfini, IButtner, SFranssen, CFMHemmelder, MHCanal C.Facundo C.ERACODA CollaboratorsCOVID-19dialysiskidneymortalitysecond presentationtransplantationBackground. 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 nonhospitalized 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 representing 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.OXFORD UNIV PRESS2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=8049https://hdl.handle.net/2434/854562NEPHROLOGY DIALYSIS TRANSPLANTATIONISSN: 09310509ISSNe: 14602385reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p80492026-06-14T12:41:47Z
dc.title.none.fl_str_mv Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis
title Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis
spellingShingle Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis
Mitra, S
COVID-19
dialysis
kidney
mortality
second presentation
transplantation
title_short Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis
title_full Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis
title_fullStr Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis
title_full_unstemmed Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis
title_sort Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis
dc.creator.none.fl_str_mv Mitra, S
Jayanti, A
Vart, P
Coca, A
Gallieni, M
Ovrehus, MA
Midtvedt, K
Abd ElHafeez, S
Gandolfini, I
Buttner, S
Franssen, CFM
Hemmelder, MH
Canal C.
Facundo C.
ERACODA Collaborators
author Mitra, S
author_facet Mitra, S
Jayanti, A
Vart, P
Coca, A
Gallieni, M
Ovrehus, MA
Midtvedt, K
Abd ElHafeez, S
Gandolfini, I
Buttner, S
Franssen, CFM
Hemmelder, MH
Canal C.
Facundo C.
ERACODA Collaborators
author_role author
author2 Jayanti, A
Vart, P
Coca, A
Gallieni, M
Ovrehus, MA
Midtvedt, K
Abd ElHafeez, S
Gandolfini, I
Buttner, S
Franssen, CFM
Hemmelder, MH
Canal C.
Facundo C.
ERACODA Collaborators
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv COVID-19
dialysis
kidney
mortality
second presentation
transplantation
topic COVID-19
dialysis
kidney
mortality
second presentation
transplantation
description 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 nonhospitalized 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 representing 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.
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=8049
https://hdl.handle.net/2434/854562
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=8049
https://hdl.handle.net/2434/854562
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv OXFORD UNIV PRESS
publisher.none.fl_str_mv OXFORD UNIV PRESS
dc.source.none.fl_str_mv NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 09310509
ISSNe: 14602385
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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