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 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. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Авторы
Mitra S. 1 , Jayanti A. 1 , Vart P. 2, 3 , Coca A. 4 , Gallieni M. 5 , Øvrehus M.A. 6 , Midtvedt K. 7 , Abd Elhafeez S. , Gandolfini I. 9 , Büttner S. 10, 74 , Franssen C.F.M. 3 , Hemmelder M.H. 12, 11 , Van Der Net J.B. , Essig M. 14 , Du Buf-Vereijken P.W.G. , Van Ginneken B. , Maas N. 15 , Vogt L. 16 , Van Jaarsveld B.C. , Jager K.J. 16 , Bemelman F.J. 16 , Klingenberg-Salahova F. 16 , Heenan-Vos F. 16 , Vervloet M.G. 16 , Nurmohamed A. 16 , Abramowicz D. 17 , Verhofstede S. 17 , Maoujoud O. 18 , Malfait T. 19 , Fialova J. 20 , Melilli E. 21 , Favà A. 21 , Cruzado J.M. 21 , Perez N.M. 21 , Lips J. 22 , Krepel H. 23 , Adilovic H. 24 , Hengst M. 25 , Rydzewski A. 26 , Gellert R. 27 , Oliveira J. 28 , Alferes D.G. 29 , Zakharova E.V. 30 , Ambuehl P.M. 31 , Walker A. 31 , Winzeler R. 31 , Lepeytre F. 32 , Rabaté C. 32 , Rostoker G. 32 , Marques S. 33 , Azasevac T. 34 , Katicic D. 35 , Dam M.T. 36 , Krüger T. 37 , Brzosko S. 38 , Zanen A.L. 39 , Logtenberg S.J.J. 40 , Fricke L. 41 , Slebe J.J.P. 42 , Kemlin D. 43 , Van De Wetering J. , Reinders M.E.J. 44 , Eiselt J. 45 , Kielberger L. 45 , El-Wakil H.S. 46 , Verhoeven M.A.M. 47 , Canal C. 48 , Facundo C. 48 , Ramos A.M. 49 , Debska-Slizien A. 50 , Veldhuizen N.M.H. 51 , Tigka E. 52 , Konsta M.A.P. 53 , Panagoutsos S. 54 , Mallamaci F. 55 , Postorino A. 55 , Cambareri F. 55 , Covic A. 57, 56 , Matceac I. 57, 56 , Nistor I. 56, 57 , Cordos M. 57, 56 , Groeneveld J.H.M. 58 , Jousma J. 58 , Marjolijn Van Buren , Diekmann F. 60 , Tiago Assis Pereira , Santos A.C.S. 62 , Arias-Cabrales C. 63 , Crespo M. 63 , Llinàs-Mallol L. 63 , Buxeda A. 63 , Tàrrega C.B. 63 , Redondo-Pachon D. 63 , Jimenez M.D.A. 63 , Hofstra J.M. 64 , Franco A. 65 , Arroyo D. 66 , Rodríguez-Ferrero M.L. 66 , Manzanos S.B. 67 , Barrios R.H.S. 68 , Ávila G. 69 , Laranjinha I. 69 , Mateus C. 69 , Lemahieu W. 70 , Bartelet K. 71 , Dirim A.B. 72 , Sever M.S. 72 , Demir E. 72 , Şafak S. 72 , Turkmen A. 72 , Hollander D.A.M.J. 73 , De Vries A.P.J. , Meziyerh S. 75 , Van Der Helm D. , Mallat M. 75 , Bouwsma H. 75 , Sridharan S. 76 , Petruliene K. 77 , Maloney S.-R. 78 , Verberk I. 79 , Van Der Sande F.M. , Christiaans M.H.L. 80 , Mohankumar N. 81 , Di Luca M. , Tuǧlular S.Z. 83 , Kramer A. 84 , Beerenhout C. 85 , Luik P.T. 86 , Kerschbaum J. 87 , Tiefenthaler M. 88 , Watschinger B. 89 , Adema A.Y. 90 , Stepanov V.A. 91 , Zulkarnaev A.B. 91 , Turkmen K. 92 , Fliedner A. 93 , Åsberg A. 94 , Mjoen G. 94 , Miyasato H. 95 , De Fijter C.W.H. , Mongera N. 97 , Pini S. 98 , De Biase C. , Duivenvoorden R. 99 , Hilbrands L. 99 , Kerckhoffs A. 99 , Van De Logt A.-E. , Maas R. 99 , Lebedeva O. 100 , Lopez V. 101 , Verhave J. 102 , Reichert L.J.M. 102 , Titov D. 103 , Parshina E.V. 104 , Zanoli L. 105 , Marcantoni C. 105 , Van Gils-Verrij L.E.A. , Harty J.C. 107 , Meurs M. 108 , Myslak M. 109 , Battaglia Y. 110 , Lentini P. 111 , Den Deurwaarder E. , Stendahl M. 113 , Rahimzadeh H. 114 , Schouten M. 115 , Rychlik I. 116 , Cabezas-Reina C.J. 117 , Roca A.M. 117 , Nauta F. 118 , Goffin E. 119 , Kanaan N. 119 , Labriola L. 119 , Devresse A. 119 , Diaz-Mareque A. 120 , Meijers B.K.I. 121 , Naesens M. 121 , Kuypers D. 121 , Desschans B. 121 , Tonnelier A. 122 , Wissing K.M. 122 , De Arriba G. , Dedinska I. 124 , Pessolano G. 125 , Maggiore U. 126 , Malik S. 127 , Papachristou E. 128 , Gansevoort R.T. 129 , Noordzij M. 129 , Berger S.P. 129 , Meijer E. 129 , Özyilmaz A. 129 , Sanders J.S.F. 130 , Ponikvar J.B. 131 , Arnol M. 131 , Pernat A.M. 131 , Kovac D. 131 , Ekart R. 132 , Abrahams A.C. 133 , Molenaar F.M. 133 , Van Zuilen A.D. , Meijvis S.C.A. 133 , Dolmans H. 133 , Tantisattamo E. 134 , Esposito P. 135 , Krzesinski J.-M. 136 , Barahira J.D. 136 , Sabiu G. 137 , Martin-Moreno P.L. 138 , Guglielmetti G. 139 , Guzzo G. 140 , Toapanta N. 141 , Soler M.J. 141 , Luik A.J. 142 , Van Kuijk W.H.M. , Stikkelbroeck L.W.H. 142 , Hermans M.M.H. 142 , Rimsevicius L. 143 , Righetti M. 144 , Islam M. 145 , Braak N.H.-T. 146 , ERACODA Collaborators
Журнал
NEPHROLOGY DIALYSIS TRANSPLANTATION
Издательство
Oxford University Press
Номер выпуска
12
Язык
Английский
Страницы
2308-2320
Статус
Опубликовано
Ссылка
Внешняя ссылка
DOI
10.1093/NDT/GFAB196
Том
36
Год
2021
Организации
  • 1 Department of Renal Medicine, Manchester University Hospitals, Manchester Academy of Health Sciences Centre, Manchester, United Kingdom
  • 2 Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
  • 3 Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
  • 4 Department of Nephrology, University Clinical Hospital of Valladolid, Valladolid, Spain
  • 5 ASST Fatebenefratelli Sacco, University of Milano, Milan, Italy
  • 6 Department of Renal Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  • 7 Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  • 8 Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
  • 9 University Hospital Parma, Parma, Italy
  • 10 Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
  • 11 Department Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands
  • 12 CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
  • 13 Albert Schweitzer Hospital, Dordrecht, Netherlands
  • 14 Ambroise Pare Hospital, APHP Paris-Saclay University, Boulogne Billancourt, France
  • 15 Amphia Hospital, Breda, Netherlands
  • 16 Amsterdam UMC, Amsterdam, Netherlands
  • 17 Antwerp University Hospital, Antwerp, Belgium
  • 18 Faculty of Medicine, Avicennes Military Hospital, Cadi Ayyad University, Marrakech, Morocco
  • 19 AZ Delta, Roeselare, Belgium
  • 20 B. Braun Avitum, Litomerice, Czech Republic
  • 21 Hospitalet de Llobregat, Bellvitge University Hospital, Barcelona, Spain
  • 22 Bernhoven Hospital, Uden, Netherlands
  • 23 Bravis Hospital, Roosendaal/Bergen op Zoom, Netherlands
  • 24 Cantonal Hospital Zenica, Bosnia and Herzegovina
  • 25 Catharina Hospital, Eindhoven, Netherlands
  • 26 Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
  • 27 Centre Hospitalier du Nord, Luxembourg and Centre of Postgraduate Medical Education, Warsaw, Poland
  • 28 Centrodial, Sao Joao da Madeira, Portugal
  • 29 Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
  • 30 City Hospital N.a. S.P. Botkin, Moscow, Russian Federation
  • 31 City Hospital Waid, Zürich, Switzerland
  • 32 Claude Galien Hospital Ramsay Santé, Quincy-sous-Senart, France
  • 33 Clínica de Hemodiálise de Felgueiras, Felgueiras, Portugal
  • 34 Clinical Centre of Vojvodina, Novi Sad, Serbia
  • 35 Croatian Society of Nephrology, Dialysis and Transplantation, Zagreb, Croatia
  • 36 CWZ Nijmegen, Nijmegen, Netherlands
  • 37 DaVita Geilenkirchen, Geilenkirchen, Germany
  • 38 DaVita, Wrocław, Poland
  • 39 Deventer Ziekenhuis, Deventer, Netherlands
  • 40 Dianet Dialysis Center, Utrecht, Netherlands
  • 41 Dialysis Center Bochum, Bochum, Germany
  • 42 Elyse Klinieken voor Nierzorg, Kerkrade, Netherlands
  • 43 Erasme Hospital, Brussels, Belgium
  • 44 Erasmus Medical Center, Rotterdam, Netherlands
  • 45 Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
  • 46 Faculty of Medicine, Alexandria University, Alexandria, Egypt
  • 47 Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands
  • 48 Fundació Puigvert, Barcelona, Spain
  • 49 Fundación Jiménez Díaz, Madrid, Spain
  • 50 Gdansk Medical University, Gdansk, Poland
  • 51 Gelre Hospital, Apeldoorn, Netherlands
  • 52 General Hospital of Athens G. Gennimatas, Athens, United States
  • 53 General Hospital of Serres, Serres, Greece
  • 54 General University Hospital of Alexandroupolis, Alexandroupolis, Greece
  • 55 Grande Ospedale Metropolitano and CNR, Reggio Calabria, Italy
  • 56 Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
  • 57 Dr Ci Parhon Hospital, Iasi, Romania
  • 58 Haaglanden Medisch Centrum, Hague, Netherlands
  • 59 Haga Hospital, Hague, Netherlands
  • 60 Hospital Clínic de Barcelona, Barcelona, Spain
  • 61 Hospital Curry Cabral-Central Lisbon University Hospital Center, Lisbon, Portugal
  • 62 HC-UFMG, CMN Contagem-MG, Unimed-BH, Contagem, Brazil
  • 63 Hospital Del Mar, Barcelona, Spain
  • 64 Hospital Gelderse Vallei, Ede, Netherlands
  • 65 Hospital General of Alicante, Alicante, Spain
  • 66 Hospital General Universitario Gregorio Marañón, Madrid, Spain
  • 67 Hospital Obispo Polanco, Salud Aragon, Spain
  • 68 Hospital Universitario Ramón y Cajal, Madrid, Spain
  • 69 Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
  • 70 Imelda Hospital, Bonheiden, Belgium
  • 71 Isala, Zwolle, Netherlands
  • 72 Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  • 73 Jeroen Bosch Ziekenhuis, Den Bosch, Netherlands
  • 74 Klinikum Aschaffenburg - Alzenau, Aschaffenburg, Germany
  • 75 Leiden University Medical Center, Leiden, Netherlands
  • 76 Lister Hospital, Stevenage, United Kingdom
  • 77 Lithuanian University of Health Sciences, Kaunas, Lithuania
  • 78 Luzerner Kantonsspital, Luzern, Switzerland
  • 79 Maasstad Ziekenhuis, Rotterdam, Netherlands
  • 80 Maastricht University Medical Center, Maastricht, Netherlands
  • 81 Manipal Hospital, Bangalore, India
  • 82 Marche Nord Hospital, Pesaro, Italy
  • 83 Marmara University School of Medicine, Istanbul, Turkey
  • 84 Martini Ziekenhuis, Groningen, Netherlands
  • 85 Maxima Medisch Centrum, Veldhoven, Netherlands
  • 86 Meander Medisch Centrum, Amersfoort, Netherlands
  • 87 Austrian Dialysis and Transplant Registry, Rohr, Austria
  • 88 Medical University Innsbruck, Innsbruck, Austria
  • 89 Medical University of Vienna, Vienna, Austria
  • 90 Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
  • 91 Moscow Regional Research and Clinical Institute, Moscow, Russian Federation
  • 92 Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
  • 93 Nierenzentrum Reutlingen-Tübingen, Reutlingen, Germany
  • 94 Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Olso, Norway
  • 95 Okinawa Chubu Hospital, Nakagami, Japan
  • 96 OLVG, Amsterdam, Netherlands
  • 97 Ospedale S. Maurizio, Bolzano, Italy
  • 98 Padua University Hospital, Padua, Italy
  • 99 Radboud University Medical Center, Nijmegen, Netherlands
  • 100 Regional Clinical Hospital, Yaroslavl, Russian Federation
  • 101 Regional Hospital of Malaga, Malaga, Spain
  • 102 Rijnstate Hospital, Arnhem, Netherlands
  • 103 RUDN University, Moscow, Russian Federation
  • 104 Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
  • 105 San Marco Hospital, University of Catania, Catania, Italy
  • 106 Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
  • 107 Southern Health & Social Care Trust, Newry, United Kingdom
  • 108 Spaarne Gasthuis, Haarlem, Netherlands
  • 109 SPWSZ Hospital, Szczecinie, Poland
  • 110 St. Anna University Hospital, Ferrara, Italy
  • 111 St. Bassiano Hospital, Bassano del Grappo, Italy
  • 112 Streekziekenhuis Koningin Beatrix, Winterswijk, Netherlands
  • 113 Swedish Renal Registry, Jönköping, Sweden
  • 114 Tehran University of Medical Sciences, Tehran, Iran
  • 115 Tergooi, Hilversum, Netherlands
  • 116 Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
  • 117 Toledo University Hospital, Toledo, Spain
  • 118 Treant/Scheper Ziekenhuis, Emmen, Netherlands
  • 119 Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium
  • 120 University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
  • 121 University Hospital Leuven, Leuven, Belgium
  • 122 University Hospital Brussels, Brussels, Belgium
  • 123 Universitary Hospital of Guadalajara, Guadalajara, Spain
  • 124 University Hospital Martin, Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
  • 125 University Hospital Medical Center Verona, Verona, Italy
  • 126 University Hospitals Parma, Parma, Italy
  • 127 University Hospitals of Coventry, Warwickshire NHS Trust, Coventry, United Kingdom
  • 128 University Hospital of Patras, Patras, Greece
  • 129 Dialysis Center Groningen, Groningen, Netherlands
  • 130 University Medical Center Groningen, Groningen, Netherlands
  • 131 University Medical Center Ljubljana, Ljubljana, Slovenia
  • 132 University Medical Centre Maribor, Maribor, Slovenia
  • 133 University Medical Center Utrecht, Utrecht, Netherlands
  • 134 University of California Irvine School of Medicine, Orange, CA, United States
  • 135 University of Genoa, Genoa, Italy
  • 136 University of Liége, Liége, Belgium
  • 137 University of Milano, Milan, Italy
  • 138 University of Navarra Clinic, Pamplona, Spain
  • 139 University of Piemonte Orientale, Novara, Italy
  • 140 Valais Hospital, Sion, Switzerland
  • 141 Vall d'Hebron University Hospital, Barcelona, Spain
  • 142 VieCuri Medical Centre, Venlo, Netherlands
  • 143 Vilnius University, Vilnius, Lithuania
  • 144 Vimercate Hospital, Vimercate, Italy
  • 145 Zonguldak Ataturk State Hospital, Zonguldak, Turkey
  • 146 Zuyderland Medical Center, Geleen and Heerlen, Netherlands
Ключевые слова
COVID-19; Dialysis; Kidney; Mortality; Second presentation; Transplantation
Цитировать
ГОСТ MLA RIS BibTex
Поделиться

Другие записи