Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis
Author:
Mitra Sandip1, Jayanti Anuradha1, Vart Priya23, Coca Armando4ORCID, Gallieni Maurizio5ORCID, Øvrehus Marius Altern6, Midtvedt Karsten7, Abd ElHafeez Samar8, Gandolfini Iliaria9, Büttner Stefan10, Franssen Casper F M3, Hemmelder Marc H1112, van der Net Jeroen B, Essig Marie, du Buf-Vereijken Peggy W G, 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 J J, Fricke Lutz, Slebe Jeroen J P, Kemlin Delphine, van de Wetering Jacqueline, Reinders Marlies E J, Eiselt Jaromir, Kielberger Lukas, El-Wakil Hala S, Verhoeven Martine A M, Canal Cristina, Facundo Carme, Ramos Ana M, Debska-Slizien Alicja, Veldhuizen Nicoline M H, Tigka Eirini, Konsta Maria Anna Polyzou, Panagoutsos Stylianos, Mallamaci Francesca, Postorino Adele, Cambareri Francesco, Covic Adrian, Matceac Irina, Nistor Ionut, Cordos Monica, Groeneveld J H M, 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, Bartelet Karlijn, Dirim Ahmet Burak, Sever Mehmet Sukru, Demir Erol, Şafak Seda, Turkmen Aydin, Hollander Daan A M J, Büttner Stefan, de Vries Aiko P J, Meziyerh Soufian, van der Helm Danny, Mallat Marko, Bouwsma Hanneke, Sridharan Sivakumar, Petruliene Kristina, Maloney Sharon-Rose, Verberk Iris, van der Sande Frank M, Christiaans Maarten H L, MohanKumar N, Di Luca Marina, Tuğlular Serhan Z, Beerenhout Andrea Kramer Charles, Luik Peter T, Kerschbaum Julia, Watschinger Bruno, Adema Aaltje Y, Stepanov Vadim A, Zulkarnaev Alexey B, Turkmen Kultigin, Fliedner Anselm, Åsberg Anders, Mjoen Geir, de Fijter Hitoshi Miyasato Carola W H, Mongera Nicola, Pini Stefano, de Biase Consuelo, Duivenvoorden Raphaël, Hilbrands Luuk, Kerckhoffs Angele, van de Logt Anne-Els, Maas Rutger, Lebedeva Olga, Lopez Veronica, Verhave Jacobien, Reichert Louis J M, Titov Denis, Parshina Ekaterina V, Zanoli Luca, Marcantoni Carmelita, van Gils-Verrij Liesbeth E A, Harty John C, Meurs Marleen, Myslak Marek, Battaglia Yuri, Lentini Paolo, den Deurwaarder Edwin, Stendahl Maria, Rahimzadeh Hormat, Schouten Marcel, Rychlik Ivan, Cabezas-Reina Carlos J, Roca Ana Maria, Nauta Ferdau, Goffin Eric, Kanaan Nada, Labriola Laura, Devresse Arnaud, Diaz-Mareque Anabel, Meijers Björn K I, Naesens Maarten, Kuypers Dirk, Desschans Bruno, Tonnelier Annelies, Wissing Karl M, de Arriba Gabriel, Dedinska Ivana, Pessolano Giuseppina, Maggiore Umberto, Malik Shafi, Papachristou Evangelos, Gansevoort Ron T, Noordzij Marlies, Berger Stefan P, Meijer Esther, Özyilmaz Akin, Ponikvar Jadranka Buturović, Arnol Miha, Pernat Andreja Marn, Kovac Damjan, Ekart Robert, Abrahams Alferso C, Molenaar Femke M, van Zuilen Arjan D, Meijvis Sabine C A, Dolmans Helma, Tantisattamo Ekamol, Esposito Pasquale, Krzesinski Jean-Marie, Barahira Jean Damacène, Sabiu Gianmarco, Martin-Moreno Paloma Leticia, Guglielmetti Gabriele, Guzzo Gabriella, Toapanta Nestor, Soler Maria Jose, Luik Antinus J, van Kuijk Willi H M, Stikkelbroeck Lonneke W H, Hermans Marc M H, Rimsevicius Laurynas, Righetti Marco, Islam Mahmud, Braak Nicole Heitink-ter,
Affiliation:
1. Department of Renal Medicine, Manchester University Hospitals, Manchester Academy of Health Sciences Centre, Manchester, UK 2. Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 3. Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The 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, The Netherlands 12. CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
Abstract
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.
Funder
ERA-EDTA, the Dutch Kidney Foundation, Baxter and Sandoz
Publisher
Oxford University Press (OUP)
Subject
Transplantation,Nephrology
Cited by
4 articles.
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