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Clinical Triage of Patients on Kidney Replacement Therapy Presenting With Covid-19: An Eracoda Registry Analysis Publisher Pubmed



Mitra S1 ; Jayanti A1 ; Vart P2, 3 ; Coca A4 ; Gallieni M5 ; Ovrehus MA6 ; Midtvedt K7 ; Abd Elhafeez S8 ; Gandolfini I9 ; Buttner S10, 74 ; Franssen CFM3 ; Hemmelder MH11, 12 ; Van Der Net JB13 ; Essig M14 Show All Authors
Authors
  1. Mitra S1
  2. Jayanti A1
  3. Vart P2, 3
  4. Coca A4
  5. Gallieni M5
  6. Ovrehus MA6
  7. Midtvedt K7
  8. Abd Elhafeez S8
  9. Gandolfini I9
  10. Buttner S10, 74
  11. Franssen CFM3
  12. Hemmelder MH11, 12
  13. Van Der Net JB13
  14. Essig M14
  15. Du Bufvereijken PWG15
  16. Van Ginneken B15
  17. Maas N15
  18. Vogt L16
  19. Van Jaarsveld BC16
  20. Jager KJ16
  21. Bemelman FJ16
  22. Klingenbergsalahova F16
  23. Heenanvos F16
  24. Vervloet MG16
  25. Nurmohamed A16
  26. Abramowicz D17
  27. Verhofstede S17
  28. Maoujoud O18
  29. Malfait T19
  30. Fialova J20
  31. Melilli E21
  32. Fava A21
  33. Cruzado JM21
  34. Perez NM21
  35. Lips J22
  36. Krepel H23
  37. Adilovic H24
  38. Hengst M25
  39. Rydzewski A26
  40. Gellert R27
  41. Oliveira J28
  42. Alferes DG29
  43. Zakharova EV30
  44. Ambuehl PM31
  45. Walker A31
  46. Winzeler R31
  47. Lepeytre F32
  48. Rabate C32
  49. Rostoker G32
  50. Marques S33
  51. Azasevac T34
  52. Katicic D35
  53. Dam MT36
  54. Kruger T37
  55. Brzosko S38
  56. Zanen AL39
  57. Logtenberg SJJ40
  58. Fricke L41
  59. Slebe JJP42
  60. Kemlin D43
  61. Van De Wetering J44
  62. Reinders MEJ44
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  64. Kielberger L45
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  66. Verhoeven MAM47
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  78. Covic A56, 57
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  80. Nistor I56, 57
  81. Cordos M56, 57
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  115. Sridharan S76
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  120. Christiaans MHL80
  121. Mohankumar N81
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  129. Watschinger B89
  130. Adema AY90
  131. Stepanov VA91
  132. Zulkarnaev AB91
  133. Turkmen K92
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  136. Mjoen G94
  137. Miyasato H95
  138. De Fijter CWH96
  139. Mongera N97
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  143. Hilbrands L99
  144. Kerckhoffs A99
  145. Van De Logt AE99
  146. Maas R99
  147. Lebedeva O100
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  183. Maggiore U126
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  207. Martinmoreno PL138
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  215. Hermans MMH142
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  218. Islam M145
  219. Braak NHT146
Show Affiliations
Authors Affiliations
  1. 1. Department of Renal Medicine, Manchester University Hospitals, Manchester Academy of Health Sciences Centre, Manchester, United Kingdom
  2. 2. Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
  3. 3. Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
  4. 4. Department of Nephrology, University Clinical Hospital of Valladolid, Valladolid, Spain
  5. 5. ASST Fatebenefratelli Sacco, University of Milano, Milan, Italy
  6. 6. Department of Renal Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  7. 7. Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  8. 8. Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
  9. 9. University Hospital Parma, Parma, Italy
  10. 10. Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
  11. 11. Department Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands
  12. 12. CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
  13. 13. Albert Schweitzer Hospital, Dordrecht, Netherlands
  14. 14. Ambroise Pare Hospital, APHP Paris-Saclay University, Boulogne Billancourt, France
  15. 15. Amphia Hospital, Breda, Netherlands
  16. 16. Amsterdam UMC, Amsterdam, Netherlands
  17. 17. Antwerp University Hospital, Antwerp, Belgium
  18. 18. Faculty of Medicine, Avicennes Military Hospital, Cadi Ayyad University, Marrakech, Morocco
  19. 19. AZ Delta, Roeselare, Belgium
  20. 20. B. Braun Avitum, Litomerice, Czech Republic
  21. 21. Hospitalet de Llobregat, Bellvitge University Hospital, Barcelona, Spain
  22. 22. Bernhoven Hospital, Uden, Netherlands
  23. 23. Bravis Hospital, Roosendaal/Bergen op Zoom, Netherlands
  24. 24. Cantonal Hospital Zenica, Bosnia and Herzegovina
  25. 25. Catharina Hospital, Eindhoven, Netherlands
  26. 26. Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
  27. 27. Centre Hospitalier du Nord, Luxembourg and Centre of Postgraduate Medical Education, Warsaw, Poland
  28. 28. Centrodial, Sao Joao da Madeira, Portugal
  29. 29. Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
  30. 30. City Hospital N.a. S.P. Botkin, Moscow, Russian Federation
  31. 31. City Hospital Waid, Zurich, Switzerland
  32. 32. Claude Galien Hospital Ramsay Sante, Quincy-sous-Senart, France
  33. 33. Clinica de Hemodialise de Felgueiras, Felgueiras, Portugal
  34. 34. Clinical Centre of Vojvodina, Novi Sad, Serbia
  35. 35. Croatian Society of Nephrology, Dialysis and Transplantation, Zagreb, Croatia
  36. 36. CWZ Nijmegen, Nijmegen, Netherlands
  37. 37. DaVita Geilenkirchen, Geilenkirchen, Germany
  38. 38. DaVita, Wroclaw, Poland
  39. 39. Deventer Ziekenhuis, Deventer, Netherlands
  40. 40. Dianet Dialysis Center, Utrecht, Netherlands
  41. 41. Dialysis Center Bochum, Bochum, Germany
  42. 42. Elyse Klinieken voor Nierzorg, Kerkrade, Netherlands
  43. 43. Erasme Hospital, Brussels, Belgium
  44. 44. Erasmus Medical Center, Rotterdam, Netherlands
  45. 45. Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
  46. 46. Faculty of Medicine, Alexandria University, Alexandria, Egypt
  47. 47. Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands
  48. 48. Fundacio Puigvert, Barcelona, Spain
  49. 49. Fundacion Jimenez Diaz, Madrid, Spain
  50. 50. Gdansk Medical University, Gdansk, Poland
  51. 51. Gelre Hospital, Apeldoorn, Netherlands
  52. 52. General Hospital of Athens G. Gennimatas, Athens, United States
  53. 53. General Hospital of Serres, Serres, Greece
  54. 54. General University Hospital of Alexandroupolis, Alexandroupolis, Greece
  55. 55. Grande Ospedale Metropolitano and CNR, Reggio Calabria, Italy
  56. 56. Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
  57. 57. Dr Ci Parhon Hospital, Iasi, Romania
  58. 58. Haaglanden Medisch Centrum, Hague, Netherlands
  59. 59. Haga Hospital, Hague, Netherlands
  60. 60. Hospital Clinic de Barcelona, Barcelona, Spain
  61. 61. Hospital Curry Cabral-Central Lisbon University Hospital Center, Lisbon, Portugal
  62. 62. HC-UFMG, CMN Contagem-MG, Unimed-BH, Contagem, Brazil
  63. 63. Hospital Del Mar, Barcelona, Spain
  64. 64. Hospital Gelderse Vallei, Ede, Netherlands
  65. 65. Hospital General of Alicante, Alicante, Spain
  66. 66. Hospital General Universitario Gregorio Maranon, Madrid, Spain
  67. 67. Hospital Obispo Polanco, Salud Aragon, Spain
  68. 68. Hospital Universitario Ramon y Cajal, Madrid, Spain
  69. 69. Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
  70. 70. Imelda Hospital, Bonheiden, Belgium
  71. 71. Isala, Zwolle, Netherlands
  72. 72. Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  73. 73. Jeroen Bosch Ziekenhuis, Den Bosch, Netherlands
  74. 74. Klinikum Aschaffenburg - Alzenau, Aschaffenburg, Germany
  75. 75. Leiden University Medical Center, Leiden, Netherlands
  76. 76. Lister Hospital, Stevenage, United Kingdom
  77. 77. Lithuanian University of Health Sciences, Kaunas, Lithuania
  78. 78. Luzerner Kantonsspital, Luzern, Switzerland
  79. 79. Maasstad Ziekenhuis, Rotterdam, Netherlands
  80. 80. Maastricht University Medical Center, Maastricht, Netherlands
  81. 81. Manipal Hospital, Bangalore, India
  82. 82. Marche Nord Hospital, Pesaro, Italy
  83. 83. Marmara University School of Medicine, Istanbul, Turkey
  84. 84. Martini Ziekenhuis, Groningen, Netherlands
  85. 85. Maxima Medisch Centrum, Veldhoven, Netherlands
  86. 86. Meander Medisch Centrum, Amersfoort, Netherlands
  87. 87. Austrian Dialysis and Transplant Registry, Rohr, Austria
  88. 88. Medical University Innsbruck, Innsbruck, Austria
  89. 89. Medical University of Vienna, Vienna, Austria
  90. 90. Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
  91. 91. Moscow Regional Research and Clinical Institute, Moscow, Russian Federation
  92. 92. Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
  93. 93. Nierenzentrum Reutlingen-Tubingen, Reutlingen, Germany
  94. 94. Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Olso, Norway
  95. 95. Okinawa Chubu Hospital, Nakagami, Japan
  96. 96. OLVG, Amsterdam, Netherlands
  97. 97. Ospedale S. Maurizio, Bolzano, Italy
  98. 98. Padua University Hospital, Padua, Italy
  99. 99. Radboud University Medical Center, Nijmegen, Netherlands
  100. 100. Regional Clinical Hospital, Yaroslavl, Russian Federation
  101. 101. Regional Hospital of Malaga, Malaga, Spain
  102. 102. Rijnstate Hospital, Arnhem, Netherlands
  103. 103. RUDN University, Moscow, Russian Federation
  104. 104. Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
  105. 105. San Marco Hospital, University of Catania, Catania, Italy
  106. 106. Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
  107. 107. Southern Health & Social Care Trust, Newry, United Kingdom
  108. 108. Spaarne Gasthuis, Haarlem, Netherlands
  109. 109. SPWSZ Hospital, Szczecinie, Poland
  110. 110. St. Anna University Hospital, Ferrara, Italy
  111. 111. St. Bassiano Hospital, Bassano del Grappo, Italy
  112. 112. Streekziekenhuis Koningin Beatrix, Winterswijk, Netherlands
  113. 113. Swedish Renal Registry, Jonkoping, Sweden
  114. 114. Tehran University of Medical Sciences, Tehran, Iran
  115. 115. Tergooi, Hilversum, Netherlands
  116. 116. Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
  117. 117. Toledo University Hospital, Toledo, Spain
  118. 118. Treant/Scheper Ziekenhuis, Emmen, Netherlands
  119. 119. Universite Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium
  120. 120. University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
  121. 121. University Hospital Leuven, Leuven, Belgium
  122. 122. University Hospital Brussels, Brussels, Belgium
  123. 123. Universitary Hospital of Guadalajara, Guadalajara, Spain
  124. 124. University Hospital Martin, Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
  125. 125. University Hospital Medical Center Verona, Verona, Italy
  126. 126. University Hospitals Parma, Parma, Italy
  127. 127. University Hospitals of Coventry, Warwickshire NHS Trust, Coventry, United Kingdom
  128. 128. University Hospital of Patras, Patras, Greece
  129. 129. Dialysis Center Groningen, Groningen, Netherlands
  130. 130. University Medical Center Groningen, Groningen, Netherlands
  131. 131. University Medical Center Ljubljana, Ljubljana, Slovenia
  132. 132. University Medical Centre Maribor, Maribor, Slovenia
  133. 133. University Medical Center Utrecht, Utrecht, Netherlands
  134. 134. University of California Irvine School of Medicine, Orange, CA, United States
  135. 135. University of Genoa, Genoa, Italy
  136. 136. University of Liege, Liege, Belgium
  137. 137. University of Milano, Milan, Italy
  138. 138. University of Navarra Clinic, Pamplona, Spain
  139. 139. University of Piemonte Orientale, Novara, Italy
  140. 140. Valais Hospital, Sion, Switzerland
  141. 141. Vall d'Hebron University Hospital, Barcelona, Spain
  142. 142. VieCuri Medical Centre, Venlo, Netherlands
  143. 143. Vilnius University, Vilnius, Lithuania
  144. 144. Vimercate Hospital, Vimercate, Italy
  145. 145. Zonguldak Ataturk State Hospital, Zonguldak, Turkey
  146. 146. Zuyderland Medical Center, Geleen and Heerlen, Netherlands

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