Investigation of the effect of predialysis patient education on COVID-19 disease course and renal functions in chronic kidney disease patients with a history of COVID-19 infection and not yet receiving renal replacement therapy

Introduction and Aim The zoonotic virus named SARS-CoV-2, which emerged in Wuhan, China in December 2019, causes Coronavirus Disease 2019 (Covid 19), a severe acute respiratory infection. Although respiratory tract pathologies are frequently observed in the course of Covid 19 disease, an increase in cardiovascular diseases, renovascular pathologies, endocrine disorders and haematological problems is also observed in studies. Predialysis patient education has positive effects on disease survival in patients with chronic kidney disease who have not started renal replacement therapy. In many studies in the literature, it is observed that the duration of admission to dialysis is prolonged, the frequency of complications decreases, and compliance with medical treatment increases in patients receiving predialysis patient education. In the current literature, there are not enough studies examining the effect of predialysis patient education on both the infection process and renal function monitoring in chronic renal failure patients during the Covid 19 pandemic. In this study, it was aimed to examine the effect of predialysis patient education on the infection process and the course of renal functions in patients with chronic kidney disease and Covid 19 infection. Material and Method Our study is a retrospective study. Within the scope of the study, the cases followed by Balıkesir University Nephrology Department were retrospectively scanned. Among these patients, 98 patients with a diagnosis of Chronic Kidney Disease (CKD) who did not receive Renal Replacement Therapy and with a history of Covid-19 Disease (polymerase chain reaction (PCR) positive by nasopharyngeal swab) were included. Of these, the patients who were under our follow-up for at least 1 year before Covid-19 disease were called the educated group. The patients we followed for less than 1 year were called the untrained group. Patients with malignancy, advanced-stage congestive heart failure, kidney transplant patients, pregnant patients, patients who have had any Covid-19 vaccines, patients under the age of 18 and dialysis patients were not included in the study. Demographic data of selected patients (age, gender), smoking or alcohol use, pre- and post-disease laboratory findings (blood glucose, complete blood count, urea, creatinine, sodium, potassium, calcium, phosphorus, glomerular filtration rate (GFR), parathormone (PTH), magnesium, uric acid, c-reactive protein (CRP), spot urine protein/creatinine ratio), whether there is an educated patient, hemodialysis need in the course, favipiravir use, mortality rate, intubation rate, The need for intensive care, hospitalization, duration of hospitalization, morbidity rate (cerebrovascular accident (CVA), myocardial infarction (MI), pulmonary embolism, etc.) were recorded in the digital environment and recorded in the SPSS 22.0 program. Thus, statistical calculations were made and the comparison of the two groups was made. Descriptive statistical analyzes of the data were performed. Frequencies were presented as %, continuous numerical data as mean (± standard error), and median (25th-75th percentiles) for data not suitable for normal distribution. Relationship analyses between non-parametric nominal data were analyzed with the Chi-Square test, Mann-Whitney U test and Fisher's Exact Test. P value below 0,05 accepted as significant in all statistical analyses. Results Of the 98 cases evaluated in the study, 34 (34.7%) were uneducated and 64 (65.3%) were educated. Fifty-three (54%) of the cases were women and their ages were between 25-96 years. It was found that 13 (38.2%) of the uneducated cases and 40 (62.5%) of the educated cases were female. Smoking rates of uneducated cases were found to be statistically significantly higher than the smoking rates of educated cases (p=0.008). In addition, it was found that the rates of alcohol and drugs used did not differ statistically between the educated and uneducated cases. The median values of urea (p=0.040) and creatinine (p=0.008) after Covid-19 of uneducated cases increased statistically significantly compared to the median values of urea and creatinine before Covid-19, while the median value of GFR (p=0.014) was statistically significant, found to decrease in the level. It was found that the median creatinine values of educated cases after Covid-19 decreased significantly (p=0.004) compared to the median creatinine values before Covid-19. It was found that the post-Covid-19 GFR median values of educated cases increased statistically significantly (p<0.001) compared to the pre-Covid-19 GFR median values. When the percentage of change in urea, creatinine and GFR before and after Covid-19 disease was examined, it was found that creatinine values increased significantly more in uneducated cases compared to the educated group (p=0.027). Favipiravir usage rates of educated cases were found to be statistically significantly higher than those of uneducated cases (p=0.026). In addition, it was found that the rates of hospitalization, endpoint difference, intubation rate, complication development such as CVA and MI, mortality rate, need for temporary hemodialysis (HD) in the course and need for routine HD during the course did not differ statistically between educated and uneducated cases. Conclusions In our study, we showed that predialysis CKD patient education does not cause renal function loss that may develop after Covid-19, and even improves kidney functions. In addition, we found that favipravir use was higher and smoking was less in the group that received training. Among the two groups, we observed an increase in urea, creatinine and phosphorus levels and a decrease in GFR after Covid-19 in the group without education. In the educated group, we saw a decrease in creatinine and an increase in GFR, and a decrease in hemoglobin after Covid-19. We did not find any difference between the two groups in terms of hospitalization, length of stay, intubation rate, development of morbidity and mortality in the course of the disease, need for temporary hemodialysis in the course of the disease, and need for routine hemodialysis after the disease. This may be due to the small number of patients. In the literature, there is no study investigating the effect of Covid-19 on the kidneys with predialysis patient education in CKD patients. For this reason, we think that this study will be a pioneer for other studies on this subject.