Investigation of risk factors affecting mortality and morbidity in patients under a chronic dialysis program patient with COVID-19

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), which started in China in December 2019, has spread around the world at an alarming rate. The epidemic disease, called COVID-19, was recognized as a pandemic by WHO on March 11, 2020. The severity of COVID-19 symptoms ranges from mild complaints to life-threatening serious infection. In a multivariate-adjusted series of analyzes based on cohorts of COVID-19 patients, higher disease severity was found to be associated with demographic factors such as advanced age and male gender, and comorbidities. The most common comorbidities were hypertension in hospitalized patients (48-57% of patients), diabetes mellitus (17-34%), cardiovascular disease (21-28%), chronic lung disease (4-10%), chronic kidney disease (3-13%), malignancy (6-8%) and chronic liver disease (<5%). People with chronic kidney disease (CKD) were also counted in the high-risk group for COVID-19. In particular, dialysis patients are among the most risky groups for COVID-19 due to their current immunosuppressive status and comorbidities. MATERIALS AND METHODS: 112 Covid-19 positive dialysis patients who applied to Akdeniz University Medical Faculty Hospital and were in the routine dialysis program were included in the study. 88 patients were in the hemodialysis group, 18 patients were in the peritoneal dialysis group, and 6 patients were in the group that received both hemodialysis and peritoneal dialysis. It was aimed to determine the risk factors in terms of outpatient Covid-19 infection, developing the need for hospitalization or intensive care, and causing death by examining the patients' age, gender, comorbidity, BMI, kt/v ratio, laboratory values. In addition to mortality, it was aimed to determine the complications that developed during Covid-19 and the factors affecting the development of complications. Mann-Whitney U test and Independent t-test were used to analyze the difference between continuous variables according to mortality and complication development status due to COVID-19. All analyzes were done with IBM SPSS 23.0 package program. P values less than 0.05 were considered statistically significant. RESULTS: According to the statistical data, 47 patients (42%) of 112 patients received outpatient treatment, 45 patients (40.2%) were admitted to the service and 20 patients (17.9%) were admitted to the intensive care unit. 15 patients died. In mortality, advanced age, male gender, low body weight, kt/v ratio, laboratory values of leukocytes, neutrophil lymphocyte ratio, crp, albumin, ferritin and d-dimer were statistically significant. Especially infective and nutritional parameters in intensive care and service admission; Kt/v ratio, neutrophil lymphocyte ratio, crp, albumin were found to be statistically significant. In the group of patients who were admitted to the intensive care unit and died, there was no patient who underwent peritoneal dialysis. Complications were found especially in patients admitted to the intensive care unit. D-dimer elevation stood out as a significant value for the development of complications. CONCLUSIONS: It was observed that Covid-19 was more mortal especially in the group receiving hemodialysis. Advanced age, male gender and laboratory findings, especially crp, albumin, kt/v ratio and ferritin were found to have a significant effect on mortality.