Clinical Characteristics and Short-Term Outcomes of Chronic Dialysis Patients Admitted for COVID-19 in Metro Manila, Philippines

Aim: Data published on COVID-19 in the Filipino population, particularly those with end stage kidney disease (ESKD) are still lacking. Methods: We performed a retrospective, observational study of 68 ESKD patients admitted with COVID-19 infection at a tertiary hospital in Metro Manila, Philippines from April 1, 2020 to July 31, 2020. We compared the clinical features, baseline laboratory data, treatment strategies and short-term outcomes between those who survived and those who died. We also determined the risk factors associated with mortality from COVID-19. Results: Mean age was 54.5 years old, 66% were male. All patients admitted were on maintenance hemodialysis (HD). The most common presenting symptoms were dyspnea (57%), fever (47%) and cough (38%). There was an equal number of patients on high flow nasal cannula (17.7%) and invasive mechanical ventilation (17.7%). ICU admission was required in 17.7% of the cohort. In-hospital death occurred in 25% of the patients. Admission PaO2/FiO(2) (PF) ratios (162 +/- 134 versus 356 +/- 181; p=0.0009) were lower, and procalcitonin (6.07 +/- 10.5ng/mL versus 0.73 +/- 3.61 ng/mL; p=0.02), lactate dehydrogenase (396 +/- 274U/L versus 282 +/- 148 U/L; p=0.03), and white blood cell counts (10 +/- 7.3 x 10(9)/L versus 6.3 +/- 4.2 x 10(9)/L; p= 0.0039) were significantly higher among those who died compared to those who survived. After adjusting for confounders, only low PF ratio (HR 1.01 for every unit decrease, 95% CI 1-1.01) and need for ventilation (HR 6.45, 95% CI 1.16-35.97) conferred a significant risk for in-hospital mortality. Conclusion: Short-term, in-hospital mortality is high among patients on chronic hemodialysis admitted for COVID-19 infection. They present similarly with the general population. Low PF ratio on admission and need for ventilation are independent risk factors for inhospital mortality.