Infección por COVID-19 en pacientes en Hemodiálisis en Panamá 2020

[COVID-19 infection in Hemodialysis patients in Panamá. 2020]

Karen Courville1, Norman Bustamante1, Herna Mosquera2, Carlos Viggiano3, Rafaél Pérez-Carillo3, María Niedda4, Cesar Cuero2, Jermaine Tomlinson5, José Manzanares6, Rocio Arroyo7, Ernesto Alvarado8, Dayan Saldo9, Francisco Vargas8, Regulo Valdés2

1. Unidad de Hemodiálisis y Diálisis Peritoneal, Departamento de Nefrología, Hospital Dr Gustavo N Collado, Chitré, Herrera; 2. Coordinación Nacional de Diálisis, Panamá; 3. Complejo Hospitalario Metropolitano, Panamá, Panamá; 4. Hospital Susana Jones Cano, Panamá, Panamá; 5. Centro Atención Integral Renal, Colón, Panamá; 6. Policlínica Santiago Barraza, Panamá Oeste, Panamá; 7. Hospital Rafael Hernández, Hospital Dionisio Arrocha, Chiriquí, Panamá; 8. Policlínica Horacio Díaz Gómez, Santiago, Veraguas; 9. Hospital Ezequiel Abadía, Soná, Veraguas;

Publicado: 2021-12-24

Descargas

Resumen

Antecedentes y objetivo: Los pacientes con Enfermedad Renal Crónica (ERC) en Hemodiálisis son pacientes que tienen condiciones que los hacen pacientes de riesgo para la infección por COVID-19. Los pacientes en hemodiálisis han sido un grupo muy afectado, debido a que no pueden suspender sus tratamientos para mantener el aislamiento domiciliario, lo que aumenta su exposición y riesgo a infección por COVID-19. Para evaluar el comportamiento de la infección por SARS-CoV-2 en los pacientes en hemodiálisis crónica en Panamá, realizamos un estudio prospectivo de los pacientes infectados por COVID-19 en las Unidades de Hemodiálisis de la CSS de todo el país, para determinar las características de los pacientes afectados, los síntomas que presentaron, su evolución clínica y el desenlace de los pacientes infectados.

Materiales y Médodos: Realizamos un estudio longitudinal descriptivo prospectivo multicéntrico de los casos positivos que se diagnosticaron desde el 15 de julio hasta el 31 de diciembre de 2020 en las 14 Unidades de Hemodiálisis de la CSS del país. 

Resultados y conclusiones: Fueron incluidos un total de 333 pacientes en hemodiálisis con diagnóstico positivo para  infección  por SARS-CoV-2, de un total de 2194 pacientes que realizan hemodiálisis en las Unidades de la Caja de Seguro Social.  El 59.5% de los afectados fueron de sexo masculino.  La edad promedio fue de 56.75 años (DS 15.1 años).  La Tasa de Mortalidad encontrada en nuestro estudio fue de 26%. La incidencia acumulada de COVID-19 en pacientes en Hemodiálisis fue de 16% para el período de estudio del 2020.


Abstract

Background and objective: Patients with Chronic Kidney Disease (CKD) on Hemodialysis are patients who have conditions that make them patients at risk for COVID-19 infection. Hemodialysis patients have been a highly affected group because they cannot stop their treatments to maintain home isolation, which increases their exposure and risk of COVID-19 infection. To evaluate the behavior of SARS-CoV-2 infection in patients on chronic hemodialysis in Panama, we conducted a prospective study of patients infected by COVID-19 in hemodialysis units throughout the country, to determine the characteristics of the affected patients, the symptoms they presented, their clinical evolution and the outcome of the infected patients.

Materials and Methods: We conducted a multicenter prospective descriptive longitudinal study of the positive cases that were diagnosed from July 15, 2020 to December 31, 2020 in the 14 Hemodialysis Units of the Social Security Fund of the country.

Results and conclusions: A total of 333 hemodialysis patients with a positive diagnosis for SARS-CoV-2 infection were included, out of a total of 2194 patients undergoing hemodialysis in the Units of the Social Security Fund. Fifty nine percet of those affected were male.  The mean age was 56.75 years (DS 15.1 years).  The Mortality Rate found in our study was 26%. The cumulative incidence of COVID-19 in hemodialysis patients was 16% for the 2020 study period.

Biografía del autor/a

Karen Courville, Unidad de Hemodiálisis y Diálisis Peritoneal, Departamento de Nefrología, Hospital Dr. Gustavo N. Collado, Chitré, Herrera

Hospital Dr. Gustavo Nelson Collado

 

 

Citas

[1] World Health Organization. Coronavirus disease 2019 (COVID-19): situation report, 80. MMWR Morb Mortal Wkly Rep. 2020; 69(13): 382–386. DOI: 10.15585/mmwr.mm6913e2

[2] Caja de Seguro Social. Plan Operativo para las Unidades de Hemodiálisis para la prevención y control del nuevo coronavirus. Coordinación Nacional de Diálisis 2020; p1-13. www.css.gob.pa [consultada el 01 de julio de 2020]

[3] Panamá: Economía y Demografía. Población total 2020. https://datosmacro.expansion.com/paises/panama [consultada el 01 de junio de 2021]

[4] Coordinación Nacional de Diálisis, Caja de Seguro Social. Estadísticas Nacionales de Diálisis 2020. www.css.gob.pa [consultada el 01 de julio de 2020]

[5] Ikizler TA. COVID-19 and Dialysis Units: What Do We Know Now and What Should We Do? Am J Kidney Dis. 2020 Jul;76(1):1-3. DOI: 10.1053/j.ajkd.2020.03.008.

[6] Meyer TW, Hostetter TH. Uremia. N Eng. J Med 2007; 357(13): 1316-1325. 10.1056/NEJMra071313

[7] Haag-Weber M, Hörl WH. Dysfunction of polymorphonuclear leukocytes in uremia. Semin Nephrol 1996; 16(3):192-201. PMID: 8734462

[8] Sela S, Shurtz-Swirski R, Cohen-Mazor M, et al. Primed peripheral polymorphonuclear leukocyte: a culprit underlying chronic low-grade inflammation and systemic oxidative stress in chronic kidney disease. J Am Soc of Nephrol 2015; 16(8): 2431-2438. https://doi.org/10.1681/ASN.2004110929

[9] Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–1242. DOI:10.1001/jama.2020.2648

[10] COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU CSSE COVID-19 Data) https://github.com/CSSEGISandData/COVID-19. [consultada el 01 de junio de 2021]

[11] Actualización Epidemiológica Enfermedad por coronavirus (COVID-19) 29 de diciembre de 2020. OPS/OMS. https://www.paho.org/es/documentos/actualizacion-epidemiologica-enfermedad-por-coronavirus-covid-19-29-diciembre-2020. [consultada el 01 de junio de 2021]

[12] Datos de mortalidad de Panamá. https://datosmacro.expansion.com/demografia/mortalidad/panama [consultada el 01 de junio de 2021]

[13] Ohammad JN, Haddadi S, Tahvildari A al. MCOVID-19 clinical characteristics, and sex-specific risk of mortality: Systematic Review and Meta-analysis. Front Med 2020. DOI: https://doi.org/10.1101/2020.03.24.20042903 [consultada el 03 de junio de 2021]

[14] Stokes EK, Zambrano LD, Anderson KN et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020 Jun 19;69(24):759-765. DOI: 10.15585/mmwr.mm6924e2.

[15] Creput C, Fumeron C, Toledano D, Diaconita M, Izzedine H. COVID-19 in Patients Undergoing Hemodialysis: Prevalence and Asymptomatic Screening During a Period of High Community Prevalence in a Large Paris Center. Kidney Med. 2020 Nov-Dec;2(6):716-723.e1. DOI: 10.1016/j.xkme.2020.09.001.

[16] Sosa R, García P, Cipriano EO et al. Coronavirus Disease 2019 in Patients With End-Stage Kidney Disease on Hemodialysis in Guatemala. Kidney Int Rep. 2021 Apr;6(4):1110-1117. DOI: 10.1016/j.ekir.2021.01.028.

[17] Gemmati D, Bramanti B, Serino ML, Secchiero P, Zauli G, Tisato V. COVID-19 and Individual Genetic Susceptibility/Receptivity: Role of ACE1/ACE2 Genes, Immunity, Inflammation and Coagulation. Might the Double X-chromosome in Females Be Protective against SARS-CoV-2 Compared to the Single X-Chromosome in Males? Int J Mol Sci. 2020 May 14;21(10):3474. DOI: 10.3390/ijms21103474.

[18] Olsen NJ, Kovacs WJ. Effects of androgens on T and B lymphocyte development. Immunol Res. 2001;23(2-3):281-8. DOI: 10.1385/IR:23:2-3:281.

[19] Schurz H, Salie M, Tromp G, Hoal EG, Kinnear CJ, Möller M. The X chromosome and sex-specific effects in infectious disease susceptibility. Hum Genomics. 2019 Jan 8;13(1):2. DOI: 10.1186/s40246-018-0185-z.

[20] Xiong F, Tang H, Liu L et al. Clinical characteristics of and medical interventions for COVID-19 in hemodialysis patients in Wuhan, China. J Am Soc. Nephrol 2020; 31(7): 1387-1397. DOI: https://doi.org/10.1681/ASN.2020030354

[21] Manganaro M, Baldovino S. The Working group of the Piedmont and Aosta Valley Section of the SIN. et al. First considerations on the SARS-CoV-2 epidemic in the Dialysis Units of Piedmont and Aosta Valley, Northern Italy. J Nephrol 2020; 33: 393–395. https://doi.org/10.1007/s40620-020-00732-1

[22] Alberici F, Delbarba E, Manenti C et al. Management of patients on dialysis and with kidney transplantation during the SARS-CoV-2 (COVID-19) pandemic in Brescia, Italy. Kidney Int Rep 2020; 5(5): 580-585. DOI: 10.1016/j.ekir.2020.04.001.

[23] Organización Panamericana de Salud OPS. Informe de Situación - Panamá. Reporte No.44 COVID-19. Diciembre 29 de 2020. www.paho.org/es/documentos/covid-19-informe-situacion-panama-ndeg44-diciembre-27-2020 [consultada el 05 de junio de 2021]

[24] Corbett RW, Blakey S, Nitsch D et al for the West London Renal and Transplant Centre. Epidemiology of COVID-19 in an Urban Dialysis Center. J Am Soc Nephrol 2020; 31(8): 1815-1823. DOI: https://doi.org/10.1681/ASN.2020040534

[25] Roper T, Kumar N, Lewis-Morris T et al. Delivering Dialysis During the COVID-19 Outbreak: Strategies and Outcomes. Kidney Int Rep 2020; 5(7):1090-1094. DOI: 10.1016/j.ekir.2020.05.018.

[26] Valeri A, Robbins-Juarez S, Stevens J et al. Presentation and Outcomes of Patients with ESKD and COVID-19. J Am Soc. Nephrol 2020; 31(7): 1409-141. DOI: https://doi.org/10.1681/ASN.2020040470

[27] Su K, Ma Y, Wang Y, et al. How we mitigated and contained the COVID-19 outbreak in a hemodialysis center: Lessons and experience. Infection Control & Hospital Epidemiology. 2020;41(10):1240-1242. DOI:10.1017/ice.2020.161

[28] Maldonado M, Ossorio M, Del Peso G et al. COVID-19 incidence and outcomes in a home dialysis unit in Madrid (Spain) at the height of the pandemic. Nefrologia (Engl Ed). 2021 May-Jun;41(3):329-336. English, Spanish. DOI: 10.1016/j.nefro.2020.09.002.

[29] Albalate M, Arribas P, Torres E et al. Grupo de Enfermería HUIL; Grupo enfermería HUIL. High prevalence of asymptomatic COVID-19 in haemodialysis: learning day by day in the first month of the COVID-19 pandemic. Nefrología (Engl Ed). 2020 May-Jun;40(3):279-286. DOI: 10.1016/j.nefro.2020.04.005.

[30] La Milia V, Bacchini G, Bigi MC et al. COVID-19 Outbreak in a Large Hemodialysis Center in Lombardy, Italy. Kidney Int Rep. 2020 May 24;5(7):1095-1099. DOI: 10.1016/j.ekir.2020.05.019.

[31] Goicoechea M, Sánchez-Cámara LA, Macías N et al. COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain. Kidney Int. 2020 Jul;98(1):27-34. DOI: 10.1016/j.kint.2020.04.031.

[32] Sánchez-Pérez P, González-Calero P, Poma-Saavedra FH et al. Results of a healthcare organization model for COVID-19 on hemodialysis in a tertiary hospital and its subsidized centers. Nefrologia (Engl Ed). 2020 Jul-Aug;40(4):453-460. English, Spanish. DOI: 10.1016/j.nefro.2020.05.006.

[33] COVID-19 Task Force Committee of the Japanese Association of Dialysis Physicians; Japanese Society for Dialysis Therapy; Japanese Society of Nephrology, Kikuchi K, Nangaku M, Ryuzaki M et al. COVID-19 of dialysis patients in Japan: Current status and guidance on preventive measures. Ther Apher Dial. 2020 Aug;24(4):361-365. DOI: 10.1111/1744-9987.13531.

[34] Jung HY, Lim JH, Kang SH et al. Outcomes of COVID-19 among patients on In-Center Hemodialysis: An Experience from the Epicenter in South Korea. J Clin Med. 2020 Jun 2;9(6):1688. DOI: 10.3390/jcm9061688.

[35] Cummings MJ, Baldwin MR, Abrams D et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020 Jun 6;395(10239):1763-1770. DOI: 10.1016/S0140-6736(20)31189-2.

[36] Valencia I, Peiró C, Lorenzo Ó, Sánchez-Ferrer CF, Eckel J, Romacho T. DPP4 and ACE2 in Diabetes and COVID-19: Therapeutic Targets for Cardiovascular Complications? Front Pharmacol. 2020 Aug 7; 11:1161. DOI: 10.3389/fphar.2020.01161.

×