WCN23-0636 CHALLENGES OF TREATING COVID 19 IN PATIENTS WITH CHRONIC RENAL FAILURE UNDER LIMITED CONDITIONS

Abstract

Introduction Relevant clinical studies indicate a significantly poorer outcome in patients with advanced renal failure during Covid 19 probably due to significantly slower clearance of proinflammatory cytokines produced during infection but also in the presence of significantly higher cardiovascular comorbidity in these patients. Methods We present the characteristics of patients with chronic renal failure (CRF) who were treated for Covid 19 bronchopneumonia at the Temporary Covid 19 hospital "Stark Arena" Belgrade,during 2020/2021. In this period we have treated about 5200 patients with Covid 19 bronchopneumonia under limited conditions. Results We analyzed a records of 466 patients with a history of CRF: 261 male (56.01%) and 67 female 67(43.99%), mean age 75 ± 11.14 years (40-88 years), 297 of them (63.73%) suffered from high blood pressure, 154 patients (33,05%) suffered from diabetes mellitus and 114 patients (24,46%) had both diseases.The mean value of sO2 at admission was 92±4,45%, CRP 87±99.7mg/l, Interleukin-6 61±33.4 pg/ml, hemoglobin (Hgb)126±14.22g/l, urea 12±7,53 mmol /l, creatinine 137.43±121.22µmol/l, glomerul filtration rate (GFR) 47.44ml/min/1.73m². Patients were treated according to the current protocol where 305 out of than (65,45%) also received an interleukin-6 receptor blocker (Tocilizumab 8-16 mg/kg). A total of 452 patients (96.99%) after successful treatment of bronchopneumonia were discharged for home treatment with average creatinine values of 116±31.32µmol/l and GFR 56.13ml/min/1.73m²,while 14 patients (3,01%) due to the worsening of their general condition, were transferred to a higher - level health institution, from where they were further discharged without necessity for chronic dialysis treatment. There were no lethal outcomes. Parameters on admission: sO2 CRP Interleukin-6 Hgb urea creatinine GFR 92±4,45% 87±99.7mg/l 61±33.4 pg/ml 126±14.22g/l 12±7,53 mmol/l 137.43±121.22µmol/l 47.44ml/min/1.73m² Parameters at discharge: sO2 urea creatinine GFR 97±2,21% 8±3,23 mmol/l 116±31.32µmol/l 56.13ml/min/1.73m² Conclusions Advanced renal failure is a significant risk factor for adverse clinical outcome during Covid 19. In our group majority of patients were with moderate CRF who had a successful end-therapeutic outcome, but a significant percentage of them required the use of Tocilizumab (without adverse effects). The verified improvement of GFR at discharge is most likely a consequence of the remediation of factors (inflammation, dehydration, nephrotoxicity of drugs etc.) which led to worsening of preexistent CRF. Regardless of the existing degree, all patients with renal failure require serious monitoring during Covid 19. No conflict of interest