Status of SARS-CoV-2 infection in patients on renal replacement therapy. Report of the COVID-19 Registry of the Spanish Society of Nephrology (SEN)

Summary The recent appearance of the SARS-CoV-2 coronavirus pandemic has had a significant impact on the general population. Patients on renal replacement therapy (RRT) have not been unaware of this situation and due to their characteristics they are especially vulnerable. We present the results of the analysis of the COVID-19 Registry of the Spanish Society of Nephrology. Material and methods The Registry began operating on March 18th, 2020. It collects epidemiological variables, contagion and diagnosis data, signs and symptoms, treatments and outcomes. It is an “online” registry. Patients were diagnosed with SARS-Cov-2 infection based on the results of the PCR of the virus, carried out both in patients who had manifested compatible symptoms or had suspicious signs, as well as in those who had undergone screening after some contact. acquainted with another patient. Results As of April 11, the Registry had data on 868 patients, from all the Autonomous Communities. The most represented form of TRS is in-center hemodialysis (ICH) followed by transplant patients. Symptoms are similar to the general population. A very high percentage (85%) required hospital admission, 8% in intensive care units. The most used treatments were hydroxychloroquine, lopinavir-ritonavir, and steroids. Mortality is high and reaches 23%; deceased patients were more frequently on ICH, developed pneumonia more frequently, and received less frequently lopinavir-ritonavir and steroids. Age and pneumonia were independently associated with the risk of death. Conclusions SARS-CoV-2 infection already affects a significant number of Spanish patients on RRT, mainly those on ICH, hospitalization rates are very high and mortality is high; age and the development of pneumonia are factors associated with mortality. Resumen La reciente aparicion de la pandemia por el coronavirus SARS-CoV-2ha impactado de forma muy importante en la poblacion general. Los pacientes en tratamiento renal sustitutivo (TRS) no han sido ajenos a esta situacion y por sus caracteristicas resultan especialmente vulnerables. Presentamos los resultados del analisis del Registro COVID-19 de la S.E.N. Material y metodos EL Registro comenzo a funcionar el 18 de marzo de 2020. Recoge variables epidemiologicas, datos del contagio y diagnostico, clinica acompanante, tratamientos y desenlace. Se trata de un registro “on line”. Los pacientes fueron diagnosticados de infeccion por SARS-Cov-2 en base a los resultados de la PCR del virus, realizada tanto en pacientes que habian manifestado clinica compatible o tenian signos sospechosos como en aquellos a los que se habia hecho como cribado tras algun contacto conocido con otro enfermo. Resultados A fecha 11 de abril el Registro disponia de datos de 868 pacientes, procedentes de todas las Comunidades Autonomas. La modalidad de TRS mas representada es la hemodialisis en centro (HDC) seguida de los pacientes trasplantados. La clinica de presentacion es similar a la poblacion general. Un porcentaje muy elevado (85%) requirio ingreso hospitalario, un 8% en unidades de cuidados intensivos. Los tratamientos mas utilizados fueron hidroxicloroquina, lopinavir-ritonavir y esteroides. La mortalidad es elevada y alcanza el 23%: los pacientes fallecidos estaban con mas frecuencia en HDC, desarrollaban mas frecuentemente neumonia y recibian en menos ocasiones lopinavir-ritonavir y esteroides. La edad y la neumonia se asociaban de forma independiente al riesgo de fallecer. Conclusiones La infeccion por SARS-CoV-2 afecta ya a un numero importante de pacientes espanoles en TRS, fundamentalmente aquellos que estan en HDC, las tasas de hospitalizacion son muy elevadas y la mortalidad es elevada; la edad y el desarrollo de neumonia son factores asociados a mortalidad.