CHALLENGES OF TREATING COVID 19 IN PATIENTS WITH CHRONIC RENAL FAILURE - BEYOND THE HORIZON

 

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CHALLENGES OF TREATING COVID 19 IN PATIENTS WITH CHRONIC RENAL FAILURE - BEYOND THE HORIZON

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Dejan
Pilcevic
Dejan Pilcevic dejan.pilcevic@gmail.com Military Medical academy Clinic for nephrology Belgrade Serbia *
Dejan Marinkovic dejan.pilcevic@gmail.com Military Medical academy Clinic for endocrinology Belgrade Serbia -
Miloje Pantovic dejan.pilcevic@gmail.com Military Medical academy Clinic for hematology Belgrade Serbia -
Boris Dzudovic dejan.pilcevic@gmail.com Military Medical academy Clinic of emergency internal medicine Belgrade Serbia -
Milica Petrovic dejan.pilcevic@gmail.com Military Medical academy Clinic for nephrology Belgrade Serbia -
Marijana Petrovic dejan.pilcevic@gmail.com Military Medical academy Clinic for nephrology Belgrade Serbia -
Violeta Rabrenovic dejan.pilcevic@gmail.com Military Medical academy Clinic for nephrology Belgrade Serbia -
Predrag Bogdanovic dejan.pilcevic@gmail.com Military Medical academy Clinic for cardiology Belgrade Serbia -
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Relevant clinical studies have shown a significantly worse outcome in patients with advanced chronic renal failure (CRF) during Covid-19, probably due to a significantly slower clearance of pro-inflammatory cytokines produced during infection, but also due to worsening of cardiovascular comorbidities presented in these patients. Also, follow-up studies have shown a significant worsening of CRF after Covid-19 infection.

We present the characteristics of patients with CRF who were successfully previously treated for Covid 19 bronchopneumonia at the Temporary Covid 19 hospital "Stark Arena", Belgrade, during 2021 who were follow up in further period.

We analyzed a records of 60 patients with a history of CRF:34 male (56.67%) and 26 female (43.33%),mean age 67 ± 9.2 years (47-75 years), 47 of them (78.33%) suffered from high blood pressure, 19 (31.67%) from diabetes mellitus (DM) and 4 (6.67%) of them had adult polycystic kidney diseases (APKD). The mean value of urea, creatinine and GFR at admission were 14±5,51 mmol /l, 141.22±117.23µmol/l, GFR 47.03ml/min/1.73m². Patients were treated according to the standard protocols where 28 out of them also received an interleukin-6 receptor blocker (Tocilizumab 8-16 mg/kg). On the discharging average values of urea, creatinine and GFR were 12±5,21 mmol /l, 129±34.16µmol/l and GFR 52,34ml/min/1.73m². After 3 years of follow up, the mean value of urea, creatinine and GFR were 16±7,34 mmol /l, 144.22±105.45µmol/l, GFR 46.13ml/min/1.73m². Highly statistically significant worsening were noticed in patients with diabetes mellitus and APKD who were not treated with interleukin-6 receptor blocker and in cohorts of patients with elder age (over 70) and in patients with high neutrophil to lymphocite ratio (NLR).

Advanced CRF is a significant risk factor for adverse clinical outcome during Covid 19, but this infection is also risk factor for worsening of CRF. In our paper we presented results of follow up patients with moderate CRF who were previously successfully treated from Covid 19 bronchopneumonia. These patients have developed worsening of CRF during 3 years, especially patients with standard risk factors /older age, history of DM and APKD/and patients with high NLR,  but subanalysis of this cohorts showed protective effects and benefits of previously treatment with Tocilizumab. This results shows potentially persistence of inflammation after Covid 19 in patients with CRF (probably due to slower clearance of pro-inflammatory cytokines produced during infection) which should be controled and treated more seriously in post Covid period. Also, regardless of the existing degree, all patients with CRF require serious monitoring during and after Covid 19 infection.

Kewords