COVID-19 incidence and outcomes in hemodialysis patients in Mexico

Background: HD pts are at high risk for COVID-19 High incidence and death rate were reported in China and Europe with more than 20% of asymptomatics We report incidence, features and outcomes of COVID-19 in HD patients in a network of 8 clinics in Mexico A protocol was started on Mar 15 with hygiene measures;symptoms triage;separation by age;use of PPE and isolation of suspected cases We use a more inclusive case definition, different from Mexico Health Ministry's(SSA) All cases are referred for PCR but most aren't tested Methods: Retrospective analysis of cases (suspect or PCR(+)) from mar 15 to may 22 2020 compared to controls T-test and Chi2 were used Hospitalization, IMV and deaths were registered Overall mortality from mar - may 2020 compared to same period of 2019 We compared the number of cases using our case definition with that using the SSA's Incidence of COVID-19 in staff was also analyzed Results: Total 1276 pts;Of 102 suspects 25 (24%) had PCR and 16 (64%) were(-) 13 (12%) non-tested were discarded based on alternative dx 2 pts with (-) PCR were cases based on CT Total 75 cases (10 (+)PCR, 65 w/o test) were analyzed and compared to controls No differences in HD vintage, DM, CVD, HD session length, VA, BUN or Kt/V Less age, fem gender, HTN, more sessions/wk, ACEi/ARB and lower Hb were found in the cases 7 (9%) hospitalized and 2 (3%) required IMV There were 6 (8%) deaths, only 1 (1 3%) attributed to COVID-19 Overall mortality minimally higher than that of the same period of 2019 (1 35% vs 1 30%) 31% of cases had only 1 symptom Only 1 PCR(+) and 14 PCR(-) cases fulfilled SSA's definition Among 231 staff members, 31 cases (13 8%), 11 (35%) PCR(+) and 20 non tested Conclusions: Incidence of probable or confirmed COVID-19 was 5 9%;probably overestimated suggested by scarce testing and low mortality ACEi/ARB use more frequent in cases, adjusted for HTN and age Our protocol helps prevent in-clinic contagion A more comprehensive probable case definition appears more useful for HD patients