A Study of Viral Shedding in Chronic Hemodialysis Patients with COVID-19 and Factors Affecting Viral shedding on Day 14 of the Study
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Abstract
BACKGROUND: Pakchong Nana hospital hemodialysis (HD) unit was a separate area for end-stage renal disease (ESRD) patients infected with corona disease 2019 (COVID-19) and high risk of contracting COVID-19 patients with only 5 HD beds. The criteria for discontinue HD isolation was nasopharyngeal swab using real time polymerase chain reaction (RT- PCR) with Cycle threshold (Ct) value of ≥ 30 or not detected on 14th day after first positive by antigen test kits (ATK) or RT-PCR.
OBJECTIVE: To conclude that on the14th day after first positive ATK or RT-PCR is safe to discontinue HD isolation without repeating RT-PCR, and what factors contributed to the high volume of viral shedding on14th day.
METHODS: The fundamental prognostic research and prognostic factor research in the form of retrospective cohort design in 58 cases of COVID-19-positive ESRD patients who on dialysis at the HD unit from September 1st, 2021 to June 3rd, 2022. The viral shedding was estimated with Ct value on 1st day and 14th day. Patients were divided into 2 groups by using Ct value on 14th day: 1. High volume of viral shedding group (Ct value < 30) and 2.Low volume of viral shedding group (Ct value ≥ 30 or not detected). Compared between two groups used t-test and exact probability test with different factors.
RESULTS: At 14th day, the low volume of viral shedding group was 81% of all infected patients. Each group had no significant difference in basic characteristic, admission chest X-ray as pneumonia, Ct E-gene, C reactive protein (CRP), complete blood count and steroid treatment. However, the patients with age ≥ 60, unvaccinated patients, on oxygen therapy and Ct E gene on 1stday>30 patients found in the high volume of viral shedding group more than the low volume of viral shedding group (p=0.024, p=0.013, p= 0.034, p=0.020 respectively).
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References
Jonny, Violetta L, Kartasasmita AS, Amirullah Roesli RM, Rita C. Pharmacological treatment options for coronavirus disease-19 in renal patients. Int J Nephrol. 2021;2021:4078713
Clinical practice guideline for diagnosis, caring and infectious control of COVID-19 [Internet]. Nonthaburi: Department of Medical Services, Ministry of Public Health; 2022 [updated July 12; cited 2022 September 12]. Available from: https://covid19.dms.go.th/backend/Content/Content_File/Covid_Health/Attach/25650712140709PM_CPG_COVID-19_v.24.1.n_20220711.pdf.
El Karoui K, De Vriese AS. COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment. Kidney Int.
;101(5):883-94.
Sethuraman N, Jeremiah SS, Ryo A. Interpreting diagnostic tests for SARS-CoV-2. JAMA. 2020;323(22):2249-51.
Hiroi S, Kubota-Koketsu R, Sasaki T, Morikawa S, Motomura K, Nakayama EE, et al. Infectivity assay for detection of SARS-CoV-2 in samples from patients with COVID-19. J Med Virol. 2021;93(10):5917-23.
Suwatanapongched T, Nitiwarangkul C, Sukkasem W, Phongkitkarun S. Rama Co-RADS: categorical assessment scheme of chest radiographic findings for diagnosing pneumonia in patients with confirmed COVID-19. Rama Med J 2021; 44(2): 50-62.
Alfano G, Ferrari A, Magistroni R, Fontana F, Cappelli G, Basile C. The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review. J Nephrol. 2021;34(5):1387-1403.
Center for COVID-19 Situation Administration (CSSA), Ministry of Public Health. Thailand. Coronavirus Disease 2019, May 30,2022 [internet]2022[cited 2022 Sept 13]. Avialble from : URL: https://media.thaigov.go.th/uploads/public_img/source/300565.pdf .(in Thai)
Kooman JP, van der Sande FM. COVID-19 in ESRD and acute kidney injury. Blood Purif. 2021;50(4-5):610-20.
Samrah SM, Al-Mistarehi AH, Kewan T, Al-Khatib SM, Ibnian AM, Samrah RS, et al. Viral clearance course of COVID-19 outbreaks. J Multidiscip Healthc. 2021;14:555-65.
Kissler SM, Fauver JR, Mack C, Tai CG, Breban MI, Watkins AE, et al. Viral dynamics of SARS-CoV-2 variants in vaccinated and unvaccinated persons. N Engl J Med. 2021;385(26):2489-91.
Liu Y, Yan LM, Wan L, Xiang TX, Le A, Liu JM, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020 20(6):656-7.
Li J, Liao X, Zhou Y, Wang L, Yang H, Zhang W, et al. Association between glucocorticoids treatment and viral clearance delay in patients with COVID-19: a systematic review and meta-analysis. BMC Infect Dis. 2021;21(1):1063.
De Vriese AS, Reynders M. IgG antibody response to SARS-CoV-2 infection and Viral RNA persistence in patients on maintenance hemodialysis. Am J Kidney Dis. 2020;76(3):440-1.
Qirjazi E, Kaunda J, Andersen T, Peterson J, Iwaasa K, MacRae J, et al. SARS-CoV-2 shedding in dialysis patients with COVID-19. Kidney Int Rep. 2021;6(11):2897-9.
Bardossy AC, Korhonen L, Schatzman S, Gable P, Herzig C, Brown NE, et al. Clinical course of SARS-CoV-2iInfection in adults with ESKD receiving outpatient hemodialysis. Kidney360. 2021;2(12): 1917–27.
Waudby-West R, Parcell BJ, Palmer CNA, Bell S, Chalmers JD, Siddiqui MK. The association between SARS-CoV-2 RT-PCR cycle threshold and mortality in a community cohort. Eur Respir J. 2021;58(1):2100360.
Shah VP, Farah WH, Hill JC, Hassett LC, Binnicker MJ, Yao JD, et al. Association between SARS-CoV-2 cycle threshold values and clinical outcomes in patients with COVID-19: a Systematic review and meta-analysis. Open Forum Infect Dis. 2021;8(9):ofab453.
