MO644:DIABETES AND DIALYSIS:PROPOSAL FOR A CONTAGION PREVENTION PROTOCOL IN COVID-19 PANDEMIA

Abstract

Abstract Background and Aims After the official coronavirus (SARS-CoV-2) pandemic declaration by the WHO, Italy had the second-largest number of confirmed cases, after China. The Italian government introduced progressive infection-mitigation measurements, thus dramatically reducing social interactions and preventing virus spread. During the summer, infection containment measures progressively loosened until, due to an unjustified interpretation of some permissions and the excessive utilization of public transportation at school reopening, the contagion rate progressively increased until causing a severe challenge for our NHS again. Aim of the study: to assess the efficiency of our previously described protocol in 18 Campania region-located Nefrocenter Consortium DCs as further adapted to new knowledge under the new ubiquitous contagion conditions and to identify SARS-CoV-2-infection mortality rate and risk factors. Method Dialysis patients did so too during that period according to the expected shifting prevalence over time (mean ± SD: 853 ± 30 per month; range 825 to 873) ± (11.8% in April, and 14.8% in November vs. a pre-COVID-19 12.0% rate in January). Results More patients got infected in November (10.19%) than in April (0,24%), and 22 patients of the 89 from the SARS-CoV-2 November positive subjects required hospitalization for moderate-severe symptoms (24.72%), with death unavoidably coming in 19 (86.36% of hospitalized and 21.35% of infected patients) compared to the only one recorded in April (0.12%). The pandemic s two periods showed a strong association between mortality rate and often co-existing comorbidities, primarily represented by arterial hypertension, type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD). Conclusion The prevously efficient contagion containment measures adopted by our DCs were not enough in November to fight the global infection risk pending on the whole Italian social community around. The Authors discuss possible reasons and put forward further suggestions for the best handling of any future infection wavesMO644 \u2003 Table 1. General features of subjects on chronic dialysis as of April 23, 2020, and co-morbidities observed according to diabetes status. *IHD/AF/HF= composite outcome: Ischemic Heart Disease/ Atrial Fibrillation/ Heart Failure. Data expressed as Mean+SD, range, or n; (%). In no case were HIV Infection, Autoimmune Disease, and Obesity present. SARS-CoV-2 positive patients (n. 89) SARS-CoV-2 negative patients (n. 784) Total n. N (%) N (%) p Comorbidities IHD/AF/HF * 12 69.16 386 49.23 <.0001 398 Stroke 7 7.87 176 22.45 <.001 183 Arterial Hypertension 76 85.39 509 64.92 <.01 585 Type 2 Diabetes Mellitus 79 88.76 253 32.40 < 0001 332 Chronic Obstructive Pulmonary Disease 31 34.83 178 22.70 <.01 209 Active Cancer in the past 5 years 2 2.25 0 - - 2 Dementia 9 10.11 27 3.44 <.05 36 Chronic Liver Disease 19 21.35 156 19.90 n.s. 175 Respiratory Failure 14 15.73 134 17.59 n.s. 148 Number of Comorbities 0 0 - 5 0.64 - 5 1 0 - 105 13.39 - 105 2 0 - 189 24.11 - 189 3 at least 89 100.00 485 61.86 < 0001 574 MO644 \u2003 Table 2. Most common co-morbidities observed in SARS-CoV-2 positive patients compared to negative ones in the second pandemic period (1st august - 13th November). In no case were HIV Infection, Autoimmune Disease, and Obesity present. *IHD/AF/HF = composite outcome = Ischemic Heart Disease/ Atrial Fibrillation/ Heart Failure. MO644 \u2003 Figure 1 : Identification and management flowchart of SARS-CoV-2 positive dialysis patients. *asymptomatic, pre-symptomatic or mild symptomatic infection (fever, cough, dysgeusia, disosmia, headache, myalgia, in the absence of dyspnea and X-ray abnormalities (stage 1 and 2 according to NIH classification [64]); ° moderate, severe or critical illness according to the same classification.