Pulmonary Function and CT Scan Finding in CKD Patients After COVID-19 Infection
Condition: COVID-19; Lung Function Decreased; Xray Complication
MeSH terms: COVID-19
Study type: Observational

Summary: 
      COVID-19 is associated with increased morbidity and mortality in patients with chronic kidney
      disease (CKD) on dialysis. CKD requires particular emphasis during the pandemic due to
      concern for increased susceptibility to infection from greater use of health facilities in
      people undergoing maintenance hemodialysis. COVID-19 due to SARS-CoV-2 involves multiple
      organs and lung injury is one of the most clinical manifestations. The binding of SARS-CoV-2
      to the ACE2 receptors at target cells ,including type II pneumocytes ,and alveolar
      macrophages in the lung could arise into acute systemic inflammatory responses and cytokine
      storm.The consequentially leading to lung-resident dentritic cells (rDCs) activation, T
      lymphocytes production and release antiviral cytokines into the alveolar septa and
      interstitial compartments resulting in diffuse alveolar epithelium destruction,hyaline
      membrane formation, alveolar septal fibrous proliferation and pulmonary fibrosis.Although it
      has been reported that subgroups of COVID-19 survivors developed persistent lung parenchymal
      injury that persisted at least after 6 months 5-6 ,the data in CKD patients has not been
      reported yet.In addition, a study of pulmonary function test after COVID-19 is needed to be
      investigated.Thus,we plan to assess pulmonary sequalae of COVID-19 in hemodialysis (HD)
      patients and pulmonary function test after recovered of infection at least 3 months.
    

Detailed description: 
      This is the prospective,observational cohort study including CKD stage 5 on hemodialysis who
      survived acute COVID-19 and presented for clinical follow-up after either mild/moderate or
      severe COVID-19.The study was conducted at Faculty of Medicine ,Vajira Hospital
      ,Navamindradhiraj University from June 2022 -September 2022.We adhered to the Declaration of
      Helsinki,and all patients provided written informed consent before inclusion.Ethics approval
      was obtained from Institutional Review Board (IRB) prior to start of the study (COA No 302/64
      E).
    

Intervention name(s): Pulmonary function test; Chest computer scan
Intervention type(s): Diagnostic Test; Diagnostic Test
Intervention description(s): Spirometry was performed by trained nurse at division of pulmonology, Vajira hospital. The forced vital capacity (FVC), forced expiratory volume in first second of exhalation (FEV1), forced mid-expiratory flow (FEF25-75%), and the FEV1/FVC ratio before and after bronchodilators (2 puffs of salbutamol via spacer) were collected in all cases. Total lung capacity (TLC) using the spirometry (Masterscreen PFT, Jaeger, Germany) and diffusion capacity of carbon monoxide was performed in selected case with abnormalities of lung parenchyma found from computed tomography of the chest.; High-resolution computed tomography (HRCT) was performed in a single breath-hold on a 128 slice multidetector computed tomography (MDCT) scanner (Philips Healthcare Nederland B.V, Ingenuity 128, Netherlands). HRCT was performed with the patient in the supine position during end-inspiration, supine position during end-expiration, and prone position during end-inspiration with 1 millimeter (mm) slice thickness.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        100 end stage renal disease patients requirung renal replacement therapy with history of
        COVID-19 admitted to Faculty of Medicine, Vajira hospital,Navamindradhiraj University